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3.
Medicine (Baltimore) ; 99(36): e20976, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898990

RESUMO

BACKGROUND: Adequate bowel preparation is essential for the detection of pathological lesions during colonoscopy. However, it has been found to be inadequate in approximately 20% to 30% of colonoscopy examinations. Educational interventions focused on health staff, such as physicians and nurses, may improve the patients' understanding of the bowel preparation instructions, and consequently, increase the quality of bowel preparation. OBJECTIVES: To investigate whether enhanced education of ward nurses could improve the bowel preparation quality in inpatients undergoing colonoscopy. DESIGN: This was a single-center randomized controlled study. METHODS: A total of 190 consecutive inpatients scheduled to undergo colonoscopy from March 2019 to March 2020 were randomized to the educated (nurses with enhanced education) or control group (nurses without enhanced education). We assessed the bowel preparation quality using the Boston bowel preparation scale. RESULTS: There were 89 patients in the educated group and 101 patients in the control group. The proportion of colonoscopies with adequate bowel preparation was 83.1% in the educated group and 69.3% in the control group. Patients' compliance with bowel preparation in the educated group was superior to that in the control group. Furthermore, significantly better sleep quality was found in the educated group. The multivariate logistic regression analysis identified the ward nurses-focused enhanced educational intervention as a risk factor for bowel preparation quality. CONCLUSIONS: The ward nurses-focused educational intervention improved the bowel preparation quality and reduced the adverse event rates in inpatients undergoing colonoscopy. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry under number ChiCTR2000030366.


Assuntos
Catárticos/uso terapêutico , Colonoscopia/normas , Recursos Humanos de Enfermagem no Hospital/educação , Cooperação do Paciente/estatística & dados numéricos , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório
4.
Rev Esp Enferm Dig ; 112(10): 748-755, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32954775

RESUMO

INTRODUCTION: the global SARS-CoV-2 pandemic forced the closure of endoscopy units. Before resuming endoscopic activity, we designed a protocol to evaluate gastroscopies and colonoscopies cancelled during the pandemic, denying inappropriate requests and prioritizing appropriate ones. METHODS: two types of inappropriate request were established: a) COVID-19 context, people aged ≤ 50 years without alarm symptoms and a low probability of relevant endoscopic findings; and b) inappropriate context, requests not in line with clinical guidelines or protocols. Denials were filed in the medical record. Appropriate requests were classified into priority, conventional and follow-up. Requests denied by specialty were compared and the findings of priority requests were evaluated. RESULTS: between March 16th and June 30th 2020, 1,658 requests (44 % gastroscopies and 56 % colonoscopies) were evaluated, of which 1,164 (70 %) were considered as appropriate (priority 8.5 %, conventional 48 %, follow-up 43 % and non-evaluable 0.5 %) and 494 (30 %) as inappropriate (20 % COVID-19 context, 80 % inappropriate context). The reasons for denial of gastroscopy were follow-up of lesions (33 %), insufficiently studied symptoms (20 %) and relapsing symptoms after a previous gastroscopy (18 %). The reasons for denial of colonoscopies were post-polypectomy surveillance (25 %), colorectal cancer after surgery (21 %) and a family history of cancer (13 %). There were significant differences in denied requests according to specialty: General Surgery (52 %), Hematology (37 %) and Primary Care (29 %); 31 % of priority cases showed relevant findings. CONCLUSIONS: according to our study, 24 % of endoscopies were discordant with scientific recommendations. Therefore, their denial and the prioritization of appropriate ones optimize the use of resources.


Assuntos
Betacoronavirus , Colonoscopia/normas , Infecções por Coronavirus/prevenção & controle , Gastroscopia/normas , Alocação de Recursos para a Atenção à Saúde/normas , Acesso aos Serviços de Saúde/normas , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Colonoscopia/tendências , Feminino , Gastroscopia/tendências , Alocação de Recursos para a Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Hospitais Públicos/normas , Hospitais Públicos/tendências , Humanos , Controle de Infecções/normas , Controle de Infecções/tendências , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Espanha , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/tendências , Adulto Jovem
5.
Am J Gastroenterol ; 115(8): 1183-1190, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32759620

RESUMO

Colonoscopy is a safe and effective tool, but operator dependent. Room for improvement in the quality of colonoscopy is the impetus for the development and measurement of colonoscopy quality indicators and the focus of many efforts to improve colonoscopy quality indicator prevention and control in provider practices and health systems. We present the preprocedural, intraprocedural, and postprocedural quality indicators and benchmarks for colonoscopy. Every provider and practice must make a commitment to performing high-quality colonoscopy and implement and monitor quality metrics. There are a variety of tools available to assist in improving quality indicators that range from distal attachment devices to education and feedback. Although technology can help, it is not a substitute for proper technique. The commitment also requires provider feedback through audits and report cards. The impact of these efforts on patient outcomes is an important area of further research.


