scholarly journals Az endoszkópos regiszterek szerepe a minőségi betegellátásban. Az új magyar Endoszkópos Retrográd Cholangiopancreatographia (ERCP) Regiszter első eredményei

2018 ◽  
Vol 159 (37) ◽  
pp. 1506-1515 ◽  
Author(s):  
Dániel Pécsi ◽  
Péter Hegyi ◽  
Andrea Szentesi ◽  
Szilárd Gódi ◽  
Ferenc Pakodi ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Continuous Monitoring ◽  
Gastrointestinal Endoscopy ◽  
Late Complications ◽  
First Year ◽  
Free Text ◽  
Data Collecting ◽  
Clinically Significant ◽  
American Society ◽  
Collecting System

Abstract: Introduction: The continuous monitoring of quality indicators in gastrointestinal endoscopy has become an essential requirement nowadays. Most of these data cannot be extracted from the currently used free text reports, therefore a structured web-based data-collecting system was developed to record the indicators of pancreatobiliary endoscopy. Aim: A structured data-collecting system, the ERCP Registry, was initiated to monitor endoscopic retrograde cholangiopancreatography (ERCP) examinations prospectively, and to verify its usability. Method: From January 2017, all ERCPs performed at the First Department of Medicine, University of Pécs, have been registered in the database. In the first year, the detailed data of 595 examinations were entered into the registry. After processing these data, the testing period of the registry is now finished. Results: On 447 patients, 595 ERCPs were performed. The success rate of cannulation is 93.8% if all cases are considered. Difficult biliary access was noted in 32.1% of patients with native papilla, and successful cannulation was achieved in 81.0% of these cases during the first procedure. Post-ERCP pancreatitis was observed in 13 cases (2.2%), clinically significant post-papillotomy bleeding was registered in 2 cases (0.3%), while 27 patients (4.5%) developed temporary hypoxia during the procedure. 30-day follow-up was successful in 75.5% of the cases to detect late complications. All of the quality indicators determined by the American Society of Gastrointestinal Endoscopy (ASGE) were possible to monitor with the help of the registry. Our center already complies with most of these criteria. Conclusions: Continuous monitoring of the quality indicators of endoscopic interventions are not supported by the current hospital information system but it became possible with our registry. The ERCP Registry is a suitable tool to detect the quality of patient care and also useful for clinical research. Several endoscopy units have joined already this initiative and it is open for further centres through our web page ( https://tm-centre.org/hu/regiszterek/ercp-regiszter/ ). Orv Hetil. 2018; 159(37): 1506–1515.

Tu1020 A Pragmatic Evaluation of Targets Set by the American Society for Gastrointestinal Endoscopy for ERCP Priority Quality Indicators in a Cancer Population

2017 ◽  
Vol 85 (5) ◽  
pp. AB542-AB543
Author(s):  
Tomas DaVee ◽  
Aman Deep ◽  
Samreen Khuwaja ◽  
Gandhi Lanke ◽  
Graciela M. Nogueras-González ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Gastrointestinal Endoscopy ◽  
American Society

A European scale monitoring system to assess water quality of multi-national river basins in the accession countries

2003 ◽  
Vol 48 (10) ◽  
pp. 103-110 ◽  
Author(s):  
J. Fehér ◽  
A. Lázár
Keyword(s):  
Water Resources ◽  
Subsurface Water ◽  
Nutrient Concentrations ◽  
Environmental Assessments ◽  
Data Collecting ◽  
Accession Countries ◽  
Catchment Size ◽  
Environment Agency ◽  
Collecting System

In the middle of the 1990s the European Environment Agency (EEA) started to develop a data collecting system for surface and subsurface water resources for assessing pressures, states and impacts on European water resources. The main objective of this system was to provide reliable, comparable, homogenous information, and support integrated environmental assessments at European level. The data collecting system for water is called Eurowaternet. The extent and information content of the network makes not only pan-European, but also regional or thematic environmental assessments possible. An extensive programme started in 1997 to support the Phare countries in their accession to the EU with implementation of this data collecting system in their countries. The paper briefly introduces the methodology of the system, but it focuses more on the application of the system in the accession countries, highlighting, through examples, the usefulness of the implemented network and assembled database. The examples present - among several other possible ones - trends of average nutrient concentrations; relationships between catchment size and annual average nutrient concentrations; relationships between catchment size and agricultural usage.

scholarly journals 1043. The impact of integrase strand transfer inhibitors (InSTIs) on weight gain among adults with HIV in clinical care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S551-S551
Author(s):  
Sneha Thatipelli ◽  
Chad Achenbach ◽  
Shannon Galvin
Keyword(s):  
Weight Gain ◽  
Weight Change ◽  
Metabolic Diseases ◽  
Clinical Care ◽  
First Year ◽  
Strand Transfer ◽  
Art Initiation ◽  
Integrase Strand Transfer Inhibitors ◽  
Clinically Significant ◽  
The Impact

