Open access colonoscopy in the training setting: which factors affect patient satisfaction and pain?

BACKGROUND AND STUDY AIM

Patient satisfaction with colonoscopy is important for quality assurance; it may be affected by various factors, including patient characteristics, physician training level, and procedural or organizational features. We aimed to analyze how these factors influenced patient satisfaction and pain in an outpatient training setting.

METHODS

Consecutive patients for open access colonoscopy (OAC) were enrolled in a prospective, single-blinded, controlled study. Primary and secondary outcomes were satisfaction and pain scores with and without trainee participation. A multivariate analysis was designed to achieve an 80 % power with an alpha value of 0.05.

RESULTS

368 patients were enrolled. Satisfaction with the procedure was high (mean score 1.36; 1 = best to 5 = worst). In the multivariate analysis only waiting time in the endoscopy suite was significantly associated with lower satisfaction scores ( P = 0.024). Satisfaction was unaffected by patient factors (gender, American Society of Anesthesiologists' [ASA] score, anxiety, etc). Higher pain scores were associated with higher anxiety levels ( P = 0.02), female gender ( P = 0.02), longer procedure ( P< 0.001), and lower sedation levels ( P = 0.001); trainee involvement (49 % of procedures) did not adversely affect satisfaction or pain scores.

CONCLUSIONS

Patient satisfaction with OAC using sedation appears to depend primarily on organizational factors (waiting time beforehand). In contrast, pain is associated with patient characteristics (female gender, anxiety) and procedural factors (lower sedation, longer procedure). Trainee participation did not affect satisfaction or pain scores, a finding which may help to reassure patients undergoing OAC with trainee participation.

CXCR4 homologues of gibbon ape, African green monkey, squirrel monkey, and cotton-top marmoset

CXCR4 gene homologues were isolated from an ape (gibbon), an Old World monkey (African green monkey), and two New World monkeys (squirrel monkey and cotton-top marmoset), and their DNA sequences determined. The squirrel monkey and cotton-top marmoset CXCR4 sequences more closely resemble homologues from apes than Old World monkeys, a pattern not seen for the related chemokine receptor CCR5. The African green monkey CXCR4 gene is similar to its homologue in baboon, a pattern that has also been seen among CCR5 homologues. The gibbon CXCR4 contains the first polymorphisms recognized in ape homologues, the human and chimpanzee CXCR4 proteins being identical, and two of these three differences are also observed in one or more Old World monkey homologues. While 18 positions within CXCR4 are now known to be polymorphic in primates, 7 of these polymorphisms have been observed in multiple examples and 11 have been observed only once.

Low-voltage coagulation for welding sutures watertight: an experimental study

A rat model was developed to test the watertightness of sutures. In this model it was proved that welding by use of low-voltage coagulation current did not improve on the watertightness obtained with conventional skin suturing. The mean leak pressure after welding was about 4.2 cm H2O, i.e. statistically significantly lower than the mean leak pressure of the conventional suture, which is 14.1 cm H2O. Neither addition of protein solder nor an additional conventional suture improved these results. It is therefore concluded that low-voltage coagulation is unsuitable for welding tissues.

Effects of tapioca obtained from cassava (Manihot utilissima) on the disintegration and dissolution rates of paracetamol tablets

The properties of tapioca obtained from cassava (Manihot utilissima) have been evaluated. Its binding effect in tablets of paracetamol on the disintegration and dissolution rates was compared with tablets prepared with polyvinylpyrrolidone and gelatin. The nature and amount of the binders were found to alter the disintegration and dissolution rates of the tablets by reducing their wettability as measured by the adhesion tension of water. A linear relationship has been found to exist between the adhesion of water on the tablets and their disintegration and dissolution rates.

The effects of interacting variables on the tensile strength, disintegration and dissolution of paracetamol tablets

A factorially designed scheme has been used to analyse the separate and combined effects of packing fraction (P), nature of binder (N) and concentration of binder (C) on the tensile strength, disintegration and dissolution (t50%) times of paracetamol tablets. In general, P has the greatest effect on tensile strength, disintegration and dissolution times followed by C then N. For the variables in combination, the ranking of the effects on tensile strength, for the PVP/gelatin formulations, are P x N greater than N x C greater than P x C and for the PVP/tapioca formulations are P x C = N x C greater than P x N. For disintegration and for dissolution, the ranking for the PVP/gelatin formulations are P x C greater than P x N = N x C and P x N greater than P x C greater than N x C, respectively, and for the PVP/tapioca formulations are P x N greater than N x C = P x C. The results also show that tapioca acts as a binding agent when included in paracetamol tablet formulations, but it is a weaker binder than either PVP or gelatin. It is thus required in a higher concentration to produce tablets of comparable physical properties with those formulated with PVP or gelatin.