Assuntos
Benchmarking , Colonoscopia/normas , Indicadores de Qualidade em Assistência à Saúde , Humanos , Estados Unidos
6.
Clin Med (Lond) ; 20(4): 352-358, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32518104

RESUMO

Many non-emergency clinical services were suspended during COVID-19 pandemic peak. It is essential to develop a plan for restarting services following the peak. It is equally important to protect patients and staff and to use resources and personal protective equipment (PPE) efficiently. The British Society of Gastroenterology Endoscopy Committee and Quality Improvement Programme has produced guidance on how a restart can be safely delivered. Key recommendations include the following: all patients should have need for endoscopy assessed by senior clinicians and prioritised according to criteria we have outlined; once the need for endoscopy is confirmed, patients should undergo telephone screening for symptoms using systematic questionnaires; all outpatients should undergo RT-PCR testing for COVID-19 virus 1-3 days prior to endoscopy; and PPE should be determined by patient risk stratification, the nature of the procedure and the results of testing. While this guidance is tailored to endoscopy services, it could be adapted for any interventional medical discipline.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Endoscopia Gastrointestinal/normas , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Endoscopia por Cápsula/normas , Colangiopancreatografia Retrógrada Endoscópica/normas , Colonoscopia/normas , Endossonografia/normas , Humanos , Saúde do Trabalhador , Segurança do Paciente , Equipamento de Proteção Individual
7.
Medicine (Baltimore) ; 99(22): e20311, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481401

RESUMO

For acute lower gastrointestinal bleeding (LGIB), lower gastrointestinal endoscopy is the preferred initial diagnostic test. However, it is difficult to perform urgently. Computed tomography (CT) is a convenient alternative.This study aimed to determine the diagnostic performance of CT compared to lower endoscopy as an initial test for evaluating acute LGIB.The medical records of 382 patients who visited our emergency department with hematochezia between January 2012 and January 2017 were retrospectively analyzed. Of them, 112 underwent CT, 65 underwent colonoscopy, and 205 underwent sigmoidoscopy as an initial test. For each method, sensitivity, specificity, positive predictive value, and negative predictive value were calculated upon active bleeding site detection and LGIB etiology diagnosis.The sensitivity, specificity, positive predictive value, and negative predictive value of CT for active bleeding site detection were 85.7%, 100%, 100%, and 96.9%, respectively, while those for identifying the etiology of LGIB were 87.4%, 40.0%, 83.5, and 47.6%, respectively.CT was not inferior to lower endoscopy for active bleeding site detection. Early localization and the exclusion of active bleeding were possible with CT. Etiology was diagnosed with high sensitivity and PPV by CT. Thus, CT can be an alternative initial diagnostic tool for evaluating acute LGIB.


Assuntos
Colonoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/normas , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Sigmoidoscopia/métodos , Sigmoidoscopia/normas , Tomografia Computadorizada por Raios X/normas , Adulto Jovem
8.
Rev. argent. coloproctología ; 31(2): 42-50, jun. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1117006

RESUMO

Se trató de redactar una guía para la práctica segura de la especialidad en tiempos de COVID-19. Se realizó una búsqueda de las publicaciones recientes disponibles en Pub-Med y en otros buscadores, se utilizó la experiencia de expertos a través de diferentes conferencias o comunicados de sociedades científicas. Esta pandemia nos ha obligado a aprender de una manera vertiginosa el manejo de una nueva enfermedad, donde especialistas en cirugía comenzamos a hablar de terminología clínica, virológica, entre otras completamente nueva y desconocida para la mayoría de nosotros. Tuvimos que adaptar nuestra práctica habitual a nuevos estándares, cometiendo diferentes errores en el manejo inicial, provocados por la falta de información previa. La guía trata de abarcar los tópicos considerados más relevantes en este momento, como son el manejo del consultorio, recomendaciones de que patologías se recomienda operar y cuáles no. Recomendaciones de tratamientos alternativos al quirúrgico mientras dura la pandemia. Métodos de diagnósticos utilizados para evaluar infección en pacientes que se someterán a una cirugía, etc. Se agregaron links y apéndices para aquellos que deseen ampliar algún tema en particular, esto evita que la guía sea más extensa y pierda su practicidad con la que fue pensada. Esperamos esta guía sirva para facilitar la compresión de esta nueva enfermedad y su manejo para cualquier cirujano que necesite asistir a pacientes con patología colorrectal. Seguramente al finalizar estas líneas habrá nueva evidencia que deberá ser adaptada e incorporada a la presentada actualmente.


