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Quality indicators and patient satisfaction in colonoscopy. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 42:73-81. [PMID: 30170708 DOI: 10.1016/j.gastrohep.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/29/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Colonoscopy is the diagnostic/therapeutic confirmation test for colorectal cancer. The monitoring of the experience of people who have undergone the test is interesting to improve the quality of the colonoscopy. The aim of the project was to study factors affecting patients' experience and their relationship with the quality indicators of the Clinical Practice Guidelines. PATIENTS AND METHODS An observational cross-sectional study was conducted, including quality and experience indicators (adapted mGHAA-9 questionnaire and clinical history) in a sample of 432 participants aged between 40- and 75-years-old who had undergone a colonoscopy in 2015. Univariate and multivariate analysis with multiple logistic regression. RESULTS Satisfaction was associated in the multivariate analysis with evaluating the waiting time for the colonoscopy as short (OR=3.80) (1.76-10.90, 95% CI),>55-years-old (OR=2.60) (1.19-5.68, 95% CI), rating the experience with the preparation positively (OR=7.34) (3.15-17.09, 95% CI), not reporting pain or discomfort during the procedure (OR=3.71) (1.03-13.40, 95% CI) (P=.006) and being examined in a tertiary hospital (OR=2.81) (1.17-6.72; 95% CI) (P=.020). DISCUSSION The mGHAA-9 questionnaire adapted to Spanish is useful to evaluate patient experience factors. There are aspects to improve in terms of waiting time, colon cleansing, satisfaction with preparation and post-colonoscopy problems. Interventions should be implemented to enhance patient experience and colonoscopy quality.
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Ding Y, Yao P, Li H, Zhao R, Zhao G. Evaluation of combined radiofrequency and chemical blockade of multi-segmental lumbar sympathetic ganglia in painful diabetic peripheral neuropathy. J Pain Res 2018; 11:1375-1382. [PMID: 30100752 PMCID: PMC6067610 DOI: 10.2147/jpr.s175514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Painful diabetic peripheral neuropathy (PDPN) is one of the most common complications of diabetes. PDPN seriously affects the quality of life and is difficult to treat; therefore, there is an urgent need for new cost-effective treatment methods for PDPN. Objective To investigate the efficacy and safety of radiofrequency thermocoagulation (RF) combined with anhydrous ethanol (AE) chemical blockade of lumbar sympathetic ganglia (LSG) in patients with PDPN using computed tomography (CT). Study design Retrospective comparative study. Setting Shengjing Hospital of China Medical University. Methods Ninety patients diagnosed with PDPN were enrolled in this study. The patients were randomly divided into AE group (A, n=30), RF group (B, n=30), and RF+ AE group (C, n=30). The follow-up included preoperative basic conditions, visual analog scale (VAS), the total remission rate (TRR), skin temperature (ST) and the improvement of numbness and hyperalgesia in the lower extremities, complications, and degree of satisfaction (DOS) before and after surgery. Results Postoperative VASs were significantly decreased compared to preoperative VASs in all groups (P<0.05). The VAS in group A began to increase 3 months (3M) after surgery; VAS scores at 3M, 6 months (6M) and 1 year (1Y) were significantly different compared to group B and C (P<0.05); VAS in group B began to increase after 6M; VAS scores at 6M and 1Y were significantly different compared to group C (P<0.05); Moreover, group C maintained relatively long duration of pain relief. TRR in group A, group B and group C at 1Y after operation was 66.7%, 73.3% and 93.3%, respectively; TRR in group C was statistically different compared to groups A and B (P<0.05). Higher ST in the lower extremities was observed after surgery in all groups compared to peroration (P<0.05); nonetheless, the difference was not statistically significant. The numbness and hyperalgesia improved in all three groups after surgery compared to preoperational time, the numbness in group C was significantly higher compared to groups A and B. In addition, no severe complications were observed. At 6M and 1Y after surgery, the degree of satisfaction in patients from group C was significantly higher compared to groups A and B. Conclusion Radiofrequency thermocoagulation combined with AE chemical blockade of the LSG was safe and effective. Nevertheless, the details underlying analgesic mechanisms still need to be investigated.
