WorldWideScience

Sample records for incomplete colonoscopy prospective

  1. Enteroscope without overtube for cecal intubation after an incomplete colonoscopy.

    Science.gov (United States)

    Coppola, Franco; Gaia, Silvia; Cosimato, Maurizio; Recchia, Serafino

    2011-06-01

    Cecal intubation is one of the targets of colon endoscopic evaluation, however even under experienced hands 5-10% of colonoscopies are incomplete. The aim of the study is to evaluate the usefulness of single balloon enteroscope (SBE) without employing overtube-balloon equipment in patients with incomplete colonoscopy. Between January 2009 and July 2010, patients with an incomplete standard colonscopy were prospectively enrolled to perform a colonoscopy with a single balloon enteroscope. Examinations were performed by the same expert operator during the same session. Enteroscopy was performed on 79 patients, cecal intubation were obtained in 93.6% of the cases (74/79). It provided a new diagnosis in 43% of cases (34/79). Procedure was safe and well tolerated. Overall the additional use of single balloon enteroscope allowed to obtain the cecal intubation in up to 99.2% cases (898/905). The use of the enteroscope without overtube-balloon equipment may be an effective method to increase the cecal intubation rate after failure of a standard colonoscopy. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  2. Predictors of incomplete optical colonoscopy using computed tomographic colonography

    Directory of Open Access Journals (Sweden)

    Reetika Sachdeva

    2016-01-01

    Full Text Available Background/Aims: Optical colonoscopy (OC is the primary modality for investigation of colonic pathology. Although there is data on demographic factors for incomplete OC, paucity of data exists for anatomic variables that are associated with an incomplete OC. These anatomic variables can be visualized using computed tomographic colonography (CTC. We aim to retrospectively identify variables associated with incomplete OC using CTC and develop a scoring method to predict the outcome of OC. Patients and Methods: In this case-control study, 70 cases ( with incomplete OC and 70 controls (with complete OC were identified. CTC images of cases and controls were independently reviewed by a single CTC radiologist. Demographic and anatomical parameters were recorded. Data was examined using descriptive linear statistics and multivariate logistic regression model. Results: On analysis, female gender (80% vs 58.6% P = 0.007, prior abdominal/pelvic surgeries (51.4% vs 14.3% P < 0.001, colonic length (187.6 ± 30.0 cm vs 163.8 ± 27.2 cm P < 0.001, and number of flexures (11.4 ± 3.1 vs 8.4 ± 2.9 P < 0.001 increased the risk for incomplete OC. No significant association was observed for increasing age (P = 0.881 and history of severe diverticulosis (P = 0.867 with incomplete OC. A scoring system to predict the outcome of OC is proposed based on CTC findings. Conclusion: Female gender, prior surgery, and increasing colonic length and tortuosity were associated with incomplete OC, whereas increasing age and history of severe diverticulosis were not. These factors may be used in the future to predict those patients who are at risk of incomplete OC.

  3. Colonic work-up after incomplete colonoscopy: significant new findings during follow-up

    NARCIS (Netherlands)

    M. Neerincx; J.S. Terhaar sive Droste; C.J. Mulder; M. Räkers; J.F. Bartelsman; R.J. Loffeld; H.A. Tuynman; R.M. Brohet; R.W. van der Hulst

    2010-01-01

    Background and study aims: Cecal intubation is not achieved in 2-23% of colonoscopies. The efforts made by physicians to visualize the remaining colon and the number of missed significant lesions are unknown. This study evaluates 1) the reasons for incomplete colonoscopy, 2) the rates of complete co

  4. CT colonography with reduced bowel preparation after incomplete colonoscopy in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Iafrate, F.; Stagnitti, A. [University of Rome, Department of Radiological Sciences, Rome (Italy); Hassan, C.; Zullo, A. [Hospital-Rome, Gastroenterology and Digestive Endoscopy Unit, Rome (Italy); Spagnuolo, A. [Univeristy of Rome, I.C.O.T, Department of Radiological Sciences, Latina (Italy); Ferrari, R.; Laghi, A.

    2008-07-15

    We prospectively assessed the feasibility and acceptance of computerized tomographic colonography (CTC) without bowel cathartic preparation in elderly patients after incomplete colonoscopy. A total of 136 patients underwent CTC without cathartic preparation. The time delay between conventional colonoscopy and CTC ranged between 3 and 20 days, depending on the clinical situation. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. CTCs were interpreted using a primary two-dimensional (2D) approach and 3D images for further characterization. Patients were interviewed before and 2 weeks after CTC to assess preparation acceptance. CTC was feasible and technically successful in all the 136 patients. Fecal tagging was judged as excellent in 113 (83%) patients and sufficient in 23 (17%). Average CT image interpretation time was 14.8 min. Six (4.4%) cases of colorectal cancer and nine (6.6%) large polyps were detected, as well as 23 (11.3%) extracolonic findings of high clinical importance. No major side effect occurred, although 25% patients reported minor side effects, especially diarrhea. Overall, 76/98 patients replied that they would be willing to repeat the test if necessary. CTC without cathartic preparation is a technically feasible and safe procedure to complete a colonic study in the elderly, prompting its use in clinical practice. (orig.)

  5. Colonoscopy

    Science.gov (United States)

    ... that their insurance will cover. Read more about colon cancer at www. cancer. gov. 2 Colonoscopy 1 Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for ...

  6. Colonoscopy

    Science.gov (United States)

    ... be treated with rest, fluids, antibiotics, and close observation. Bleeding is reported in 0 to 6 of ... al. Complication rates of colonoscopy in an Australian teaching hospital environment. Internal Medical Journal . 2003;33:355- ...

  7. Quality of bowel cleansing in hospitalized patients undergoing colonoscopy: A multicentre prospective regional study.

    Science.gov (United States)

    Rotondano, Gianluca; Rispo, Antonio; Bottiglieri, Maria E; De Luca, Leonardo; Lamanda, Roberto; Orsini, Luigi; Bruzzese, Dario; Galloro, Giuseppe; Romano, Marco; Miranda, Agnese; Loguercio, Carmelina; Esposito, Pasquale; Nardone, Gerardo; Compare, Debora; Magno, Luca; Ruggiero, Simona; Imperatore, Nicola; De Palma, Giovanni D; Gennarelli, Nicola; Cuomo, Rosario; Passananti, Valentina; Cirillo, Michele; Cattaneo, Domenico; Bozzi, Rosa Maria; D'Angelo, Valentina; Marone, Piero; Riccio, Elisabetta; De Nucci, Claudio; Monastra, Santo; Caravelli, Giancarlo; Verde, Clelia; Di Giorgio, Pietro; Giannattasio, Francesco; Capece, Giuseppe; Taranto, Domenico; De Seta, Massimiliano; Spinosa, Giuseppe; De Stefano, Salvatore; Familiari, Valeria; Cipolletta, Livio; Bianco, Maria Antonia; Sansone, Stefano; Galasso, Giovanni; De Colibus, Patrizia; Romano, Maurizio; Borgheresi, Patrizia; Ricco, Giovanni; Martorano, Marco; Gravina, Antonietta Gerarda; Marmo, Riccardo; Rea, Matilde; Maurano, Attilio; Labianca, Orazio; Colantuoni, Enrico; Iuliano, Donato; Trovato, Claudio; Fontana, Aldo; Pasquale, Luigi; Morante, Aristide; Perugini, Bruno; Scaglione, Giuseppe; Mauro, Biagio

    2015-08-01

    Quality of bowel cleansing in hospitalized patients undergoing colonoscopy is often unsatisfactory. No study has investigated the inpatient or outpatient setting as cause of inadequate cleansing. To assess degree of bowel cleansing in inpatients and outpatients and to identify possible predictors of poor bowel preparation in the two populations. Prospective multicentre study on consecutive colonoscopies in 25 regional endoscopy units. Univariate and multivariate analysis with odds ratio estimation were performed. Data from 3276 colonoscopies were analyzed (2178 outpatients, 1098 inpatients). Incomplete colonoscopy due to inadequate cleansing was recorded in 369 patients (11.2%). There was no significant difference in bowel cleansing rates between in- and outpatients in both colonic segments. In the overall population, independent predictors of inadequate cleansing both at the level of right and left colon were: male gender (odds ratio, 1.20 [1.02-1.43] and 1.27 [1.05-1.53]), diabetes mellitus (odds ratio, 2.35 [1.68-3.29] and 2.12 [1.47-3.05]), chronic constipation (odds ratio, 1.60 [1.30-1.97] and 1.55 [1.23-1.94]), incomplete purge intake (odds ratio, 2.36 [1.90-2.94] and 2.11 [1.68-2.65]) and a runway time >12h (odds ratio, 3.36 [2.40-4.72] and 2.53 [1.74-3.67]). We found no difference in the rate of inadequate bowel preparation between hospitalized patients and outpatients. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  8. Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients

    Directory of Open Access Journals (Sweden)

    Kaan Meric

    2015-01-01

    Full Text Available Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n=56 and 4-day diet group (n=45. Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring 0.05. The prevalence of moderate discomfort was significantly higher in 4-day group (P<0.001. Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients.

  9. Prevalence of organic colonic lesions in patients meeting Rome III criteria for diagnosis of IBS: a prospective multi-center study utilizing colonoscopy.

    Science.gov (United States)

    Ishihara, Shunji; Yashima, Kazuo; Kushiyama, Yoshinori; Izumi, Akio; Kawashima, Kousaku; Fujishiro, Hirofumi; Kojo, Haruhiko; Komazawa, Yoshinori; Hamamoto, Tetsuro; Yamamoto, Tetsuo; Sasaki, Yuichiro; Shimizu, Tatsunori; Okamoto, Eiji; Yoshimura, Teiji; Furuta, Koichiro; Noguchi, Naoya; Tanaka, Hisao; Murawaki, Yoshikazu; Kinoshita, Yoshikazu

    2012-10-01

    It remains unknown whether the Rome III criteria can exclude organic colonic lesions prior to the diagnosis of irritable bowel syndrome (IBS). We evaluated the colonoscopy results of patients meeting the Rome III criteria for the diagnosis of IBS to determine the presence of organic colonic lesions. This study was prospectively conducted at 17 centers in Japan. We enrolled 4528 patients who underwent diagnostic colonoscopy examinations. The diagnosis of IBS was evaluated by questionnaire results according to the Rome III criteria. We evaluated 4178 patients (350 were excluded because of incomplete data or previous colonic surgery), of whom 203 met the Rome III criteria (mean age 57.9 years; range 14-87 years) prior to the diagnostic colonoscopy examination. We identified organic colonic diseases in 21 of these 203 patients (10.3 %) , and these disease were also identified in 338 (8.5 %) of 3975 patients who did not fulfill the Rome III criteria. There were no differences in regard to the prevalence of organic colonic diseases between patients who did and did not fulfill the Rome III criteria. The prevalence of organic colonic diseases in patients who met the Rome III criteria was at an acceptably low level, indicating that the Rome III criteria are adequately specific for the diagnosis of IBS without performing a colonoscopy examination.

