scholarly journals Expertise in colonoscopy intubation does not predict diagnostic accuracy: a simulation-based study

2022 ◽  
Vol 10 (01) ◽  
pp. E30-E36
Author(s):  
Andreas S. Vilmann ◽  
Christian Lachenmeier ◽  
Morten Bo S. Svendsen ◽  
Bo Soendergaard ◽  
Yoon S. Park ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Assessment Tool ◽  
Training System ◽  
Endoscopy Training ◽  
Technical Performance ◽  
Adenoma Detection ◽  
Simulation Based ◽  
Cecal Intubation Rate ◽  
Inspection Performance ◽  
Insignificant Correlation

Abstract Background and study aims Studies have linked cecal intubation rate with adenoma detection rate; however, the direct association between technical performance during colonoscopy intubation and withdrawal has never been explored. Thus, it remains unclear whether gentle and efficient intubation predicts superior mucosal inspection. The aim of this study was to investigate the correlation between performance during intubation and withdrawal in a simulation-based setup. Methods Twenty-four physicians with various experience in colonoscopy performed twice on the Endoscopy Training System (ETS). Intubation skills were evaluated by assessing tasks on the ETS related to intubation (scope manipulation and loop management) and use of a computerized assessment tool called the 3D-Colonoscopy Progression Score (3D-CoPS). Diagnostic accuracy was defined by the number of polyps found during the ETS task of mucosal inspection. Pearson’s correlations were calculated to explore associations between intubation skill and diagnostic accuracy. Results The correlation analysis between 3D-CoPS and number of polyps found during mucosal inspection revealed a weak and insignificant correlation (0.157, P = 0.3). Likewise, an insignificant correlation was seen between ETS intubation and number of polyps found (0.149, P = 0.32). Conclusions We found no evidence to support that technical performance during intubation is correlated with mucosal inspection performance in a simulation-based setting.

Lower gastrointestinal polypectomy competencies in the United Kingdom: a retrospective analysis of Directly Observed Polypectomy Skills (DOPyS)

Endoscopy ◽  
2020 ◽  
Author(s):  
Arun Rajendran ◽  
Siwan Thomas-Gibson ◽  
Paul Bassett ◽  
Paul Dunckley ◽  
Rajaratnam Rameshshanker ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Training System ◽  
National Database ◽  
Advisory Group ◽  
Cecal Intubation ◽  
Endoscopy Training ◽  
The United Kingdom ◽  
Cecal Intubation Rate ◽  
The Uk ◽  
Provisional Certification

Abstract Background Polypectomy is often the most hazardous part of colonoscopy. There is significant variability in polypectomy training and assessment internationally. DOPyS (Directly Observed Polypectomy Skills) is a validated assessment tool and is used to demonstrate polypectomy competency in the UK. This study aimed to describe the learning curve for polypectomy competency in UK trainees. Methods Retrospective DOPyS data (January 2009 to September 2015) were obtained from the UK Joint Advisory Group (JAG) for intestinal endoscopy training system (JETS) national database. The number of lower gastrointestinal (LGI) procedures, overall cecal intubation rate (CIR), procedure intensity, and time in days to the first DOPyS assessment were recorded, and time to JAG certification was calculated. Results 4965 DOPyS assessments from 336 trainees were analyzed. Within the study period, 124 and 53 trainees achieved provisional and full colonoscopy certification, respectively. Trainees started formative assessment of polypectomy after > 130 LGI procedures and with a CIR of > 70 %. Within 3 years from the first DOPyS assessment, 94 % of trainees achieved provisional certification, and 50 % full certification. Higher procedure intensity at baseline DOPyS assessment was associated with a higher likelihood of obtaining certification sooner. Conclusion There is a significant variation in time to competency, and this potentially reflects the time necessary to acquire polypectomy skills. There is a need to start polypectomy training earlier, once sufficient skills, such as tip control, have been achieved to shorten the time to competency. Overall, the CIR could be used as a guide for such technical skills. Increasing exposure to training lists also potentially reduces the time to polypectomy competency.

scholarly journals Outcomes of colonoscopy with non-anesthesiologist-administered propofol (NAAP): an equivalence trial

