Avaliação do serviço de coleta para exame colpocitológico pela escala SERVQUAL / Evaluación del servicio de recolección para examen colpocitológico por la escala SERVQUAL / Avaliação do serviço de coleta para exame colpocitológico pela escala SERVQUAL

ABSTRACT Objective: To analyze women's perception of the quality of the service provided for colposcopy test in the city of Belém (PA), Brazil. Method: Quantitative-descriptive study on 400 women who underwent Pap test on the public healthcare network, using the Service Quality (SERVQUAL) model. We used the Cronbach's alpha index to measure the reliability of the scale, and data were analyzed by quartiles of the gaps of the dimensions: tangibility, responsiveness, reliability, assurance, and empathy. Results: The assurance dimension, corresponding to the knowledge and courtesy of staff, featured the highest degree of importance to users; and empathy, which corresponds to the staff's concern with women's needs, featured the lower degree. The most expressive negative gaps concerned the structure of services and the attitude of healthcare professionals when collecting the material. Conclusion: All gaps featured negative relationship between what was expected and perceived, expressing dissatisfaction regarding the service.

RESUMEN Objetivo: Analizar la percepción de mujeres acerca de la calidad del servicio de colpocitología oncótica en Belém (PA). Método: Estudio cuantitativo-descriptivo con 400 mujeres que realizaron el examen de colpocitología oncótica en la red pública de salud, utilizando el modelo Service Quality (SERVQUAL). Se utilizó el Alpha de Cronbach para medir la confiabilidad de la escala, y los datos fueron analizados por los cuartiles de los gaps de las dimensiones: tangibilidad, responsividad, confiabilidad, credibilidad y empatía. Resultados: La dimensión credibilidad, correspondiente al conocimiento y a la cortesía de los funcionarios, presentó mayor grado de importancia para las usuarias; y la empatía, que corresponde a la preocupación demostrada por los funcionarios con las necesidades de las mujeres, exhibió menor grado. Los gaps negativos más expresivos se refieren a la estructura de los servicios y a la actitud de los profesionales con ocasión de la recolección del material. Conclusión: Todos los gaps presentaron relación negativa entre lo esperado y lo percibido expresando la insatisfacción con relación al servicio.

RESUMO Objetivo: Analisar a percepção de mulheres acerca da qualidade do serviço de colpocitologia oncótica em Belém (PA). Método: Estudo quantitativo-descritivo com 400 mulheres que realizaram o exame de colpocitologia oncótica na rede pública de saúde, utilizando o modelo Service Quality (SERVQUAL). Utilizou-se o Alpha de Cronbach para medir a confiabilidade da escala, e os dados foram analisados pelos quartis dos gaps das dimensões: tangibilidade, responsividade, confiabilidade, credibilidade e empatia. Resultados: A dimensão credibilidade, correspondente ao conhecimento e cortesia dos funcionários, apresentou maior grau de importância para as usuárias, e a empatia, que corresponde à preocupação demonstrada pelos funcionários com as necessidades das mulheres, exibiu menor grau. Os gaps negativos mais expressivos dizem respeito à estrutura dos serviços e a atitude dos profissionais por ocasião da coleta de material. Conclusão: Todos os gaps apresentaram relação negativa entre o esperado e o percebido expressando a insatisfação em relação ao serviço.

Programa multicéntrico de cribado de cáncer colorrectal en Chile / Results of a multicentric colorectal cancer screening program in Chile

Background: Colorectal Cancer Screening Programs (CRCSP) are widely accepted in developed countries. Unfortunately, financial restrictions, low adherence rate and variability on colonoscopy standardization hamper the implementation of CRCSP in developing countries. Aim: To analyze a multicentric pilot model of CRCSP in Chile. Material and Methods: A prospective model of CRCSP was carried out in three cities, from 2012 to 2015. The model was based on CRC risk assessment and patient education. Health care personnel were trained about logistics and protocols. The endoscopy team was trained about colonoscopy standards. A registered nurse was the coordinator in each center. We screened asymptomatic population aged between 50 and 75 years. Immunological fecal occult blood test (FIT) was offered to all participants. Subjects with positive FIT underwent colonoscopy. Results: A total of 12,668 individuals were enrolled, with a FIT compliance rate of 93.9% and 2,358 colonoscopies were performed. Two hundred and fifty high-risk adenomas and 110 cancer cases were diagnosed. One patient died before treatment due to cardiovascular disease, 74 patients (67%) underwent endoscopic resection and 35 had surgical treatment. Ninety one percent of patients had an early stage CRC (0-I-II). Among colonoscopy indicators, 80% of cases had an adequate bowel preparation (Boston > 6), cecal intubation rate was 97.7%, adenoma detection rate was 36.5%, and in 94.5% of colonoscopies, withdrawal time was adequate (> 8 min). Conclusions: This CRCS pilot model was associated to a high rate of FIT return and colonoscopy quality standards. Most CRCs detected with the program were treated by endoscopic resection.

