Effects of Posture and Swallow Volume on Esophageal Motility Morphology and Probability of Bolus Clearance: A Study Using High-Resolution Impedance Manometry.

The Chicago classification diagnostic criteria of esophageal motility disorders are based on 5-ml water swallows in the supine position and have not been analyzed for the correlation between the morphology and bolus transit in the upright position and larger volume swallow conditions. This study aimed to evaluate the effect of posture and swallow volume on peristaltic morphology and the probability of bolus clearance in patients with nonspecific esophageal disorder. A total of 139 patients (4,214 swallows) were included for high-resolution impedance manometry analysis in the right lateral recumbent and upright positions, as well as 5- and 10-ml liquid swallows. Intact peristalses were more frequent in the right lateral recumbent position than in the upright position. No difference was reported on failed peristalsis between both positions. Breaks were more frequent in the upright position. A 20 mmHg isobaric contour (compared with 30 mmHg) was associated with decreased bolus clearance. Bolus clearance probability with 10-ml swallows is greater than that with 5-ml swallows. There was no significant difference in the total bolus clearance comparing between the right lateral recumbent and upright positions. The right lateral recumbent position was associated with a higher intact peristalsis. The volume of swallow did not affect the integrality of esophageal peristalsis but did improve the bolus clearance.

Impact of Endotracheal Intubation on Interventional Endoscopy Unit Efficiency Metrics at a Tertiary Academic Medical Center.

OBJECTIVES: Measures for evaluating interventional endoscopy unit efficiency have not been adequately validated, especially in reference to the involvement of anesthesia services for endoscopy. Primary aim was to compare process measures/metrics of interventional endoscopy unit efficiency between intubated and non-intubated patients. Secondary aim was to assess variables associated with the need for endotracheal intubation. METHODS: The prospectively collected endoscopy unit metrics database at UF Health was reviewed for procedures performed in the interventional endoscopy unit for 6 months. Parameters included hospital-mandated metrics available from the database. RESULTS: A total of 1,421 patients underwent 1,635 interventional endoscopic procedures and 271/1,421 patients (19.1%) were intubated. There was no significant difference between intubated and non-intubated cohorts with respect to age, gender, BMI, ASA Score, Mallampati Score, or the Charlson Comorbidity Index. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were more frequently intubated than those undergoing non-ERCP procedures (41.3 vs. 12.4%, P<0.0001). Inpatients comprised 48.3% of all intubated patients, whereas only 29.2% of non-intubated patients were inpatients (P<0.0001). Most patients (159/271, 58.7%) were intubated per anesthesiologist preference. All process efficiency metrics were significantly prolonged in the intubated compared with the non-intubated patient cohort, except the time interval between successive procedures. Multivariate analysis revealed that patients with an anesthesiologist who had performed a greater number of total endoscopic sedations were less likely to be intubated than patients with an anesthesiologist who had performed fewer total procedures (P=0.0066). CONCLUSIONS: Endotracheal intubation negatively impacts efficiency metrics in an interventional endoscopy unit. Careful assessment for the need for intubation should be emphasized.

Evaluation of interventional endoscopy unit efficiency metrics at a tertiary academic medical center.

BACKGROUND AND STUDY AIMS: There is an increasing demand for interventional endoscopic services and the need to develop efficient endoscopic units. The aim of this study was to analyze performance data and define metrics to improve efficiency in a single academic interventional endoscopy center. ] PATIENTS AND METHODS: The prospective operations performance data (6-month period) of our interventional endoscopy unit (EU) was analyzed. First-case start time (FIRST) delay was defined as any time the first patient of the day entered the endoscopy room after the scheduled time. Non-endoscopy time (NET) and total time (TT) were defined as non-procedural and total time elapsed in the EU, respectively. Time-interval between successive patients (TISP) was defined as the time from one patient departure from the room until the time of arrival of the next patient in the room. RESULTS: A total of 1421 patients underwent 1635 endoscopic procedures. FIRST was delayed (54.2 % cases) by 13.6 min (range 1 - 53), but started within 15 min of the scheduled time in 85 % of the cases. NET accounted for 9.1 hours (67.2 %) of 13.5 hours TT/day. TISP (37.1 min, range 5 - 125) comprised 54.2 % of the NET, and was delayed (> 30 min) in 49.8 % of cases. "Patient flow" processes (registration, admission, transportation, scheduling) accounted for 50.1 % of TISP delays. CONCLUSIONS: Delays in NET, specifically TISP, rather than FIRST, were identified as a cause for decreased efficiency. "Patient flow" processes were the main reasons for delays in TISP. This study identifies potential process measures that can be used as benchmarks to improve efficiency in the EU.