  10. Carbon Dioxide Insufflation in Colonoscopy Is Safe: A Prospective Trial of 347 Patients

    Directory of Open Access Journals (Sweden)

    M. Geyer

    2012-01-01

    Full Text Available Available evidence suggests that the use of CO2 insufflation in endoscopy is more comfortable for the patient. The safety of CO2 use in colonoscopy remains contentious, particularly in sedated patients. The objective of the present prospective trial was to assess the safety of CO2 colonoscopies. Methods. 109 patients from our previous randomized CO2 colonoscopy study and an additional 238 subsequent consecutive unselected patients who had a routine colonoscopy performed in a private practice were enrolled from April 2008 through September 2008. All but 2 patients were sedated. All patients were routinely monitored with transcutaneous CO2 measurement. Volumes of CO2 administered were correlated with capnographic measurements from transcutaneous monitoring. Results. Of the 347 patients examined, 57% were women; mean (SD age of participants was of 60.2 years (12.8. Mean propofol dosage was 136 mg (64 mg. Mean CO2 values were 34.7 mm Hg (5.3 at baseline, 38.9 mm Hg (5.5 upon reaching the ileum, and 36.9 mm Hg (5.0 at examination's end. Mean maximum increase of CO2 was 4.5 mm Hg (3.6. No correlation was observed between volume of CO2 administered and increase in level of CO2 (correlation coefficient: 0.01; P value: 0.84. No complications were observed. Conclusions. The present prospective study, which was based on one of the largest sedated patient sample reported to date in this setting, provides compelling evidence that CO2 insufflation in colonoscopy is safe and unassociated with relevant increases in transcutaneously measured levels of CO2.

  11. Manual versus target-controlled infusion of balanced propofol during diagnostic colonoscopy: A prospective randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vučićević Vera

    2016-01-01

    Full Text Available Introduction. There is an increasing interest in balanced propofol sedation (BPS for colonoscopy in outpatient settings. Propofol is a potent anesthetic agent for this purpose and has a narrow therapeutic range, which increases a risk of cardiovascular and respiratory complications in case of improper administration. Objective. The aim of this study was to compare patients’ safety and comfort of endoscopists in two methods of BPS targeting deep sedation - propofol target-controlled infusion (TCI and manual intravenous titration technique (MT - during colonoscopy. Methods. This prospective randomized controlled trial included 90 patients (class I or II of the American Society of Anesthesiologists deeply sedated with propofol, coadministered with small doses of midazolam and fentanyl. Propofol was given by MT technique (45 patients or by TCI (45 patients. The following adverse effects were recorded: hypotension, hypertension, bradycardia, tachycardia, hypoxemia, bradypnea, apnea, hiccupping, and coughing, as well as endoscopist’s comfort during colonoscopy by means of a questionnaire. Results. The MT group compared to the TCI group had a lower mean arterial pressure in the 10th minute after the beginning (p = 0.017, and at the end of colonoscopy (p = 0.006, higher oxygen saturation in the fifth minute (p = 0.033, and in the 15th minute (p = 0.008 after the beginning of colonoscopy, and lower heart rate at the beginning of the procedure (p = 0.001. There were no statistically significant differences in adverse events. Endoscopist’s comfort during colonoscopy was high 95.6% in the TCI group vs. 88.9% in the MT group (p = 0.069. Conclusion. MT is clinically as stable as TCI of propofol for deep sedation during colonoscopy, and endoscopists experienced the same comfort during colonoscopy in both groups. Thus, both combinations are suitable for deep sedation during diagnostic colonoscopy.

  12. CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation

    Energy Technology Data Exchange (ETDEWEB)

    Jensch, Sebastiaan [University of Amsterdam, Department of Radiology, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Bipat, Shandra; Vries, Ayso H. de; Heutinck, Anneke; Stoker, Jaap [University of Amsterdam, Department of Radiology, Amsterdam (Netherlands); Peringa, Jan; Montauban van Swijndregt, Alexander D. [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Dekker, Evelien [University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam (Netherlands); Baak, Lubbertus C. [Onze Lieve Vrouwe Gasthuis, Department of Gastroenterology, Amsterdam (Netherlands)

    2010-01-15

    The purpose of this study was to prospectively compare participant experience and preference of limited preparation computed tomography colonography (CTC) with full-preparation colonoscopy in a consecutive series of patients at increased risk of colorectal cancer. CTC preparation comprised 180 ml diatrizoate meglumine, 80 ml barium and 30 mg bisacodyl. For the colonoscopy preparation 4 l of polyethylene glycol solution was used. Participants' experience and preference were compared using the Wilcoxon signed rank test and the chi-squared test, respectively. Associations between preference and experience parameters for the 173 participants were determined by logistic regression. Diarrhoea occurred in 94% of participants during CTC preparation. This side effect was perceived as severely or extremely burdensome by 29%. Nonetheless, the total burden was significantly lower for the CTC preparation than for colonoscopy (9% rated the CTC preparation as severely or extremely burdensome compared with 59% for colonoscopy; p<0.001). Participants experienced significantly more pain, discomfort and total burden with the colonoscopy procedure than with CTC (p<0.001). After 5 weeks, 69% preferred CTC, 8% were indifferent and 23% preferred colonoscopy (p<0.001). A burdensome colonoscopy preparation and pain at colonoscopy were associated with CTC preference (p<0.04). In conclusion, participants' experience and preference were rated in favour of CTC with limited bowel preparation compared with full-preparation colonoscopy. (orig.)

  13. A prospective cohort study evaluating a novel colonoscopy platform featuring full-spectrum endoscopy

    NARCIS (Netherlands)

    Gralnek, Ian Mark; Segol, Ori; Suissa, Alain; Siersema, Peter D.; Carr-Locke, David L.; Halpern, Zamir; Santo, Erwin; Domanov, Svetlana

    2013-01-01

    Background and study aims: Although colonoscopy is the criterion standard for detecting colorectal adenomas and cancers, a significant percentage of adenomas are missed with this technique. We aimed to establish the feasibility, usability, and safety of a novel colonoscopy platform featuring full-sp

  14. Patient Satisfaction With Propofol for Outpatient Colonoscopy: A Prospective, Randomized, Double-Blind Study.

    Science.gov (United States)

    Padmanabhan, Anantha; Frangopoulos, Christoforos; Shaffer, Lynn E T

    2017-10-01

    Previous literature has shown that propofol has ideal anesthetic properties for patients undergoing colonoscopy, a common procedure at outpatient surgery centers. However, there is a paucity of information regarding patient satisfaction with propofol. The aim of this study was to evaluate patient satisfaction with propofol compared with nonpropofol (fentanyl/midazolam) anesthesia for outpatient colonoscopies. Safety and complications were secondary end points. This study was a double-blind, randomized, parallel-group controlled clinical trial (NCT 02937506). This study was conducted at a single ambulatory surgery center at an urban teaching community health system. Patients were scheduled for outpatient colonoscopy. Those with high-risk cardiac or pulmonary disease were excluded. Anesthesia personnel administered either fentanyl/midazolam (n = 300) or propofol (n = 300) for sedation during outpatient colonoscopy. A single, highly experienced endoscopist performed all colonoscopies. The primary outcomes measured were patient satisfaction (5-point Likert scale) and procedure complications. Data were collected on the day of endoscopy by the nursing staff of the postanesthesia care unit. A subinvestigator blinded to the randomization called patients 24 to 72 hours after discharge to obtain data on postprocedure problems and status of resumption of normal activities. Analysis was intention-to-treat. Fewer patients who received propofol remembered being awake during the procedure (2% vs 17% for fentanyl, p propofol (p propofol group (2.7% vs 11.7%, p propofol over a combination of fentanyl/midazolam as their anesthetic for outpatient colonoscopies. From a patient and provider perspective, propofol appears to be superior to fentanyl/midazolam for outpatient colonoscopy. See Video Abstract at http://links.lww.com/DCR/A445.

  15. Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey.

    Directory of Open Access Journals (Sweden)

    Maximilien Barret

    Full Text Available INTRODUCTION: Colonoscopy can prevent deaths due to colorectal cancer (CRC through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France. METHODS: An online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR or the diagnosis of polyps or cancer were assessed. RESULTS: A total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122 procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001, age over 50 (p=0.0001, personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively, and positive fecal occult blood test (p=0.0005. The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001. CONCLUSIONS: For the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.

  16. Virtual colonoscopy

    Science.gov (United States)

    Colonoscopy - virtual; CT colonography; Computed tomographic colonography; Colography - virtual ... Differences between virtual and conventional colonoscopy include: VC can view the colon from many different angles. This is not as easy ...

  17. High dose Senna or Poly Ethylene Glycol (PEG for elective colonoscopy preparation: a prospective randomized investigator-blinded clinical trial

    Directory of Open Access Journals (Sweden)

    Ahmad Shavakhi

    2011-01-01

    Full Text Available Background: The aim of this study was to determine the efficacy of two methods of colon preparation for colon cleansing in a randomized controlled trial. Methods: In this prospective randomized investigator-blinded trial, consecutive outpatients indicated for elective colonoscopy were randomized into two groups. Patients in Senna group took 24 tablets of 11 mg Senna in two divided doses 24 hour before colonoscopy. In Poly Ethylene Glycol (PEG group they solved 4 sachets in 4 liters of water the day before the procedure and were asked to drink 250 ml every 15 minutes. The overall quality of colon cleansing was evaluated using the Aronchick scoring scale. Difficulty of the procedure, patients′ tolerance and compliance and adverse events were also evaluated. Results: 322 patients were enrolled in the study. There was no significant difference in the quality of colon cleansing, patients′ tolerance, compliance and the difficulty of the procedure between two groups (p > 0.05. The incidence of adverse effects was similar between two groups except for abdominal pain that was more severe in Senna group (p < 0.05 and nausea and vomiting that was more common in PEG group (p < 0.05 Conclusions: In conclusion we deduce that Senna has the same efficacy and patient′s acceptance as Polyethylene glycol-electrolyte solution (PEG-ES and it could be prescribed as an alternative method for bowel preparation.