An attempt was made to write a guide for the safe practice of the specialty in times of COVID-19. A search of recent publication available in Pub-Med and other platforms was performed. Experts' opinions and experiences were taken into account from various conferences or communications of scientific societies. This pandemic has forced us to learn the management of a new disease in a sudden way. Surgical specialists began to learn clinical and virologic terminology, among other new concepts previously ignored by most of us. We were forced to adapt our usual practice to new standards, making different mistakes in the initial handling, caused by the lack of prior information.The present guide tries to cover the topics considered most relevant at this time, such as outpatients ́ management, recommendations of which patients we should operate on and which procedures should be postponed. Recommendations for alternative treatments to surgery while the pandemic lasts. Diagnostic methods used to assess infection in patients who will undergo surgery, etc. Links and appendices have been added for those who wish to expand on a particular topic, this prevents the guide from being too extensive and losing the practicality with which it was intended. We hope this guide will facilitate the understanding of this new disease and its management for any surgeon who needs to assist patients with colorectal pathology. By the time we would have finished these lines there will be new evidence that must be adapted and incorporated into those currently presented.


Assuntos
Humanos , Pneumonia Viral , Segurança/normas , Cirurgia Colorretal/normas , Infecções por Coronavirus , Colonoscopia/métodos , Colonoscopia/normas , Assistência Perioperatória/normas , Endoscopia/normas , Pandemias , Assistência Ambulatorial/normas , Equipamento de Proteção Individual/normas , Enteropatias/cirurgia
9.
Curr Gastroenterol Rep ; 22(6): 28, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32377915

RESUMO

PURPOSE OF THIS REVIEW: Colorectal cancer is the third most common cancer in the USA. Colonoscopy is considered the gold standard for colorectal cancer screening and can offer both diagnosis and therapy. The bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is often cited as the most dreaded aspect of the colonoscopy process. Inadequate bowel preparations still occur in 10-25% of colonoscopies, and this in turn can lead to increased procedural times, lower cecal intubation rates, and shorter interval between colonoscopies. From a quality standpoint, it is imperative that we do what we can to decrease the rate of inadequate bowel preparations. This review will focus on recent data regarding bowel preparation and offers a glimpse into what may be coming in the future. RECENT FINDINGS: Recent advances in the field have been made to improve tolerability of bowel preparations and allow for more adequate colonoscopies. Newer, lower volume, flavored preparations, the use of adjuncts, and using split-dose preparations all can help with tolerability, compliance, and, in turn, preparation quality. Edible bowel preparations may become available in the near future. Early data on the use of artificial intelligence for assessment of preparation quality has been promising. Additionally, utilization of smartphone technology for education prior to the bowel preparation has also been shown to improve the adequacy of bowel preparations. CONCLUSIONS: Ongoing efforts to improve the tolerability and palatability of colonoscopy bowel preparations are important from a quality improvement standpoint to ensure the adequacy of colonoscopy. Incorporating patient-specific factors and comorbidities is also an essential aspect of improving the quality of bowel preparation. Leveraging technology to better communicate with and educate patients on the bowel preparation process is likely to play a larger role in the coming years.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Cuidados Pré-Operatórios/normas , Inteligência Artificial , Colonoscopia/tendências , Dieta , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/tendências , Humanos , Cooperação do Paciente , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios/tendências , Melhoria de Qualidade , Smartphone
10.
Adv Clin Exp Med ; 29(5): 573-580, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32421261

RESUMO

BACKGROUND: Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. OBJECTIVES: To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. MATERIAL AND METHODS: Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. RESULTS: An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). CONCLUSIONS: The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.


Assuntos
Colo/patologia , Neoplasias do Colo/diagnóstico , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Índice de Massa Corporal , Colo/diagnóstico por imagem , Colonoscopia/métodos , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
11.
Medicine (Baltimore) ; 99(20): e20243, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443361

RESUMO

BACKGROUND: Previous studies have reported that cuff-assisted colonoscopy (CAC) can be used for detection of adenoma (DA). However, there are inconsistent results regarding the CAC for DA. Thus, this study will systematically explore the impact of CAC for DA. METHODS: In order to retrieve potential eligible articles, this study will identify the following electronic databases from their inceptions to present: MEDLINE, EMBASE, Cochrane Library, PSYCINFO, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched without any language limitation. We will consider case-controlled studies that focused on exploring the impacts of CAC for DA. Two authors will perform study selection, information collection and risk of bias assessment, respectively. Any discrepancies between 2 authors will be resolved through discussion with a third author. RESULTS: This study will summarize the most recent evidence to assess the impact of CAC for DA. CONCLUSION: The findings of this study will provide evidence of CAC for DA in clinical practice. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040042.