A pilot study to evaluate the feasibility of implementing a split-dose bowel preparation for inpatient colonoscopy: a single-center experience.

OBJECTIVES: Feasibility of using split-dose bowel preparation in an inpatient setting has not been extensively studied. We conducted a single-centre multiphase study to (1) understand the perceived barriers to split-dose administration among nursing and providers, (2) develop and implement a split-dose electronic order set and (3) evaluate the use and impact of split-dose administration on 100 consecutive colonoscopies. METHODS: Nurse/provider interviews were conducted to understand perceived concerns and potential barriers to split-dose preparation. Next, an order set containing specific nursing instructions was developed, disseminated and implemented into the electronic health record as the default order set for inpatient colonoscopies. Finally, 100 consecutive inpatients undergoing colonoscopy were interviewed to determine prep consumption, tolerability and rate of procedural delays due to inadequate preparation. RESULTS: Survey results indicated perceived concerns about inpatients' ability to tolerate and complete the preparation, insufficient nursing support and complexity of preparation administration. Based on this, prep orders were adjusted to accommodate nursing concerns prior to implementation. 54% of inpatients actually completed the bowel preparation in split doses (SPLIT group); the remainder had the conventional full dose preparation (NON-SPLIT). Less procedural delay and a lower rate of additional laxatives use (13% vs 30.4%) were seen in the SPLIT versus NON-SPLIT group. Split-dose preparation was well tolerated among inpatients. CONCLUSIONS: Split-dose bowel preparation can be implemented for inpatients undergoing colonoscopy. This multiphase study demonstrates the steps used to implement split-dose preparation at our institution and may provide others with strategies that they could use at their institutions.

Congenital rubella syndrome in Haiti (Short communication).

OBJECTIVE: To determine if there is an unrecognized problem of congenital rubella syndrome (CRS) in Haiti, a country without a national rubella immunization program. METHODS: During March 2001 and June 2001, screening physicals were conducted on approximately 80 orphans at three orphanages in Haiti that accept disabled children. Children were classified as probable CRS cases based on established clinical criteria. Photo documentation of findings was obtained whenever possible. RESULTS: Six children met the criteria for probable CRS. Using data from surrounding Caribbean countries and from the United States of America prior to rubella immunization, we estimated that there are between 163 and 440 new cases of CRS per year in Haiti. CONCLUSIONS: CRS exists in Haiti, but its presence is generally unrecognized. A national rubella immunization policy should be considered.

Congenital rubella syndrome in Haiti

Objective. To determine if there is an unrecognized problem of congenital rubella syndrome (CRS) in Haiti, a country without a national rubella immunization program. Methods. During March 2001 and June 2001, screening physicals were conducted on approximately 80 orphans at three orphanages in Haiti that accept disabled children. Children were classified as probable CRS cases based on established clinical criteria. Photo documentation of findings was obtained whenever possible. Results. Six children met the criteria for probable CRS. Using data from surrounding Caribbean countries and from the United States of America prior to rubella immunization, we estimated that there are between 163 and 440 new cases of CRS per year in Haiti. Conclusions. CRS exists in Haiti, but its presence is generally unrecognized. A national rubella immunization policy should be considered

Congenital rubella syndrome in Haiti

Objective. To determine if there is an unrecognized problem of congenital rubella syndrome (CRS) in Haiti, a country without a national rubella immunization program. Methods. During March 2001, screening physicals were conducted on approximately 80 orphans at three orphanages in Haiti that accept disabled children. Children were classified as probable CRS cases based on established clinical criteria. Photo documentation of findings was obtained whenever possible. Results. Six children met the criteria for probable CRS. Using data from surrounding Caribbean countries and from the United States of America prior to rubella immunization, we estimated that there are between 163 and 440 new cases of CRS per year in Haiti. Conclusions. CRS exists in Haiti, but its presence is generally unrecognized. A national rubella immunization policy should be considered (AU)