  18. CT colonography with limited bowel preparation: prospective assessment of patient experience and preference in comparison to optical colonoscopy with cathartic bowel preparation

    NARCIS (Netherlands)

    S. Jensch; S. Bipat; J. Peringa; A.H. de Vries; A. Heutinck; E. Dekker; L.C. Baak; A.D. Montauban van Swijndregt; J. Stoker

    2010-01-01

    The purpose of this study was to prospectively compare participant experience and preference of limited preparation computed tomography colonography (CTC) with full-preparation colonoscopy in a consecutive series of patients at increased risk of colorectal cancer. CTC preparation comprised 180 ml di

  19. The completeness rate of colonoscopy in a cohort of unsedated patients

    Directory of Open Access Journals (Sweden)

    Aljebreen Abdulrahman

    2004-01-01

    Full Text Available Background: Colonoscopy is considered a painful procedure requiring routine intravenous sedation, however there are number of potential advantages to performing colonoscopy without sedation. The aim of this study was to determine the effect of unsedated colonoscopy on the success rate of caecal intubation. Patients and methods: All charts of patients who had unsedated colonoscopy from January 2002 to September 2003 were reviewed. Patient characteristics including age, gender, and mode of presentation were collected. The success rate of unsedated colonoscopy was compared with the standard success rate of sedated colonoscopy in the literature. The reasons for incomplete colonoscopy and sites reached were recorded. Results: During the study period, 503 examinations were performed. Patients mean age was 48.5 years, 55.9 % of them were males. Colonic polyps were the predominant abnormal endoscopic finding; occurring in 21.3%. The completion rate in the study population excluding patients with obstructive disease and patients with inadequate preparation was only 67%. Conclusion: In this cohort studiy, sedation probably affects the overall success rate of cecal intubation. A large prospective randomized study comparing sedated with unsedated colonoscopy in terms of completion rate and patient satisfaction is needed

  20. Prospective randomized comparison of oral sodium phosphate and polyethylene glycol lavage for colonoscopy preparation

    Institute of Scientific and Technical Information of China (English)

    Kai-Lin Hwang; William Tzu-Liang Chen; Koung-Hong Hsiao; Hong-Chang Chen; Ting-Ming Huang; Chien-Ming Chiu; Ger-Haur Hsu

    2005-01-01

    AIM: To compare the effectiveness, patient acceptability, and physical tolerability of two oral lavage solutions prior to colonoscopy in a Taiwanese population. METHODS: Eighty consecutive patients were randomized to receive either standard 4 L of polyethylene glycol (PEG) or 90 mL of sodium phosphate (NaP) in a split regimen of two 45 mL doses separated by 12 h, prior to colonoscopic evaluation. The primary endpoint was the percent of subjects who had completed the preparation. Secondary endpoints included colonic cleansing evaluated with an overall assessment and segmental evaluation, the tolerance and acceptability assessed by a selfadministered structured questionnaire, and a safety profile such as any unexpected adverse events, electrolyte tests, physical exams, vital signs, and body weights. RESULTS: A significantly higher completion rate was found in the NaP group compared to the PEG group(84.2% vs 27.5%, P<0.001). The amount of fluid suctioned was significantly less in patients taking NaP vs PEG (50.13±54.8 cc vs 121.13±115.4 cc, P<0.001),even after controlling for completion of the oral solution(P = 0.031). The two groups showed a comparable overall assessment of bowel preparation with a rate of "good" or "excellent" in 78.9% of patients in the NaPgroup and 82.5% in PEG group (P = 0.778). Patients taking NaP tended to have significantly better colonic segmental cleansing relative to stool amount observedin the descending (94.7% vs 70%, P = 0.007) andtransverse (94.6% vs 74.4%, P = 0.025) colon. Slightly more patients graded the taste of NaP as "good" or "very good" compared to the PEG patients (32.5% vs 12.5%;P = 0.059). Patients' willingness to take the same preparation in the future was 68.4% in the NaP compared to 75% in the PEG group (P = 0.617). There was a significant increase in serum sodium and a significant decrease in phosphate and chloride levels in NaP group on the day following the colonoscopy without any clinical sequelae. Prolonged (

  1. Women awaken faster than men after electroencephalogram-monitored propofol sedation for colonoscopy: A prospective observational study.

    Science.gov (United States)

    Riphaus, Andrea; Slottje, Mark; Bulla, Jan; Keil, Carolin; Mentzel, Christian; Limbach, Vera; Schultz, Barbara; Unzicker, Christian

    2017-10-01

    Sedation for colonoscopy using intravenous propofol has become standard in many Western countries. Gender-specific differences have been shown for general anaesthesia in dentistry, but no such data existed for gastrointestinal endoscopy. A prospective observational study. An academic teaching hospital of Hannover Medical School. A total of 219 patients (108 women and 111 men) scheduled for colonoscopy. Propofol sedation using electroencephalogram monitoring during a constant level of sedation depth (D0 to D2) performed by trained nurses or physicians after a body-weight-adjusted loading dose. The primary end-point was the presence of gender-specific differences in awakening time (time from end of sedation to eye-opening and complete orientation); secondary outcome parameters analysed were total dose of propofol, sedation-associated complications (bradycardia, hypotension, hypoxaemia and apnoea), patient cooperation and patient satisfaction. Multivariate analysis was performed to correct confounding factors such as age and BMI. Women awakened significantly faster than men, with a time to eye-opening of 7.3 ± 3.7 versus 8.4 ± 3.4 min (P = 0.005) and time until complete orientation of 9.1 ± 3.9 versus 10.4 ± 13.7 min (P = 0.008). The propofol dosage was not significantly different, with some trend towards more propofol per kg body weight in women (3.98 ± 1.81 mg versus 3.72 ± 1.75 mg, P = 0.232). The effect of gender aspects should be considered when propofol is used as sedation for gastrointestinal endoscopy. That includes adequate dosing for women as well as caution regarding potential overdosing of male patients. ClinicalTrials.gov (Identifier: NCT02687568).

  2. Virtual colonoscopy.

    Science.gov (United States)

    Vining, D J

    1997-04-01

    A new method for colon examination, virtual colonoscopy, has been created by combining spiral computed tomography and virtual reality computer technology. If virtual colonoscopy proves equal to or superior to traditional colonoscopy in sensitivity and specificity for cancer screening, it would yield significant clinical and public health benefits because of its potential for increased acceptance among patients as well as its considerably lower cost and risks.

  3. Incomplete functional recovery after delirium in elderly people: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Freter Susan H

    2005-03-01

    Full Text Available Abstract Background Delirium often has a poor outcome, but why some people have incomplete recovery is not well understood. Our objective was to identify factors associated with short-term (by discharge and long-term (by 6 month incomplete recovery of function following delirium. Methods In a prospective cohort study of elderly patients with delirium seen by geriatric medicine services, function was assessed at baseline, at hospital discharge and at six months. Results Of 77 patients, vital and functional status at 6 months was known for 71, of whom 21 (30% had died. Incomplete functional recovery, defined as ≥10 point decline in the Barthel Index, compared to pre-morbid status, was present in 27 (54% of the 50 survivors. Factors associated with death or loss of function at hospital discharge were frailty, absence of agitation (hypoactive delirium, a cardiac cause and poor recognition of delirium by the treating service. Frailty, causes other than medications, and poor recognition of delirium by the treating service were associated with death or poor functional recovery at 6 months. Conclusion Pre-existing frailty, cardiac cause of delirium, and poor early recognition by treating physicians are associated with worse outcomes. Many physicians view the adverse outcomes of delirium as intractable. While in some measure this might be true, more skilled care is a potential remedy within their grasp.

  4. CT colonography versus colonoscopy in the follow-up of patients after diverticulitis - A prospective, comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Hjern, F. [Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm (Sweden)]. E-mail: fredrik.hjern@ds.se; Jonas, E. [Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm (Sweden); Holmstroem, B. [Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm (Sweden); Josephson, T. [Division of Radiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm (Sweden); Mellgren, A. [Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm (Sweden); Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota (United States); Johansson, C. [Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institut, Stockholm (Sweden)

    2007-07-15

    Aim: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. Material and methods: Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. Results: Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good ({kappa} = 0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p < 0.03), more painful (p < 0.001), and more difficult (p < 0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC. Conclusion: CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease.

  5. Prevalence of colorectal cancer and its precursor lesions in symptomatic and asymptomatic patients undergoing total colonoscopy: results of a large prospective, multicenter, controlled endoscopy study.

    Science.gov (United States)

    Blumenstein, Irina; Tacke, Wolfgang; Bock, Herbert; Filmann, Natalie; Lieber, Elena; Zeuzem, Stefan; Trojan, Jörg; Herrmann, Eva; Schröder, Oliver

    2013-05-01

    Colorectal cancer (CRC) is the second most common cancer in Germany. Screening colonoscopies have been offered in Germany since 2002. However, validation of screening programs for CRC relies on estimates up to date. The aim of this study was to analyze the influence of the risk factor tumor-suspicious symptoms on the prevalence of CRC and its precursor lesions in patients at least 55 years of age undergoing colonoscopy in comparison with an age-matched and sex-matched control population undergoing screening colonoscopy. Multicenter, prospective, controlled colonoscopy study. Integrated care program of 49 gastroenterological practices in collaboration with a health insurance company and the screening colonoscopy program in Hesse, Germany. In total, 1075 symptomatic and 5375 asymptomatic participants were matched for age and sex (1 : 5) from 1 October 2008 to 30 September 2010. Detection of CRC and its precursor lesions. Overall, the prevalence of CRC was significantly equivalent in both the symptomatic (n=13/1075, 1.21%) and the control group [n=55/5375, 1.02%, 95% confidence interval (CI) for the difference: [-0.46%, 0.83%], P=0.0002, equivalence test with δ=1.5%], respectively. Advanced adenomas were observed in significantly fewer symptomatic patients (61/1075, 5.67%) compared with 432/5375 matched asymptomatic screening participants (8.03%, 95% CI for the difference: [-3.98%, -0.74%], P=0.0094, difference test). Finally, polyps were found significantly less often in symptomatic patients (n=269/1075, 25.0%) than in matched screening participants (n=1807/5375, 33.6%, 95% CI for the difference: [-11.53%, -5.66%], P<0.0001, difference test). The results underline the importance of screening the symptom-free population at least 55 years of age to prevent CRC.