Qualidade em colonoscopia e taxa de detecção de adenoma no Centro-Oeste do Brasil / Adenoma detection rate evaluation and quality of colonoscopy in the center-west region of brazil

ABSTRACT BACKGROUND: Colorectal cancer is the third commonest cancer in men and the second in women worldwide. Peculiarities of its evolution allow secondary prevention measures through colonoscopy, with high diagnostic and therapeutic capacity. In this context, the quality indicators of the procedure become important, among them the adenoma detection rate (ADR). OBJECTIVE: To relate the ADR in a medium risk population subjected to colonoscopy with sociodemographic, technical and histopathological indicators. METHODS: This was a descriptive, observational and retrospective study whose data were collected from medical records of colonoscopy exams with the indication of colorectal cancer screening or prevention in the period from August to October 2016. RESULTS: A total of 436 exams were included for analysis. Female sex represented 66.3% with 289 patients versus 33.7% for men. Patients aged between 50 and 59 years were 223 (51.1%) and those between 60 and 75 years were 213 (48.9%). In 99 exams (22.7%) chromoscopy was used, and 420 patients (96.3%) were adequately prepared. There were 118 patients with adenomas, resulting in an overall ADR of 27.1%. The ADR for men was 30.6% and 25.3% for women. Patients between 60 and 75 years old had a significantly higher ADR (31.9%, compared to 22.4% of the younger ones). Examinations in which chromoscopy was used also presented higher ADR. CONCLUSION: The ADR values found for the population of the studied region were compatible with internationally established goals. Continuous evaluation of the ADR may yield interventions aimed at improving quality standards for colonoscopy and promote better prevention of colorectal cancer.

RESUMO CONTEXTO: O câncer colorretal é o terceiro câncer mais incidente em homens e o segundo em mulheres em todo o mundo. Peculiaridades de sua evolução permitem medidas de prevenção secundária através da colonoscopia, com alta capacidade diagnóstica e terapêutica. Nesse contexto os indicadores de qualidade se tornam importantes, dentre eles a taxa de detecção de adenomas (TDA). OBJETIVO: Avaliar a taxa de detecção de adenomas em uma população de médio risco submetida a colonoscopia, relacionando-a a indicadores sociodemográficos, técnicos e histopatológicos. MÉTODOS: Trata-se de estudo descritivo, observacional e retrospectivo cujos dados foram coletados de registros e prontuários médicos de exames de colonoscopia com indicação de rastreamento ou prevenção do câncer colorretal no período de agosto a outubro de 2016. RESULTADOS: Foram incluídos 436 laudos de exames para análise de dados. O sexo feminino representou 66,3% com 289 pacientes contra 33,7% de homens. Os pacientes entre 50 e 59 anos de idade foram 223 (51,1%) e 213 entre 60 a 75 anos (48,9%). Em 99 exames (22,7%) foi feito uso de cromoscopia e 420 exames (96,3%) tiveram preparo adequado. Cento e dezoito pacientes tiveram adenomas, resultando em uma TDA geral no serviço de 27,1%. A TDA para homens foi de 30,6% e 25,3% para mulheres. Os pacientes entre 60 e 75 anos tiveram uma TDA significativamente maior (31,9%, contra 22,4% dos mais jovens). Exames em que foi feito uso cromoscopia também apresentaram maior TDA. CONCLUSÃO: Os valores de TDA encontrados podem validar o uso de metas estabelecidas mundialmente para a população da região estudada e sua progressão temporal pode propor medidas para o aumento dessa taxa.