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Affiliation(s)
- Yuanyuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongxi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Rongjie Zhao
- Class 5 of 2020 Session, Shenyang No. 20 High School, Shenyang, China
| | - Guangyi Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China,
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Gkolfakis P, Tziatzios G, Papadopoulos V, Dimitriadis GD, Georgopoulos SD, Triantafyllou K. A nationwide survey of training satisfaction and employment prospects among Greek gastroenterology fellows during the economic recession. Ann Gastroenterol 2017; 30:242-249. [PMID: 28243047 PMCID: PMC5320039 DOI: 10.20524/aog.2016.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/03/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study assessed Greek gastroenterology fellows' satisfaction regarding training, working conditions, quality of life and future employment perspectives. METHODS Greek gastroenterology fellows completed an anonymous multiple-choice electronic questionnaire designed to rate their satisfaction using a five-step Likert scale in two major domains: 1) fellowship program (training, working conditions, research activity, acquisition of endoscopic competencies, quality of life); and 2) professional expectations. Pareto analysis was used to determine the factors that had the most negative effect on fellows' satisfaction. RESULTS In 2016, over a two-month period, 121 invitations were distributed and 70 (58%) fellows responded. Overall, responders reported a low level of satisfaction with their training programs: the mean total satisfaction score was 42.94±11.55 (range 15-75). Pareto analysis revealed that the main factors negatively affecting satisfaction were financial remuneration, routine or menial work, and uncertainty about professional future (98.6%, 94.3% and 92.9% unfavorable answers, respectively). Of the total participants, 53% felt tired or very tired and 44.3% of them reported high levels of stress following a normal working day. Although the majority of the fellows did not regret choosing gastroenterology fellowship training, 34.4% of them would choose a different training environment, if possible. CONCLUSION Our study revealed that Greek gastroenterology fellows are dissatisfied with their training programs and with their professional perspectives. It also detected the issues that contribute most to this unfavorable outcome.
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Affiliation(s)
- Paraskevas Gkolfakis
- Hepatogastroenterology Unit, 2 Department of Internal Medicine-Propaedeutics, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital (Paraskevas Gkolfakis, Georgios Tziatzios, Vasilios Papadopoulos, George D. Dimitriadis, Konstantinos Triantafyllou)
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2 Department of Internal Medicine-Propaedeutics, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital (Paraskevas Gkolfakis, Georgios Tziatzios, Vasilios Papadopoulos, George D. Dimitriadis, Konstantinos Triantafyllou)
| | - Vasilios Papadopoulos
- Hepatogastroenterology Unit, 2 Department of Internal Medicine-Propaedeutics, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital (Paraskevas Gkolfakis, Georgios Tziatzios, Vasilios Papadopoulos, George D. Dimitriadis, Konstantinos Triantafyllou)
| | - George D Dimitriadis
- Hepatogastroenterology Unit, 2 Department of Internal Medicine-Propaedeutics, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital (Paraskevas Gkolfakis, Georgios Tziatzios, Vasilios Papadopoulos, George D. Dimitriadis, Konstantinos Triantafyllou)
| | - Sotirios D Georgopoulos
- GI and Hepatology Department, Athens Medical, Paleo Faliron Hospital (Sotirios D. Georgopoulos), Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2 Department of Internal Medicine-Propaedeutics, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital (Paraskevas Gkolfakis, Georgios Tziatzios, Vasilios Papadopoulos, George D. Dimitriadis, Konstantinos Triantafyllou)
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Short HL, Heiss KF, Wulkan ML, Raval MV. Clinical validity and relevance of accidental puncture or laceration as a patient safety indicator for children. J Pediatr Surg 2017; 52:172-176. [PMID: 27842957 DOI: 10.1016/j.jpedsurg.2016.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Accidental puncture or laceration (APL) has been endorsed as a patient safety indicator and is being used to compare hospital performance and for reimbursement. We sought to determine the positive predictive value (PPV) of APL as a quality metric in a pediatric population. METHODS We retrospectively reviewed all cases that met APL administrative criteria over 5years in a quaternary pediatric hospital system. Events were categorized as false positive (FP) or true positive (TP). TP cases were further categorized as "potentially consequential" or "inconsequential". The PPV of APL was calculated, and a z-test was used to provide 95% confidence intervals. RESULTS Of the 238 cases identified, 204 were categorized as TP (86%; 95% CI: 80%-90%). Thirty-four of these events (17%) involved injuries that were considered "inconsequential". True events that required repair were identified as "potentially consequential" (n=170). Thus, the PPV of APL was 71% (95% CI: 65%-77%). Extenuating factors such as adhesive disease or abnormal anatomy were present in 39% of TP cases. Thirty-four cases (14%) were categorized as FP because no documented injury was found. CONCLUSIONS A large proportion of APL events are either false or clinically irrelevant, thus questioning its usability as a patient safety indicator for children undergoing surgery. TYPE OF STUDY Retrospective review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Kurt F Heiss
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mark L Wulkan