  6. The Value of CT in Diagnosing Synchronous Colorectal Cancers Cases with Incomplete Colonoscopy%CT对结肠镜检查失败的同时多发大肠癌的诊断价值

    Institute of Scientific and Technical Information of China (English)

    程家乐; 彭佳远; 汪昱

    2013-01-01

    目的 评估CT在结肠镜检查不完全的同时多发大肠癌(SCRCs)中的诊断价值.方法 选取2002年1月至2011年8月期间在上海市第六人民医院行手术治疗大肠癌患者2123例的临床资料进行回顾性分析,根据是否完整地做完结肠镜检查分为完全组和不完全组.通过比较CT和病理结果 来计算CT诊断的灵敏度和特异度,并进一步分析影响CT结果 的因素.结果 CT确诊和漏诊的SCRCs患者分别为56例和36例.CT诊断的灵敏度和特异度不完全组分别为44.8%和93.6%;完全组分别为68.3%和97.0%.癌灶过小和癌灶毗邻是导致CT漏诊SCRCs的风险因子.结论 尽管CT简便易行,在诊断结肠镜检查失败的SCRCs中,其敏感性不高.当影响CT诊断的风险因素存在时,CT检查阴性的患者,应当做进一步检查,并密切随访.%Objective To assess the value of CT in diagnosing synchronous colorectal cancers( SCRCs ) cases with incomplete colonoscopy. Methods 2123 colorectal cancer patients admitted to the Sixth People's Hospital of Shanghai City from Jan. 2002 to Aug. 2011 treated by operation, were analyzed retrospectively in this research. The patients were divided into two groups according to whether complete colonoscopy was achieved, the complete group and the incomplete group. Then, CT results and final histological findings were compared to calculate the sensitivity and specificity. Factors affecting the detection of CT were further analyzed. Results Totally, 56 cases of SCRCs were identified by CT and 36 were missed. In the incomplete group,the sensitivity and specificity was 44.8% and 93.6% ,respectively,while the corresponding number of the complete group was 68.3% and 97.0% respectively. Small size of the tumors and foci adjacency of SCRCs were the risk factors causing the missed diagnosis. Methods Despite of the feasibility, CT had limited sensitivity in detecting SCRCs in patients with incomplete colonoscopy. Patients with negative CT results

  7. Clinical and Molecular Characteristics of Post-Colonoscopy Colorectal Cancer

    DEFF Research Database (Denmark)

    Stoffel, Elena M; Erichsen, Rune; Frøslev, Trine;

    2016-01-01

    BACKGROUND AND AIMS: Colonoscopy provides incomplete protection from colorectal cancer (CRC), but determinants of post-colonoscopy CRC are not well understood. We compared clinical features and molecular characteristics of CRCs diagnosed at different time intervals after a previous colonoscopy....... METHODS: We performed a population-based, cross-sectional study of incident CRC cases in Denmark (2007-2011), categorized as post-colonoscopy or detected during diagnostic colonoscopy (in patients with no prior colonoscopy). We compared prevalence of proximal location and DNA mismatch repair deficiency (d...

  8. The usefulness of a magnetic endoscope locating device in colonoscopy in daily practice: a prospective case-controlled study

    DEFF Research Database (Denmark)

    Jess, Per; Bulut, Orhan; Almasi, Ahmad

    2009-01-01

    BACKGROUND: This study aimed to investigate the effects of magnetic endoscope imaging (MEI) regarding examination time, caecal intubation rate, and sedation and analgesic requirements during routine colonoscopy compared with earlier used X-ray imaging. METHODS: Consecutive outpatients undergoing ...... 50 microg phentanyle and 2 mg midazolam in both groups). Median X-ray dose was 150 cGy in the group using X-ray imaging. CONCLUSION: MEI is the imaging methodology of choice and should always be available in colonoscopy, especially for precise locating of colonic lesions....

  9. High prevalence of advanced colorectal neoplasia in the Thai population: a prospective screening colonoscopy of 1,404 cases.

    Science.gov (United States)

    Siripongpreeda, Bunchorn; Mahidol, Chulabhorn; Dusitanond, Navara; Sriprayoon, Tassanee; Muyphuag, Bunlung; Sricharunrat, Thaniya; Teerayatanakul, Narongchai; Chaiwong, Watanya; Worasawate, Wipra; Sattayarungsee, Prassanee; Sangthongdee, Juthamas; Prarom, Jirapa; Sornsamdang, Gaidganok; Soonklang, Kamonwan; Wittayasak, Kasiruck; Auewarakul, Chirayu U

    2016-08-23

    Increasing morbidity and mortality from colorectal cancer is evident in recent years in the developing Asian nations. Particularly in Thailand and most neighbouring low-income countries, screening colonoscopy is not yet recommended nor implemented at the national policy level. Screening colonoscopy was offered to 1,500 healthy volunteers aged 50-65 years old who were registered into the program between July 2009 and June 2010. Biopsy and surgery was performed depending on the identified lesions. Fecal immunochemical tests (FIT) were additionally performed for comparison with colonoscopy. There were 1,404 participants who underwent colonoscopy. The mean age of the cohort was 56.9 ± 4.2 years and 69.4 % were females. About 30 % (411 cases) of all colonoscopies had abnormal colonoscopic findings, and of these, 256 cases had adenomatous polyps. High risk adenomas (villous or tubulovillous or high grade dysplasia or size > 1 cm or > 3 adenomatous polyps) were found in 98 cases (7 %), low risk adenoma in 158 cases (11.3 %), and hyperplastic polyps in 119 cases (8.5 %). Eighteen cases (1.3 %) had colorectal cancer and 90 % of them (16 cases) were non-metastatic including five stage 0 cases, seven stage I cases, and four stage IIA cases. Only two cases had metastasis: one to regional lymph nodes (stage IIIB) and another to other organs (stage IVA). The most common cancer site was the distal intestine including rectum (7 cases, 38.9 %) and sigmoid colon (7 cases, 38.9 %). Ten colorectal cancer cases had positive FIT whereas 8 colorectal cancer cases were FIT-negative. The sensitivity and specificity of FIT was 55.6 % and 96.2 %, respectively, while the positive predictive value was 16.4 % and negative predictive value was 99.4 %. The overall survival of colorectal cancer cases at 5-year was 83.3 %. High prevalence of colorectal cancer and high-risk adenoma was found in the Thai population aged 50-65 years old by screening colonoscopy. FIT was

  10. COLONOSCOPY AND CARCINOEMBRYONIC ANTIGEN VARIATIONS

    Directory of Open Access Journals (Sweden)

    Rita G SOUSA

    2014-03-01

    Full Text Available Context Colonoscopy is essential for synchronous and metachronous cancer detection. Carcinoembryonic antigen is a colorectal cancer tumor marker, important as a follow-up tool in patients with previous colorectal cancer. False-positive carcinoembryonic antigen elevation results in multiples exams and in patient anxiety. In literature, there is reference to transient carcinoembryonic antigen increase with colonoscopy. Objective To evaluate the influence of bowel preparation and colonoscopy in carcinoembryonic antigen blood levels. Methods We prospectively studied subjects that underwent routine colonoscopy in our institution. Blood samples were collected (1 before bowel cleaning, (2 before colonoscopy and (3 immediately after colonoscopy. Blood carcinoembryonic antigen levels were determined by “Sandwich” immunoassay. The statistical methods used were the paired t-test and ANOVA. Results Thirty-seven patients (22M/15F were included; age range 28-84 (mean 56 years. Mean carcinoembryonic antigen values were 1.9, 2 and 1.8 for (1, (2 and (3, respectively. An increase in value (2 compared with (1 was observed in 20/37 patients (P = 0.018, mainly in younger patients and in patients requiring more endoluminal interventions. In 29/37 patients, the CEA value decreased from (2 to (3 (P = 1.3x10-7. Conclusions A trend for carcinoembryonic antigen increase after bowel cleaning was observed, especially in younger patients and in patients with more endoluminal interventions, but without clinical meaning.

  11. Incomplete resection rate of cold snare polypectomy: a prospective single-arm observational study.

    Science.gov (United States)

    Matsuura, Noriko; Takeuchi, Yoji; Yamashina, Takeshi; Ito, Takashi; Aoi, Kenji; Nagai, Kengo; Kanesaka, Takashi; Matsui, Fumi; Fujii, Mototsugu; Akasaka, Tomofumi; Hanaoka, Noboru; Higashino, Koji; Tomita, Yasuhiko; Ito, Yuri; Ishihara, Ryu; Iishi, Hiroyasu; Uedo, Noriya

    2017-03-01

    Background and study aims Cold snare polypectomy (CSP) is considered to be safe for the removal of subcentimeter colorectal polyps. This study aimed to determine the rate of incomplete CSP resection for subcentimeter neoplastic polyps at our center. Patients and methods Patients with small or diminutive adenomas (diameter 1 - 9 mm) were recruited to undergo CSP until no polyp was visible. After CSP, a 1 - 3 mm margin around the resection site was removed using endoscopic mucosal resection. The polyps and resection site marginal specimens were microscopically evaluated. Incomplete resection was defined as the presence of neoplastic tissue in the marginal specimen. We also calculated the frequency at which the polyp lateral margins could be assessed for completeness of resection. Results A total of 307 subcentimeter neoplastic polyps were removed from 120 patients. The incomplete resection rate was 3.9 % (95 % confidence interval [CI] 1.7 % - 6.1 %); incomplete resection was not associated with polyp size, location, morphology, or operator experience. The polyp lateral margins could not be assessed adequately for 206 polyps (67.1 %). Interobserver agreement between incomplete resection and lateral polyp margins that were inadequate for assessment was poor (κ = 0.029, 95 %CI 0 - 0.04). Female sex was an independent risk factor for incomplete resection (odds ratio 4.41, 95 %CI 1.26 - 15.48; P  = 0.02). Conclusions At our center, CSP resection was associated with a moderate rate of incomplete resection, which was not associated with polyp characteristics. However, adequate evaluation of resection may not be routinely possible using the lateral margin from subcentimeter polyps that were removed using CSP.Trial registered at University Hospital Medical Information Network (UMIN 000010879).