Colonoscopias realizadas por médicos residentes em hospital universitário: análise consecutiva de 1000 casos / Colonoscopies performed by resident physicians in a university teaching hospital: a consecutive analysis of 1000 cases

RACIONAL: A colonoscopia tem indicação para diagnóstico em pacientes sintomáticos e é eficaz no rastreamento e vigiância de pacientes assintomáticos. Tem potencial terapêutico em diversas situções, principalmente na remoção das lesões polipóides. A proficiência e a competência do endoscopista é o esteio para o sucesso da colonoscopia diagnóstica e terapêutica. OBJETIVO: Analisar as indicações, os achados diagnósticos, e as complicações de colonoscopias realizadas por médicos residentes em um hospital universitário. MÉTODOS: Foram avaliadas 1.000 colonoscopias consecutivas realizadas por residentes de quarto ano, sob supervisão direta de colonoscopistas experientes. Foram obtidas informações sobre os dados demográficos dos pacientes, o preparo intestinal, as indicações para o procedimento, o sucesso do procedimento, os achados diagnósticos e as complicações. RESULTADOS: Foram examinados total de 596 (59,6%) mulheres e 404 (40,4%) homens. A idade variou de três a 99 anos (média 53,8). O preparo intestinal foi realizado com solução de manitol a 10% em 978 pacientes (97,8%), sendo considerada adequada em 97,6% dos casos. Principais indicações foram: diagnóstico (56,4%), terapêutica (9,6%), rastreamento (17,3%) e vigilância (22%). Taxas de intubação do ceco e válvula ileocecal foram 90,3 e 58,6%, respectivamente. A colonoscopia foi normal em 45,8% dos casos. O diagnóstico mais comum foi diverticulose (18,5%), seguido por pólipos (17%) e neoplasias (6,8%). Achados consistentes com um processo inflamatório foram identificados em 122 pacientes (12,2%) e anomalias vasculares foram detectadas em 11 pacientes (1,1%). Outros diagnósticos representaram 3,9% dos casos. Houve dois casos (0,2%) de complicações (hematoma e hemorragia submucosa), ambos após polipectomia, sem necessidade de intervenção cirúrgica. CONCLUSÃO: Os residentes sob supervisão e orientação de especialistas podem realizar colonoscopias com excelente resultado, baixo índice de complicações e com dados finais comparáveis aos obtidos por endoscopistas experientes.

BACKGROUND: Proficiency and competence of endoscopists is perhaps the mainstay of successful diagnostic and therapeutic colonoscopy. AIM: To analyze indications, diagnostic findings, and complications of colonoscopies performed by resident physicians in a university teaching hospital. METHODS: Were analyzed 1,000 colonoscopies consecutively performed by fourth-year residents under direct supervision of experienced colonoscopists. Information on patients' demographic data, bowel preparation, indications for the procedure, success of the procedure, diagnostic findings, and complications were obtained. RESULTS: A total of 596 (59.6%) female and 404 (40.4%) male patients were examined. Age ranged from 3 to 99 years (mean 53.8 years). Bowel preparation was performed with 10% mannitol solution in 978 patients (97.8%), being considered appropriate in 97.6% of cases. Main indications were: diagnosis (56.4%), therapy (9.6%), screening (17.3%), and surveillance (22%). Cecal and ileocecal valve intubation rates were 90.3 and 58.6%, respectively. Colonoscopy was normal in 45.8% of cases. The most common diagnosis was diverticulosis (18.5%), followed by polyps (17%) and malignancies (6.8%). Findings consistent with an inflammatory process were identified in 122 patients (12.2%) and vascular abnormalities were detected in 11 patients (1.1%). Other diagnoses accounted for 3.9% of cases. There were two cases (0.2%) of complications (submucosal hematoma and bleeding), both after polypectomy, with no need for surgical intervention. CONCLUSION: The residents under supervision and guidance of specialists can perform colonoscopies with excellent success and low complication rates, with final results comparable to those achieved by fully trained endoscopists.

Estudio endoscópico en familiares de primer grado de pacientes operados por cáncer colorrectal / Screening colonoscopy among first degree relatives of patients with colorectal carcinoma

Background: First degree relatives of patients with colorectal carcinoma are at a higher risk of having the disease than the general population. Therefore, they should be subjected to screening colonoscopy. Aim: To assess the effectiveness of colonoscopy among first degree relatives of patients with colorectal carcinoma. Material and methods: A free colonoscopy was offered to first degree relatives of patients operated on for colorectal cancer between 1998 and 2000. As inclusion criteria, subjects had to be asymptomatic, older than 40 years or less than 10 years younger than the index case. Each subject was contacted twice, inviting him/her to have a colonoscopy performed. Results: Two hundred forty three relatives were contacted for the study and in 76, a colonoscopy was performed. Among the latter, a neoplasm was found in 13 (17 percent): One adenocarcinoma and 12 adenomas. Three of these lesions were located in the right colon. The main reason given by the 176 subjects that did not agree to have a colonoscopy was lack of interest. Conclusions: Screening colonoscopy is effective to detect adenoma and adenocarcinomaamong first degree relatives of patients with colorectal carcinoma, however only 31 percent of all potential relatives agreed to undergo a colonoscopy.