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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Yao P, Hong T, Wang ZB, Ma JM, Zhu YQ, Li HX, Ding YY, Jiang CL, Pan SN. Treatment of bilateral idiopathic trigeminal neuralgia by radiofrequency thermocoagulation at different temperatures. Medicine (Baltimore) 2016; 95:e4274. [PMID: 27442662 PMCID: PMC5265779 DOI: 10.1097/md.0000000000004274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Radiofrequency thermocoagulation (RFT) is an effective treatment for trigeminal neuralgia, but consensus regarding an optimal treatment temperature is lacking. While treatment temperatures ranging from 60°C to 95°C have been reported, RFT at too high a temperature is often followed by serious complications, and comparative evaluations of RFT at different temperatures in a single study are rare.This current prospective cohort study was to compare immediate and long-term outcomes of RFT at varying temperatures in patients with bilateral idiopathic trigeminal neuralgia (ITN) of maxillary division of trigeminal nerve (V2), mandibular division of trigeminal nerve (V3), and V2+V3, including pain relief, complications, recurrence rate, and patient satisfaction. From May 2011 to April 2016, 62 consecutive patients with bilateral ITN of V2, V3, and V2+V3 were enrolled in the study. These patients underwent bilateral RFT at 68°C and 75°C, respectively, using the same RF parameters. Side-to-side results, including pain relief, complications, and patient satisfaction, were compared during a 5-year follow-up period.Overall pain relief was satisfactory after RFT. The rate of pain relief after treatment at 75°C was slightly higher than at 68°C (P > 0.05). The pain-free rate was 95.1% at 75°C and 93.5% at 68°C at 1 year, 84.3% and 78.1% at 3 years, and 80.7% and 74.4% at 5 years. There were 10 and 13 cases of recurrence, respectively, and 6 cases of bilateral recurrence. The incidence and severity of complications were greater at 75°C (P < 0.05) than at 68°C, and therefore the patient satisfaction at the higher temperature was lower (P < 0.05).Patients with bilateral ITN who underwent RFT at different temperatures had consistent pain relief after RFT at both 75°C and 68°C, but there were fewer and less severe complications at 68°C, which was accompanied by greater patient satisfaction. This suggests that RFT at lower temperatures may be preferable, and that a temperature of 68°C can be recommended.
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Affiliation(s)
- Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
- Correspondence: Peng Yao, Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang 110004, China (e-mail: )
| | - Tao Hong
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Zhi-bin Wang
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Jia-ming Ma
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Yong-qiang Zhu
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Hong-xi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Yuan-yuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang
| | - Chang-lin Jiang
- Department of Pain Management, Daqing Oilfield General Hospital, Daqing
| | - Shi-nong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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赖 雪, 汤 小, 黄 思, 龚 伟, 智 发, 刘 思, 陈 烨. [Risk factors of pain during colonoscopic examination]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:482-487. [PMID: 28446400 PMCID: PMC6744110 DOI: 10.3969/j.issn.1673-4254.2017.04.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the risk factorsthat predict pain during colonoscopy for decision of sedation or analgesia before the examination. METHODS A total of 283 consecutive patients undergoing colonoscopicexamination at Nanfang Hospital between July, 2016 and September, 2016were retrospectively analyzed. The clinical data and visual analogue scale after the examination were analyzed to identify the risk factors for pain during colonoscopy using univariate analysis and multivariate logistic regression. A risk stratification model for predicting pain in colonoscopy was established. RESULTS The completion rate of the procedure was significantly lower in patients with a visual analogue scale ≥5 (P<0.000). Univariate analysis showed that female patients, previous abdominal surgery, no previous experience with colonoscopy, complaint of abdominal pain before colonoscopy, insufficient experience of the endoscopists, patient's anticipation of high painlevelbefore examination, and a low body mass index (BMI) were all associated with the experience of pain in colonoscopy (P<0.05). Multivariate logistic regressionanalysis identified BMI index (X1), level of experience of the endoscopist (A1, A2, A3) and the patient's anticipation of painlevel (X2) as the risk factors of pain in colonoscopy(P<0.05), and the establishedmodel with the 3 variables was: P=eY/(1+eY),Y=0.049-0.124×X1-0.97×X2+1.713×A1+0.781×A2+0.147×A3, which showed a sensitivity of 70.3% and a specificity of 67.5%for predicting pain in colonoscopy. CONCLUSION The patient's anticipation of a high pain level in colonoscopy, insufficient experience of the endoscopist, and a low BMI are the independent risk factors for pain in colonoscopy, and evaluation of these factors can help in the decision-making concerning the use of sedation or analgesia before colonoscopy.
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Affiliation(s)
- 雪莹 赖
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 小伟 汤
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 思霖 黄
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 伟 龚
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 发朝 智
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 思德 刘
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 烨 陈
- />南方医科大学南方医院消化内科,广东 广州 510515Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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