  12. SEDATION IN COLONOSCOPY BY USING THREE DIFFERENT PROPOFOL INFUSION METHODS AND ANALYSIS OF PLASMA CONCENTRATION LEVELS: A PROSPECTIVE COMPARATIVE STUDY

    Science.gov (United States)

    de CARVALHO, Paulo Henrique Boaventura; OTOCH, José Pinhata; KHAN, Mohamad Ali; SAKAI, Paulo; GUEDES, Hugo Gonçalo; ARTIFON, Everson Luiz de Almeida

    2016-01-01

    ABSTRACT Background: The propofolemia becomes directly linked to the clinical effects of this anesthetic and is the focus for studies comparing propofol clinical use, in different administration methods routinely used in endoscopy units where sedation is widely administered to patients. Aim: To evaluate the effects of three different regimens of intravenous propofol infusion in colonoscopies. Methods: A total of 50 patients that underwent colonoscopies were consecutively assigned to three groups: 1) intermittent bolus infusion; 2) continuous manually controlled infusion; 3) continuous automatic infusion. Patients were monitored with Bispectral IndexTM (BIS) and propofol serum levels were collected at three different timepoints. The development of an original dilution of propofol and an inventive capnography catheter were necessary. Results: Regarding clinical outcomes, statistical differences in agitation (higher in group 1, p=0.001) and initial blood pressure (p=0.008) were found. As for propofol serum levels, findings were similar in consumption per minute (p=0.748) and over time (p=0.830). In terms of cost analysis, group 1 cost was R$7.00 (approximately US$2,25); group2, R$17.50 (approximately US$5,64); and group 3, R$112.70 (approximately US$36,35, p<0.001). Capnography was able to predict 100% of the oxygen saturation drop (below 90%). Conclusion: The use of propofol bolus administration for colonoscopies, through continuous manually controlled infusion or automatic infusion are similar regarding propofolemia and the clinical outcomes evaluated. The use of an innovative capnography catheter is liable and low-cost solution for the early detection of airway obstruction. PMID:28076483

  13. Migraine with aura is associated with an incomplete circle of willis: results of a prospective observational study.

    Directory of Open Access Journals (Sweden)

    Brett Cucchiara

    Full Text Available OBJECTIVE: To compare the prevalence of an incomplete circle of Willis in patients with migraine with aura, migraine without aura, and control subjects, and correlate circle of Willis variations with alterations in cerebral perfusion. METHODS: Migraine with aura, migraine without aura, and control subjects were prospectively enrolled in a 1∶1∶1 ratio. Magnetic resonance angiography was performed to examine circle of Willis anatomy and arterial spin labeled perfusion magnetic resonance imaging to measure cerebral blood flow. A standardized template rating system was used to categorize circle of Willis variants. The primary pre-specified outcome measure was the frequency of an incomplete circle of Willis. The association between circle of Willis variations and cerebral blood flow was also analyzed. RESULTS: 170 subjects were enrolled (56 migraine with aura, 61 migraine without aura, 53 controls. An incomplete circle of Willis was significantly more common in the migraine with aura compared to control group (73% vs. 51%, p = 0.02, with a similar trend for the migraine without aura group (67% vs. 51%, p = 0.08. Using a quantitative score of the burden of circle of Willis variants, migraine with aura subjects had a higher burden of variants than controls (p = 0.02. Compared to those with a complete circle, subjects with an incomplete circle had greater asymmetry in hemispheric cerebral blood flow (p = 0.05. Specific posterior cerebral artery variants were associated with greater asymmetries of blood flow in the posterior cerebral artery territory. CONCLUSIONS: An incomplete circle of Willis is more common in migraine with aura subjects than controls, and is associated with alterations in cerebral blood flow.

  14. Surgical Treatment for Subaxial Cervical Facet Dislocations with Incomplete or without Neurological Deficit: A Prospective Study of 52 Cases.

    Science.gov (United States)

    Jiang, Xingjie; Yao, Yu; Yu, Mingchen; Cao, Yong; Yang, Huilin

    2017-02-09

    BACKGROUND This study aimed to treat patients with subaxial cervical facet dislocations with incomplete or without neurological deficit by a prospectively designed surgical protocol and observe the short-term clinical outcomes. MATERIAL AND METHODS Fifty-two consecutive subaxial cervical dislocation patients with incomplete or without neurological deficit were enrolled. The surgical strategy was determined based on whether or not the initial anterior closed reduction was successful and whether or not the patients were simultaneously combined with traumatic disc herniation (TDH). Postoperative radiographs were used to assess the reduction and fusion, and kyphosis and lordosis of cervical spines were calculated. The neck pain was assessed by visual analog scale. Body function and neurologic status was evaluated according to the Neck Disability Index and classification of American Spinal Injury Association. Clinical and radiologic outcomes were compared before and after the surgery and during the follow-up. The average follow-up period was 23 months. RESULTS Five patients with TDH and 17 with non-TDH were successfully treated by a single anterior approach, 22 non-TDH patients by a posterior-anterior approach, and another eight TDH patients by an anterior-posterior-anterior approach. No neurologic deterioration or other severe adverse events occurred postoperatively. The kyphosis angle of the dislocated levels was well restored after surgery, and the neck pain was significantly relieved as well. The neurologic status was obviously improved, and bony fusion was obtained in all patients within one-year follow-up. CONCLUSIONS Our prospectively designed surgical strategy is effective for the treatment of patients with subaxial cervical dislocation with incomplete or without neurological deficit.

  15. Should prior FIT results be incorporated as an additional variable to estimate risk of colorectal neoplasia? A prospective study of 5,813 screening colonoscopies.

    Directory of Open Access Journals (Sweden)

    Martin C S Wong

    Full Text Available Recent studies showed that previous negative results from faecal immunochemical tests (FITs for colorectal cancer (CRC screening was associated with lower risk of advanced neoplasia (AN. We evaluated whether prior FIT results should be included to estimate the risk of AN in 2008-2012.A community-based screening practice recruited 5,813 asymptomatic residents aged 50 to 70 years in Hong Kong for CRC screening. We included study participants who had (1. positive FIT with subsequent colonoscopy workup (FIT+ group; n = 356; (2. negative FIT in three consecutive years and received a colonoscopy (FIT- group; n = 857; (3. received colonoscopy without FIT (colonoscopy group; n = 473; and (4. received both colonoscopy and FIT at the same time (combined group; n = 4,127. One binary logistic regression model evaluated whether prior FIT results were associated with colonoscopy findings of AN.The proportion of participants having AN/CRC was 18.0% (FIT+, 5.5% (FIT-, 8.0% (colonoscopy group, and 4.3% (combined group, respectively. When compared with the colonoscopy group, those in the FIT- group were not significantly more or less likely to have AN/CRC (AOR = 0.77, 95% C.I. = 0.51 to 1.18, p = 0.230. Having one (AOR = 0.73, 95% C.I. 0.48-1.12, p = 0.151 or three consecutive negative FIT result (AOR = 0.98, 95% C.I. 0.60-1.62, p = 0.944 were not associated with lower risks of AN/CRC. Subjects in the FIT+ group was 3.32-fold (95% C.I. 2.07 to 5.32, p < 0.001 more likely to have AN/CRC.These findings indicated that subjects with negative FIT findings could be risk stratified similarly as those who had not previously received FIT.

  16. 无痛肠镜与常规肠镜检查的前瞻性对照研究%Sedated versus conventional colonoscopy:a prospective study on patient acceptability and satisfaction

    Institute of Scientific and Technical Information of China (English)

    方一; 杜重临; 许斌; 王蕾; 程时丹; 钟捷; 龚彪; 夏璐; 吴嘉钏; 刘倩; 孟晓弘; 季明昉; 徐贝黎; 邱冬梅; 蒋慧; 戴明舟

    2014-01-01

    目的:探讨无痛肠镜和常规肠镜检查在临床工作中的选择。方法362例自愿接受无痛肠镜检查患者(无痛肠镜组)和323例自愿接受常规肠镜检查患者(常规肠镜组)纳入对照研究,均于检查结束后完成问卷调查,统计分析2组检查完成情况、操作时间、检查费用、不适反应发生情况以及问卷调查结果。结果无痛肠镜组和常规肠镜组检查完成率分别为98.9%(358/362)和89.8%(290/323)(P=0.337),操作时间分别为(5.60±3.25)min和(7.71±5.70)min(P<0.001),平均检查费用分别为人民币886.54元/人和386.00元/人( P<0.001),操作相关不适反应总发生率分别为13.3%(48/362)与83.6%(270/323)(P<0.001),患者满意度评分分别为4(3-4)分和3(2-3)分(P<0.001),操作者满意度评分分别为4(3-4)和4(4-4)分(P<0.001)。无痛肠镜组和常规肠镜组愿意再次接受相同检查方式检查的患者数分别为354例(97.79%)和225例(69.66%)(P<0.001),常规肠镜组愿意再次接受常规肠镜检查的相关因素分析结果显示男性患者( P=0.035)、无腹部手术史者(P<0.001)、检查过程中未出现腹痛者(P=0.015)更愿意再次接受常规肠镜检查。结论常规肠镜检查虽然耗时较长,但可避免麻醉风险,且检查所需费用较低,仍是目前国内结直肠疾病检查不可欠缺的重要方法。内镜医师在选择肠镜检查方式时,不仅要考虑患者术中耐受,更要根据患者实际情况严格把握适应证,在充分利用现有医疗资源的前提下使患者得到及时的诊治。%Objective To compare the clinical choosing principles of sedated colonoscopy with con-ventional colonoscopy. Methods Outpatients who were willing to accept colonoscopy with or without seda-tion were prospectively recruited,which were assigned to sedated colonoscopy group(n=362)and conven

  17. Listening to Turkish classical music decreases patients' anxiety, pain, dissatisfaction and the dose of sedative and analgesic drugs during colonoscopy: A prospective randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Nimet Ovayolu; Ozlem Ucan; Seda Pehlivan; Yavuz Pehlivan; Hakan Buyukhatipoglu; M Cemil Savas; Murat T Gulsen

    2006-01-01

    AIM: To determine whether listening to music decreases the requirement for dosages of sedative drugs, patients'anxiety, pain and dissatisfaction feelings during colonoscopy and makes the procedure more comfortable and acceptable.METHODS: Patients undergoing elective colonoscopy between October 2005 and February 2006 were randomized into either listening to music (Group 1,n = 30) or not listening to music (Group 2,n = 30).Anxiolytic and analgesic drugs (intravenous midazolam and meperidine) were given according to the patients'demand. Administered medications were monitored. We determined their levels of anxiety using the State-Trait Anxiety Inventory Test form. Patients'satisfaction, pain,and willingness to undergo a repeated procedure were self-assessed using a visual analog scale.RESULTS: The mean dose of sedative and analgesic drugs used in group 1 (midazolam: 2.1 ± 1.4,meperidine: 18.1 ± 11.7) was smaller than group 2(midazolam: 2.4 ± 1.0, meperidine: 20.6 ± 11.5), but without a significant difference (P >0.05). The mean anxiety level in group 1 was lower than group 2 (36.7 ±2.2 vs 251.0 ± 1.9, P <0.001). The mean satisfaction score was higher in group 1 compared to group 2 (87.8± 3.1 vs 58.1 ± 3.4, P <0.001). The mean pain score in group 1 was lower than group 2 (74.1 ± 4.7 vs 39.0 ± 3.9,P <0.001).CONCLUSION: Listening to music during colonoscopy helps reduce the dose of sedative medications, as well as patients'anxiety, pain, dissatisfaction during the procedure. Therefore, we believe that listening to music can play an adjunctive role to sedation in colonoscopy. It is a simple, inexpensive way to improve patients'comfort during the procedure.