2021 ◽  
Vol 09 (07) ◽  
pp. E1070-E1076
Author(s):  
Marco Alburquerque ◽  
Antonella Smarrelli ◽  
Julio Chevarria Montesinos ◽  
Sergi Ortega Carreño ◽  
Ana Zaragoza Fernandez ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Complication Rates ◽  
Withdrawal Time ◽  
Equivalence Trial ◽  
Crc Screening ◽  
Intention To Treat ◽  
Adenoma Detection ◽  
Group A ◽  
Cecal Intubation Rate

Abstract Background and study aims Efficacy and safety of NAAP for gastrointestinal endoscopy have been widely documented, although there is no information about the outcomes of colonoscopy when the endoscopist supervises the sedation. In this context, the aim of this trial was to determine the equivalence of adenoma detection rate (ADR) in colorectal cancer (CRC) screening colonoscopies performed with non-anesthesiologist-administered propofol (NAAP) and performed with monitored anesthesia care (MAC). Patients and methods This was a single-blind, non-randomized controlled equivalence trial that enrolled adults from a national CRC screening program (CRCSP). Patients were blindly assigned to undergo either colonoscopy with NAAP or MAC. The main outcome measure was the ADR in CRCSP colonoscopies performed with NAAP. Results We included 315 patients per group. The median age was 59.76 ± 5.81 years; 40.5 % of patients were women. The cecal intubation rate was 97 %, 81.8 % of patients had adequate bowel preparation, withdrawal time was > 6 minutes in 98.7 %, and the median global exploration time was 24.25 ± 8.86 minutes (range, 8–70 minutes). The ADR was 62.9 % and the complication rate (CR) was 0.6 %. Analysis by intention-to-treat showed an ADR in the NAAP group of 64.13 % compared with 61.59 % in the MAC group, a difference (δADR) of 2.54 %, 95 %CI: −0.10 to 0.05. Analysis by per-protocol showed an ADR in the NAAP group of 62.98 %, compared with 61.94 % in the MAC group, δADR: 1.04 %, 95 %CI: −0.09 to 0.07. There was no difference in CR (NAAP: 0,63 vs. MAC: 0.63); P = 1.0. Conclusions ADR in colorectal cancer screening colonoscopies performed with NAAP was equivalent to that in those performed with MAC. Similarly, there was no difference in complication rates.

Examining validity evidence for a simulation-based assessment tool for basic robotic surgical skills

2018 ◽  
Vol 13 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Maria Cecilie Havemann ◽  
Torur Dalsgaard ◽  
Jette Led Sørensen ◽  
Kristin Røssaak ◽  
Steffen Brisling ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Surgical Skills ◽  
Validity Evidence ◽  
Simulation Based

Symptoms are the Most Effective Child SCAT5 Component for Recognizing Concussion on the Day of Injury

2021 ◽  
Author(s):  
Nicholas Kevin Erdman ◽  
Patricia M. Kelshaw ◽  
Samantha L. Hacherl ◽  
Shane V. Caswell
Keyword(s):  
Middle School ◽  
Diagnostic Accuracy ◽  
School Children ◽  
Assessment Tool ◽  
Diagnostic Odds Ratio ◽  
Likelihood Ratios ◽  
Middle School Children ◽  
Predictive Values ◽  
Symptom Evaluation ◽  
Diagnostic Properties

Abstract Background: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5-12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion.Methods: Our participants included 34 concussed (21 boys, 13 girls; age=12.8±0.86 years) and 44 non-concussed (31 boys, 13 girls; age=12.4±0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes (r=z/√n) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated.Results: Concussed children endorsed more symptoms (p<0.001, r=0.45), higher symptom severity (p<0.001, r=0.44), and had higher double leg (p=0.046, r=0.23), single leg (p=0.035, r=0.24), and total scores (p=0.022, r=0.26) for the mBESS than non-concussed children. No significant differences were observed for the SAC-C scores (p’s≥0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC=0.76–0.77), negative predictive values (NPV=0.84–0.88), and negative likelihood ratios (-LR=0.22–0.31) of the Child SCAT5 scores.Conclusions: The symptom evaluation was the most effective component of the Child SCAT5 for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

"Development of Simulation-based Government Training System for Emergency"

2019 ◽  
Vol 13 (1) ◽  
pp. 199-219
Author(s):  
Mun-Kyom Kim ◽  
Hong-Gyoo Sohn ◽  
Suhong Yoo ◽  
Jisang Lee
Keyword(s):  
Training System ◽  
Simulation Based
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