Assuntos
Adenoma/diagnóstico , Colonoscopia/métodos , Adenoma/fisiopatologia , Protocolos Clínicos , Colonoscopia/normas , Colonoscopia/tendências , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/fisiopatologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/tendências , Humanos , Metanálise como Assunto
13.
Ann R Coll Surg Engl ; 102(6): 451-456, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32347738

RESUMO

INTRODUCTION: UK and European guidelines recommend consideration of a self-expandable metallic stent (SEMS) as an alternative to emergency surgery in left-sided colonic obstruction. However, there is no clear consensus on stenting owing to concern for complications and long-term outcomes. Our study is the first to explore SEMS provision across England. METHODS: All colorectal surgery department leads in England were contacted in 2018 and invited to complete an objective multiple choice questionnaire pertaining to service provision of colorectal stenting (including referrals, time, location and specialty). RESULTS: Of 182 hospitals contacted, 79 responded (24 teaching hospitals, 55 district general hospitals). All hospitals considered stenting, with 92% performing stenting and the remainder referring. The majority (93%) performed fewer than four stenting procedures per month. Most (96%) stented during normal weekday hours, with only 25% stenting out of hours and 23% at weekends. Compared with district general hospitals, a higher proportion of teaching hospitals stented out of hours and at weekends. Stenting was performed in the radiology department (64%), the endoscopy department (44%) and operating theatres (15%), by surgeons (63%), radiologists (60%) and gastroenterologists (48%). A radiologist was present in 66% of cases. Of 14 hospitals that received referrals, 3 had a protocol, 3 returned patients the same day and 4 returned patients for management in the event of failure. CONCLUSIONS: All responding hospitals in England consider the use of SEMS in colonic obstruction. Nevertheless, there is great variation in stenting practices, and challenges in terms of access and expertise. Centralisation and regional referral networks may help maximise availability and expertise but more work is needed to support this.


Assuntos
Colonoscopia/instrumentação , Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Protocolos Clínicos/normas , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Estudos Transversais , Inglaterra , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/normas , Hospitais de Distrito/estatística & dados numéricos , Hospitais Gerais/normas , Hospitais Gerais/estatística & dados numéricos , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Stents Metálicos Autoexpansíveis/normas , Inquéritos e Questionários/estatística & dados numéricos
16.
Sci Rep ; 10(1): 2167, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034266

RESUMO

Guidelines to triage patients to conscious sedation (CS) or monitored anaesthesia care (MAC) for colonoscopy do not exist. We aimed to identify the CS failure rate, predictors of failure, and its impact on the adenoma detection rate (ADR). Strict (based on patient experience) and expanded (based on doses of sedative medications) definitions of CS failure were used. Patient and procedure-related variables were extracted. Multivariable logistic regression identified predictors for CS failure and the ADR. Among 766 patients, 29 (3.8%) and 175 (22.8%) patients failed CS by strict and expanded definitions, respectively. Female gender (OR 3.50; 95% CI: 1.37-8.94) and fellow involvement (OR 4.15; 95% CI: 1.79-9.58) were associated with failed CS by the strict definition. Younger age (OR 1.27, 95% CI: 1.07-1.49), outpatient opiate use (OR 1.71; 95% CI 1.03-2.84), use of an adjunct medication (OR 3.34; 95% CI: 1.94-5.73), and fellow involvement (OR 2.20; 95% CI: 1.31-3.71) were associated with failed CS by the expanded definition. Patients meeting strict failure criteria had a lower ADR (OR 0.30; 95% CI: 0.12-0.77). Several clinical factors may be useful for triaging to MAC. The ADR is lower in patients meeting strict criteria for failed CS.


Assuntos
Adenoma/diagnóstico , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Sedação Consciente/normas , Triagem/normas , Adenoma/epidemiologia , Fatores Etários , Idoso , Colonoscopia/normas , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Sedação Consciente/métodos , Sedação Consciente/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sensibilidade e Especificidade , Triagem/métodos
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