  18. Splenic rupture following colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Francisco Guerra; Ignacio San Francisco; Fernando Pimentel; Luis Ibanez

    2008-01-01

    Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

  19. A Randomized Prospective Study of Bowel Preparation for Colonoscopy with Low-Dose Sodium Phosphate Tablets versus Polyethylene Glycol Electrolyte Solution

    Directory of Open Access Journals (Sweden)

    Erina Kumagai

    2014-01-01

    Full Text Available Optimal bowel preparation is essential for the safety and outcome of colonoscopy. A solution containing polyethylene glycol (PEG is often used as a bowel cleansing agent, but some patients are intolerant of PEG, and this may lead to discontinuation of colonoscopy. Sodium phosphates (NaP tablets are designed to improve patient acceptance and compliance. The objective of this study was to compare bowel preparation efficiency and patient acceptance of a 30 NaP tablet preparation (L-NaP and a 2 L PEG preparation. Patients were randomized into either the L-NaP or PEG group. The primary endpoint was the efficiency of colon cleansing as assessed by a validated four-point scale according to the Aronchick scale by endoscopists and was verified by blinded investigators. The secondary endpoints were patients’ tolerability and acceptance. Colon-cleansing efficiency was not significantly different between the two preparations. However, patients’ overall judgment was significantly in favor of L-NaP, reflecting better acceptance of L-NaP than PEG. Additionally, more patients favored L-NaP over PEG in a hypothetical future occasion requiring colonoscopy.

  20. [Pediatric colonoscopy at the University Hospital of Cocody (Ivory Coast)].

    Science.gov (United States)

    Okon, J B; Assi, C; Diakité, M; Siaka, K; Ouattara, A; Soro, D; Coulibaly, A; Lohouès, M J; Camara, B M

    2012-01-01

    No published data are available on pediatric colonoscopy in Ivory Coast (and only one report on pediatric gastroscopy). We conducted a retrospective study of all colonoscopy reports of procedures performed from 1 September, 1991, to December 31, 2010, at the University Hospital of Cocody in Abidjan (Ivory Coast) and examined the epidemiological aspects, conditions of performance, indications, and results of colonoscopy in patients younger than 18 years. Eleven of the total of 1 159 colonoscopies were performed in in this age group (0.94%). The mean age of these 8 girls and 3 boys was 15 years (range: 10 to 17 years). All patients had been referred by a gastroenterologist. Bowel preparation was performed in all with a water enema. Premedication was performed exclusively with midazolam. A pediatric colonoscope was used. The colonoscopy was incomplete in 36% of cases (n=4). Rectal bleeding was the main indication. Results were abnormal in 72% of cases (n=8) and the lesions found were juvenile polyps, ulcerative colitis, sigmoid varices, rectocolitis due to a caustic product, and adenomatous polyps. The results of the examination were normal in 3 children. No complications were reported. In conclusion, although the pediatric colonoscopy practice at the University Hospital of Cocody in Abidjan is extremely small, its therapeutic and diagnostic yields are high, particularly in cases of rectal bleeding. Physicians (general practitioners and pediatricians) managing children should not hesitate to ask for a colonoscopy when appropriate.

  1. NBI and NBI Combined with Magnifying Colonoscopy

    Directory of Open Access Journals (Sweden)

    Mineo Iwatate

    2012-01-01

    Full Text Available Although magnifying chromoendoscopy had been a reliable diagnostic tool, narrow-band imaging (NBI has been developed in Japan since 1999 and has now replaced the major role of chromoendoscopy because of its convenience and simplicity. In this paper, we principally describe the efficacy of magnifying chromoendoscopy and magnifying colonoscopy with NBI for detection, histological prediction, estimation of the depth of early colorectal cancer, and future prospects. Although some meta-analyses have concluded that NBI is not superior to white light imaging for detection of adenomatous polyps in screening colonoscopy, NBI with magnification colonoscopy is useful for histological prediction, or for estimating the depth of invasion. To standardize these diagnostic strategies, we will focus on the NBI International Colorectal Endoscopic (NICE classification proposed for use by endoscopists with or without a magnifying endoscope. However, more prospective research is needed to prove that this classification can be applied with satisfactory availability, feasibility, and reliability. In the future, NBI might contribute to the evaluation of real-time histological prediction during colonoscopy, which has substantial benefits for both reducing the risk of polypectomy and saving the cost of histological evaluation by resecting and discarding diminutive adenomatous polyps (resect and discard strategy.

  2. Splenic injury after colonoscopy

    DEFF Research Database (Denmark)

    Petersen, C.R.; Adamsen, S.; Gocht-Jensen, P.

    2008-01-01

    Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven...... the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates...

  3. Virtual colonoscopy (CT colonography) in the identification of colorectal cancer. A prospective study in symptomatic patients; Impiego dell'endoscopia virtuale con Tomografia Computerizzata nell'identificazione delle neoplasie colorettali. Studio prospettivo in pazienti sintomatici

    Energy Technology Data Exchange (ETDEWEB)

    Regge, D.; Martincich, L.; Gallo, T.; Pollone, M. [Istituto per la Ricerca e la Cura del Cancro, Ordine Mauriziano, Reparto di Radiologia, Candiolo, TO (Italy); Galatola, G.; Secreto, P.; Pera, A. [Ospedale Mauriziano Umberto, Turin (Italy). Unita' Operativa di Gastroenterologia; Rivolta, A. [Istituto per la Ricerca e la Cura del Cancro, Ordine Mauriziano, Candiolo, TO (Italy). Servizio di Fisica Sanitaria

    2000-06-01

    Aim of this study was to evaluate the sensitivity of virtual colonoscopy (CT colonography) in the identification of colorectal cancer and to define the limitations and the advantages of this imaging modality, as well as indications to the examination. It was examined prospectively 62 symptomatic patients aged 36 to 82 years (28 women and 34 men). All patients underwent both conventional and virtual colonoscopy on the same day; the conventional examination allowed exploration of the entire colon. Conventional colonoscopy identified 89 lesions 3-50 mm in diameter, namely 84 benign and 5 malignant lesions. No lesions were identified in 12 patients. CT colonography identified 52 of the 89 lesions, with 57.1% diagnostic accuracy. They were 11 false positives (82.5% positive predictive value and 52.2% specificity) and 37 false negatives (24.5% negative predictive value and 58.4% sensitivity). Sensitivity was significantly higher (85.7%) for polyps {>=} 1 cm. Virtual colonoscopy is an imaging modality with good diagnostic yield, well tolerated by patients and with great potentials for further development. It was suggested that the examination be performed in symptomatic patients who cannot undergo total colonoscopy or refuse the other imaging modalities. Further studies are warranted in larger series of patients, possibly introducing it in screening programs. [Italian] Scopo di questo lavoro e' valutare la sensibilita' della colonscopia virtuale con TC nell'identificazione delle neoplasie colorettali, definendo gli attuali limiti e vantaggi della metodica e le possibili indicazioni dell'indagine. E' stato condotto uno studio prospettico su 62 pazienti sintomatici con eta' compresa fra 36 e 82 anni di cui 28 donne e 34 uomini. Tutti i pazienti sono stati sottoposti nello stesso giorno sia a colonscopia tradizionale, che in ogni caso ha consentito l'esplorazione di tutto il colon, sia a colonscopia virtuale. Con colonscopia tradizionale

  4. Conventional colonoscopy; Konventionelle Kolonoskopie

    Energy Technology Data Exchange (ETDEWEB)

    Haefner, M. [Universitaetsklinik fuer Innere Medizin III, Klinische Abteilung fuer Gastroenterologie und Hepatologie, Wien (Austria)

    2008-02-15

    In the last 40 years colonoscopy has been the gold standard in diagnosis of conditions affecting the large intestine. We see its main disadvantages in the necessity for intestinal preparation and in the pain not infrequently experienced by patients who are not sedated. Widespread use of sedation has made it possible to improve patient acceptance in recent years. Complications of colonoscopy are rare, and even the removal of large polyps is regarded as a safe procedure. One of the main problems of colonoscopy is that a large number of far from trivial polyps - up to 20% in the literature - are overlooked. New developments, such as higher resolution videochips and chromoendoscopy, lead to a better diagnostic yield, especially of flat lesions. The rapidly developing sector of interventional colonoscopy in particular will ensure that colonoscopy continues to have an important place in the management of illnesses affecting the large intestine. (orig.) [German] Die Kolonoskopie war in den letzten 40 Jahren der Goldstandard zur Diagnostik von Dickdarmerkrankungen. Ihre Hauptnachteile liegen in der Notwendigkeit der Darmvorbereitung sowie nicht selten auftretenden Schmerzen beim nichtsedierten Patienten. Durch den breiten Einsatz der Sedierung konnte in den letzten Jahren die Patientenakzeptanz verbessert werden. Komplikationen der Kolonoskopie sind selten und selbst das Entfernen grosser Polypen wird als sicher angesehen. Eines der Hauptprobleme der Kolonoskopie liegt in der nicht unbetraechtlichen Anzahl uebersehener Polypen, die in der Literatur bis zu 20% betraegt. Neue Entwicklungen wie hoeher aufloesende Videochips oder die Chromoendoskopie fuehren zu einer verbesserten diagnostischen Ausbeute v. a. flacher Laesionen. Besonders das sich rasch entwickelnde Gebiet der interventionellen Kolonoskopie wird dafuer sorgen, dass die Kolonoskopie auch in Zukunft noch einen wichtigen Stellenwert beim Management von Dickdarmerkrankungen hat. (orig.)