Abstract Background Integrase strand transfer inhibitors (InSTIs) as ART for HIV has been associated with clinically significant weight gain, in addition to the “return to health phenomenon”. Methods We conducted a cohort study on adults over 18 with HIV, who had baseline weights and an additional weight at least 6 months later. Individuals with malignancies, thyroid disorders, and disseminated tuberculosis or mycobacterium avium complex were excluded. To understand the impact of InSTIs on chronic vs. recently infected persons, we divided the cohort into four groups: (1) well-controlled on non-InSTI ART [WN] (2) well-controlled on InSTI ART [WI] (3) uncontrolled on non-InSTI ART [UN], and (4) uncontrolled on InSTI ART [UI]. Well-controlled persons (viral load < 2000) were proxies for chronic infection on long-term ART and uncontrolled for recently infected and initiated on ART. New diagnoses of diabetes, hyperlipidemia, and hypertension were determined by ICD10 codes. Participants with a weight change more than 10 kg in 6 months were excluded. Results 612 of the initial 910 participants in the cohort met the inclusion criteria. Comparing those who remained on the designated regimen throughout the study led to 86 WN, 153 WI, 166 UN, and 145 UI. Mean weight change at 6 months for WN was +0.22 kg (95% CI [-0.86, 1.3]), at 1 year was -0.86 kg (95% CI [-2.94, 1.22]), and at 2 years was +0.026 kg (95% CI [-2.347, 2.399]). For WI, mean weight change at 6 months was +0.21 kg (95% CI [-0.79, 1.21]), at 1 year was -0.50 kg (95% CI [-2.02, 1.04]), and at 2 years was +0.43 kg (95% CI [-1.35, 2.21]). UN gained weight until the first year (+1.74 kg at 6 mo (95% CI [0.24, 3.24]) and +3.84 kg at 1 year (95% CI [1.57, 6.11])), but plateaued at 2 years (+2.42 kg (95% CI [-0.44, 5.28])). At 6 months mean weight gain for UI was +0.78 kg (95% CI [-0.15, 1.71]), at 1 year was +2.33 kg (95% CI [1.02, 3.64]), and at 2 years was +3.04 kg (95% CI [1.2, 4.85]). WI had a higher incidence of diabetes (37% vs. 32%, p=0.40), hyperlipidemia (32% vs. 29%, p=0.66), and hypertension (34% vs. 26%, p=0.19) compared to WN. Conclusion InSTIs may confer a larger and more sustained weight gain among individuals in the first two years after ART initiation. Well controlled individuals did not have statistically significant weight change, but those on Insti-based ART had more metabolic diseases. Disclosures All Authors: No reported disclosures

Quality Indicators for Older Persons’ Transitions in Care: A Systematic Review and Delphi Process

2021 ◽  
pp. 1-15
Author(s):  
Kaitlyn Tate ◽  
Sarah Lee ◽  
Brian H Rowe ◽  
Garnet E Cummings ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Older Persons ◽  
Steering Committee ◽  
Administrative Databases ◽  
Continuing Care ◽  
Free Text ◽  
Institute Of Medicine ◽  
Outcome Indicators ◽  
Transitions In Care ◽  
Documentation Systems

Abstract We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators

Endoscopy ◽  
2021 ◽  
Author(s):  
Geir Hoff ◽  
Edoardo Botteri ◽  
Gert Huppertz-Hauss ◽  
Jan Magnus Kvamme ◽  
Øyvind Holme ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Estimating Equation ◽  
First Year ◽  
Polyp Detection ◽  
Detection Rates ◽  
Quality Register ◽  
Polyp Detection Rate ◽  
National Quality ◽  
Systematic Training ◽  
Colonoscopy Quality

Abstract Background Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of “training-the-colonoscopy-trainer” (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators. Methods This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used. Results 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period. Conclusions Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

Processing of Adenoid and Tonsil Specimens in Children: A National Survey of Standard Practices and a Five-Year Review of the Experience at the Children's Hospital of Pittsburgh

1996 ◽  
Vol 115 (1) ◽  
pp. 94-97 ◽  
Author(s):  
Joseph E. Dohar ◽  
Jose A. Bonilla
Keyword(s):  
Microscopic Analysis ◽  
Cost Effective ◽  
Glycogen Storage ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Clinically Significant ◽  
American Society ◽  
Standard Practices ◽  
Glycogen Storage Disorder ◽  
The Cost

The best means of pathologically examining routine tonsillectomy and adenoidectomy specimens in children remains controversial. Otolaryngologists fear missing an unsuspected diagnosis. However, the cost-effectiveness of microscopic analysis, given the rare incidence of unsuspected diagnosis, is questionable. If a significant pathologic diagnosis is missed, the medicolegal implications could be significant. A questionnaire was sent to 111 members of the American Society of Pediatric Otolaryngology. Additionally, we reviewed our experience at the Children's Hospital of Pittsburgh for the 5-year span from 1989 to 1994 to determine our incidence of unsuspected pathologic diagnoses. Sixty-five questionnaires were returned (59% response rate). More than half (56%) of the respondents stated that microscopic analysis was routinely performed on all specimens, and 42% replied that only gross examination was performed, reserving microscopic examination for selected cases. Three respondents said that they discarded their specimens in the operating room. From March 1989 to October 1994, in 1985 children undergoing bilateral tonsillectomy and adenoidectomy at the Children's Hospital of Pittsburgh, no significant pathologic diagnoses were found. Twenty-seven additional children who underwent only tonsillectomy between January 1991 and October 1994 were also reviewed. One lymphoma, suspected before surgery, and a glycogen storage disorder, not suspected before surgery, were diagnosed. Therefore, in a total of 2012 children, we found only one clinically significant unsuspected diagnosis. In conclusion, we found no national consensus governing the best way to examine routine adenotonsillectomy specimens in children. Given that unsuspected diagnoses are rare, reserving microscopic analysis for specific clinical indications may be both more cost-effective and medically feasible.

scholarly journals Quality indicators for gastrointestinal endoscopy units

VideoGIE ◽  
2017 ◽  
Vol 2 (6) ◽  
pp. 119-140 ◽  
Author(s):  
Lukejohn W. Day ◽  
Jonathan Cohen ◽  
David Greenwald ◽  
Bret T. Petersen ◽  
Nancy S. Schlossberg ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Gastrointestinal Endoscopy
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