  5. Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction

    NARCIS (Netherlands)

    van Putten, P. G.; ter Borg, F.; Adang, R. P. R.; Koornstra, J. J.; Romberg-Camps, M. J. L.; Timmer, R.; Poen, A. C.; Kuipers, E. J.; Van Leerdam, M. E.

    2012-01-01

    Background and study aims: Colonoscopy is increasingly performed by nurse endoscopists. We aimed to assess the endoscopic quality and patient experience of these procedures. Patients and methods: This prospective multicenter study analyzed 100 consecutive colonoscopies each for 10 trained nurse endo

  6. A Prospective Phase 2 Multicenter Study for the Efficacy of Radiation Therapy Following Incomplete Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chihwan; Koom, Woong Sub [Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Tae Hyun [Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si (Korea, Republic of); Yoon, Sang Min [Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Lee, Hyung-Sik [Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan (Korea, Republic of); Nam, Taek-Keun [Department of Radiation Oncology, Chonnam National University Hospital, Gwang-Ju (Korea, Republic of); Seong, Jinsil, E-mail: jsseong@yuhs.ac [Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-12-01

    Purpose: The purpose of this study was to investigate the efficacy and toxicity of radiation therapy (RT) following incomplete transarterial chemoembolization (TACE) in unresectable hepatocellular carcinoma (HCC). Methods and Materials: The study was designed as a prospective phase 2 multicenter trial. Patients with unresectable HCC, who had viable tumor after TACE of no more than 3 courses, were eligible. Three-dimensional conformal RT (3D-CRT) was added for HCC treatment with incomplete uptake of iodized oil, and the interval from TACE to RT was 4 to 6 weeks. The primary endpoint of this study was the tumor response after RT following incomplete TACE in unresectable HCC. Secondary endpoints were patterns of failure, progression-free survival (PFS), time to tumor progression (TTP), overall survival (OS) rates at 2 years, and treatment-associated toxicity. Survival was calculated from the start of RT. Results: Between August 2008 and December 2010, 31 patients were enrolled. RT was delivered at a median dose of 54 Gy (range, 46-59.4 Gy) at 1.8 to 2 Gy per fraction. A best objective in-field response rate was achieved in 83.9% of patients, with complete response (CR) in 22.6% of patients and partial response in 61.3% of patients within 12 weeks post-RT. A best objective overall response rate was achieved in 64.5% of patients with CR in 19.4% of patients and PR in 45.1% of patients. The 2-year in-field PFS, PFS, TTP, and OS rates were 45.2%, 29.0%, 36.6%, and 61.3%, respectively. The Barcelona Clinic liver cancer stage was a significant independent prognostic factor for PFS (P=.023). Classic radiation-induced liver disease was not observed. There were no treatment-related deaths or hepatic failure. Conclusions: Early 3D-CRT following incomplete TACE is a safe and practical treatment option for patients with unresectable HCC.

  7. Visuo-spatial ability in colonoscopy simulator training

    OpenAIRE

    Luursema, J.-M.; Buzink, S.N.; Verwey, W.B.; Jakimowicz, J.J.

    2010-01-01

    Visuo-spatial ability is associated with a quality of performance in a variety of surgical and medical skills. However, visuo-spatial ability is typically assessed using Visualization tests only, which led to an incomplete understanding of the involvement of visuo-spatial ability in these skills. To remedy this situation, the current study investigated the role of a broad range of visuo-spatial factors in colonoscopy simulator training. Fifteen medical trainees (no clinical experience in colo...

  8. Colonoscopy does not induce small intestinal bacterial overgrowth

    Directory of Open Access Journals (Sweden)

    Ioana Gabriela Moraru

    2017-01-01

    Full Text Available Background and Aim: Small intestinal bacterial overgrowth (SIBO is associated with gastrointestinal pathology and colonoscopy. This endoscopic investigation could cause changes in gut flora including the occurrence of SIBO. We looked in this study for the effect of colonoscopy (preparation and intubation on the occurrence of SIBO. Materials and Methods: Prospective study including thirty patients with irritable bowel syndrome (IBS diagnosed according to Rome III criteria. Two groups were designed: Twenty IBS patients that performed colonoscopy (G1 and ten IBS patients (G2 not referred to colonoscopy. All patients have been tested for the presence of SIBO using glucose hydrogen breath tests (GHBT at the beginning of the study, on day 1. G1 patients have also been tested before colonoscopy (day 2 and 1 week after (day 9. G2 patients performed GHBT on day 1 and on day 9. Results: The peak value of expired H2 was assessed, and the mean value was calculated. There were no significant statistical differences between the mean H2 values in the 2 groups of patients on day 1. The mean level of H2 significantly decreased after preparing for colonoscopy in G1 patients (P < 0.0001. There were no significant statistical differences between the mean levels of H2 on day 2 versus day 9 in G1 patients (P = 0.176. The mean level of H2 1 week after performing colonoscopy (7.65 ppm is higher than that obtained after preparing for it (6.3 ppm, but no statistical significance. Patients from G2 showed no statistical differences between the mean levels of H2 on day 1 versus day 9 (P = 0.6132. Patients in G1 had a significantly lower mean H2 level versus G2 patients on day 9. Conclusions: Colonoscopy does not produce SIBO. Preparing for colonoscopy influences the level of expired H2, it reduces the number of intestinal bacteria, probably trough a mechanic effect or by inflating air during the procedure. Performing GHBT too soon after colonoscopy might result in false

  9. The impact of fair colonoscopy preparation on colonoscopy use and adenoma miss rates in patients undergoing outpatient colonoscopy

    Science.gov (United States)

    Menees, Stacy B.; Kim, H. Myra; Elliott, Eric E.; Mickevicius, Jennifer L.; Graustein, Brittany B.; Schoenfeld, Philip S.

    2013-01-01

    Background The impact of fair bowel preparation on endoscopists’ recommendations and adenoma miss rates in average-risk patients undergoing colonoscopy is unknown. Objective To assess the impact of fair bowel preparation on endoscopists’ interval colonoscopy recommendations and miss rates in colonoscopies performed within 3 years of the index colonoscopy in average-risk patients undergoing colorectal cancer screening. Design Retrospective chart review. Setting Tertiary-care center. Patients Average-risk patients undergoing index colonoscopy for colorectal cancer screening between 2004 and 2006. Intervention Colonoscopy. Main Outcome Measurements Endoscopists’ interval recommendations, adenoma miss rates. Results A total of 16,251 colonoscopy records were reviewed over a 2-year period. Of these cases, 1943 colonoscopies were performed for the sole indication of average risk or screening. Of these, fair bowel preparation was reported in 619 patients (31.9%). A repeat colonoscopy within 5 years was recommended in 70.4% of patients. The follow-up colonoscopy compliance rate within 3 years was 55.9%. Adenoma detection rates at index and follow-up colonoscopy were 20.5% and 28.2%, respectively. Of the 39 patients with follow-up colonoscopy within 3 years, the overall adenoma miss rate was 28%. Of the patients with an adenoma identified on follow-up colonoscopy, 13.6% had normal colonoscopy results on index examination. Limitations Retrospective design. Conclusion Fair bowel preparation led to a deviation from national guidelines with early repeat colonoscopy follow-up recommendations in nearly 60% of average-risk patients with normal colonoscopy results. In patients who returned for repeat colonoscopy within 3 years, the overall adenoma miss rate was 28%. Further guidelines on timing for repeat colonoscopy for fair bowel preparation are needed. PMID:23642491

  10. Splenic rupture following routine colonoscopy.

    Science.gov (United States)

    Rasul, Tabraze; Leung, Edmund; McArdle, Kirsten; Pathak, Rajiv; Dalmia, Sanjay

    2010-10-01

    Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.

  11. Quality assessment of colonoscopy in Flanders: a voluntary survey among Flemish gastroenterologist.

    Science.gov (United States)

    Macken, E; Vannoote, J; Moreels, T; Peeters, M; Wouters, K

    2015-01-01

    Colonoscopy is an important endoscopic examination for the diagnosis and treatment of pathological conditions of the colon, like polyps and colorectal cancer. However, several factors determine the quality of colonoscopy and thus the quality of polyp and colorectal cancer detection. The Flemish Society of Gastroenterology (VVGE) performed a voluntary on-line registry among its members to identify quality of colonoscopy in Flanders, Belgium. 64 gastroenterologists voluntarily registered 4276 consecutive colonoscopies performed during a 3 month study period. Colonoscopy quality indicators were prospectively collected and analysed. Results showed a low voluntary participation rate (17%), acceptable overall adenoma detection rate of 20,5% and colorectal cancer interval rate of 5,4%. Complications were low (perforation 0,1% and major bleeding 1,5%). The current study showed that in Flanders, Belgium on-line registration of colonoscopy quality indicators is feasible and that quality of colonoscopy in daily practice meets the expectations of (inter)national guidelines. However, further improvement of the registry and an open debate on the quality control of colonoscopy in Flanders is warranted (Belgian Registry B30020096548).

  12. Correlating Quantitative Fecal Immunochemical Test Results with Neoplastic Findings on Colonoscopy in a Population-Based Colorectal Cancer Screening Program: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Neal Shahidi

    2016-01-01

    Full Text Available Background and Aims. The Canadian Partnership Against Cancer (CPAC recommends a fecal immunochemical test- (FIT- positive predictive value (PPV for all adenomas of ≥50%. We sought to assess FIT performance among average-risk participants of the British Columbia Colon Screening Program (BCCSP. Methods. From Nov-2013 to Dec-2014 consecutive participants of the BCCSP were assessed. Data was obtained from a prospectively collected database. A single quantitative FIT (NS-Plus, Alfresa Pharma Corporation, Japan with a cut-off of ≥10 μg/g (≥50 ng/mL was used. Results. 20,322 FIT-positive participants underwent CSPY. At a FIT cut-off of ≥10 μg/g (≥50 ng/mL the PPV for all adenomas was 52.0%. Increasing the FIT cut-off to ≥20 μg/g (≥100 ng/mL would increase the PPV for colorectal cancer (CRC by 1.5% and for high-risk adenomas (HRAs by 6.5% at a cost of missing 13.6% of CRCs and 32.4% of HRAs. Conclusions. As the NS-Plus FIT cut-off rises, the PPV for CRC and HRAs increases but at the cost of missed lesions. A cut-off of ≥10 μg/g (≥50 ng/mL produces a PPV for all adenomas exceeding national recommendations. Health authorities need to take into consideration endoscopic resources when selecting a FIT positivity threshold.

  13. Multi-detector CT-colonography in inflammatory bowel disease: Prospective analysis of CT-findings to high-resolution video colonoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Kjel [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)]. E-mail: kjel_andersen@web.de; Vogt, Christoph [Department of Gastroenterology, Hepatology and Infectiology, University Hospital Duesseldorf (Germany); Blondin, Dirk [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany); Beck, Andreas [Institute of Informatics, Heinrich-Heine-University, Duesseldorf (Germany); Heinen, Wolfram [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany); Aurich, Volker [Institute of Informatics, Heinrich-Heine-University, Duesseldorf (Germany); Haeussinger, Dieter [Department of Gastroenterology, Hepatology and Infectiology, University Hospital Duesseldorf (Germany); Moedder, Ulrich [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany); Cohnen, Mathias [Institute of Diagnostic Radiology, University Hospital Duesseldorf (Germany)

    2006-04-15

    Aim: Prospective analysis of multi-detector CT-colonography (MDCTC) in patients with inflammatory bowel disease (IBD) compared to high-resolution video-endoscopy (HRVC). Materials and methods: Twenty-one patients (mean age 49.6 years) with Crohn's disease or ulcerative colitis underwent MDCTC (Somatom Volume Zoom, Siemens, Erlangen; 1 mm collimation, Pitch 8, 100 mAs, 120 kVp). HRVC was performed within 2 h after MDCTC. MDCTC was analyzed by two blinded readers. MDCTC-findings including bowel wall alterations and extraintestinal changes were compared to results of HRVC. Results: Over-all-sensitivity was 100% for endoluminal lesions with correct diagnosis of two cancers. Acute and chronic IBD were correctly identified by MDCTC in 63.6%, and 100%, respectively, with a specificity of 75%, and 100%. Sensitivity, specificity, positive and negative predictive values of MDCTC for diagnosis of acute and chronic disease were best for chronic disease. Sensitivity was worst for acute ulcerative colitis and specificity was worst for acute Crohn's disease. Haustral loss was seen only in ulcerative colitis. Pseudopolyps and fistulae were findings exclusive to Crohn's disease. Particularly extraintestinal findings as increased vascularization and local lymphadenopathy correlated well with endoscopic definition of acute disease. Because of the possibly more vulnerable colonic wall in acute inflammatory bowel disease, the air inflation for MDCTC should be performed most carefully to avoid any risk of colonic perforation. Conclusion: MDCTC may help to distinguish between patients with acute and chronic IBD. Especially extraintestinal complications, tumorous as well as pseudo-tumorous lesions can be detected with high sensitivity and specificity.

  14. Single-center study comparing computed tomography colonography with conventional colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Ian C Roberts-Thomson; Graeme R Tucker; Peter J Hewett; Peter Cheung; Ruben A Sebben; EE Win Khoo; Julie D Marker; Wayne K Clapton

    2008-01-01

    AIM: To compare the results from computed tomography (CT) colonography with conventional colonoscopy in symptomatic patients referred for colonoscopy. METHODS: The study included 227 adult outpatients, mean age 60 years, with appropriate indications for colonoscopy. CT colonography and colonoscopy were performed on the same day in a metropolitan teaching hospital. Colonoscopists were initially blinded to the results of CT colonography but there was segmental unblinding during the procedure. The primary outcome measures were the sensitivity and specificity of CT colonography for the identification of polyps seen at colonoscopy (i.e. analysis by polyp). Secondary outcome measures included an analysis by patient, extracolonic findings at CT colonography, adverse events with both procedures and patient acceptance and preference. RESULTS: Twenty-five patients (11%) were excluded from the analysis because of incomplete colonoscopy or poor bowel preparation that affected either CT colonography, colonoscopy or both procedures. Polyps and masses (usually cancers) were detected at colonoscopy and CT colonography in 35% and 42% of patients, respectively. Of nine patients with a final diagnosis of cancer, eight (89%) were identified by CT colonography as masses (5) or polyps (3). For polyps analyzed according to polyp, the overall sensitivity of CT colonography was 50% (95% CI, 39%-61%) but this increased to 71% (95% CI, 52%-85%) for polyps ≥ 6 mm in size. Similarly, specificity for all polyps was 48% (95% CI, 39%-58%) increasing to 67% (95% CI, 56%-76%) for polyps ≥ 6 mm. Adverse events were uncommon but included one colonic perforation at colonoscopy, Patient acceptance was high for both procedures but preference favoured CT colonography. CONCLUSION: Although CT colonography was more sensitive in this study than in some previous studies, the procedure is not yet sensitive enough for widespread application in symptomatic patients.

  15. Intravenous glucagon beneficial during colonoscopy in patient with IBS

    Directory of Open Access Journals (Sweden)

    Dharmesh H Kaswala

    2014-05-01

    Full Text Available Background and Aim: Irritable bowel syndrome (IBS is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits. Patients with IBS requiring colonoscopy take longer time to cecum with higher need for medications used for conscious sedation. Glucagon is routinely used during endoscopic procedures to reduce peristalsis that interfere with the procedure. However, randomized controlled data using glucagon during endoscopic procedures are lacking. We designed a prospective randomized placebo-controlled trial to study the effect of intravenous glucagon given during colonoscopy. Materials and Methods: We received approval from the FDA for this off-label use of glucagon during colonoscopy. This is a double-blind randomized placebo-controlled study. Patients were selected based on ROME III criteria for IBS; patients who met Rome III criteria and had an indication for colonoscopy for age-specific colon cancer screening or for work up of any alarm signs. We selected 34 patients meeting the Rome III for IBS and randomized into Group A and Group B. Both the performing endoscopist and patients were blinded. These patients in both groups initially received a standard dose of conscious sedation, up to 100 mcg of fentanyl and up to 5 mg of midazolam intravenously. In Group A, 17 patients, in addition to conscious sedation, received 1 ml saline as placebo. In Group B, 17 patients, in addition to conscious sedation, received 1 mg of intravenous glucagon. Parameters evaluated were as follows: 1 Total time required for colonoscopy 2 Completion of colonoscopy as documented by cecal intubation or visualization of appendicular orifice 3 Level of comfort in patient concerned to post- procedure spasmodic pain, which was based on Wong-Baker FACES pain rating scale and 4 Calculate the amount of sedation required in both groups of patients and also at what extent glucagon helped to decrease the requirement of sedatives. Data was

  16. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... for Clinical Research and Education, underscores the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients about the effectiveness, safety and importance of colonoscopy. Featuring the experience of a female ...

  17. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... for Clinical Research and Education, underscores the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients about the effectiveness, safety and importance of colonoscopy. Featuring the experience of a female ...

  18. Virtual colonoscopy in paediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Carrascosa, Patricia [Diagnostico Maipu, Av. Maipu 1668, Vicente Lopez (B1602ABQ), Buenos Aires (Argentina)], E-mail: patriciacarrascosa@diagnosticomaipu.com.ar; Lopez, Elba Martin; Capunay, Carlos; Vallejos, Javier; Carrascosa, Jorge [Diagnostico Maipu, Av. Maipu 1668, Vicente Lopez (B1602ABQ), Buenos Aires (Argentina)

    2010-04-15

    Objective: To determine the usefulness of perspective-filet view for polypoid lesions in paediatric patients in comparison with conventional virtual colonoscopy (VC) analysis and optical colonoscopy. Methods: Sixty-one patients (mean age 5 years old) with a previous episode of rectal bleeding were studied using a 16 slices CT scanner. All patients underwent a colonic preparation. Two acquisitions were done in supine and prone positions with slices of 2 mm thickness; increment 1 mm, 30-50 mA; 90-120 kV. In a workstation an experienced radiologist reviewed images twice. The first read was done using the conventional virtual colonoscopy technique with the evaluation of two-dimensional (2D), three-dimensional (3D) and endoscopical images. Later, in a second session, perspective-filet view was used. It shows a 360 deg. unrolled visualization of the inner colon. The presence, size and location of the lesions were determined. A record of the reading time was made. Results: At per patient evaluation the conventional virtual colonoscopy analysis obtained a sensitivity of 86% and a specificity of 98%. The perspective-filet view obtained a sensitivity of 91% and a specificity of 99%. In the evaluation on a per lesion basis the conventional analysis had a sensitivity of 81% and a specificity of 88%. Perspective-filet view, had a sensitivity of 82% and specificity of 90%. The average total reading time using conventional colonoscopy technique was 18 {+-} 3 min, versus 4 {+-} 1 min using the perspective-filet view. Conclusion: Virtual colon dissection with perspective-filet view is more time-efficient than conventional virtual colonoscopy evaluation with correct correlation in results.

  19. Surveillance colonoscopy after endoscopic treatment for colorectal neoplasia: From the standpoint of the Asia-Pacific region.

    Science.gov (United States)

    Matsuda, Takahisa; Chiu, Han-Mo; Sano, Yasushi; Fujii, Takahiro; Ono, Akiko; Saito, Yutaka

    2016-04-01

    Colonoscopy is considered the gold standard to detect and remove colorectal neoplasia. The efficacy of colonoscopy with polypectomy to reduce colorectal cancer incidence and mortality has been demonstrated. Recently, post-polypectomy surveillance colonoscopy has become a necessary intervention in daily practice not only in Western countries but also in the Asia-Pacific region. Therefore, it is crucial to establish new clinical practice guidelines to reduce the number of unnecessary surveillance colonoscopies in order to create space for screening colonoscopy. The Asia-Pacific Consensus group recommended that surveillance colonoscopy interval should be tailored according to risk level of index colonoscopy. However, precise guidelines on interval of surveillance cannot be given because of a lack of prospective data. According to Korean and Australian guidelines, surveillance intervals after index colonoscopy of 5 years for low-risk subjects and 3 years for high-risk subjects are recommended in Asia-Pacific regions at present. Prospective data including long-term outcomes from the Japan Polyp Study, which is a multicenter randomized control trial, would be useful to establish the Asia-Pacific consensus in the near future.

  20. Anterior D-rod and titanium mesh fixation for acute mid-lumbar burst fracture with incomplete neurologic deficits A prospective study of 56 consecutive patients

    Directory of Open Access Journals (Sweden)

    Zhe-yuan Huang

    2015-01-01

    Conclusion: Good mid term clinicoradiological results of anterior decompression with D-rod and titanium mesh fixation for suitable patients with mid-lumbar burst fractures with incomplete neurologic deficits can be achieved. The incident rate of complications was low. D-rod is a reliable implant and has some potential advantages in L4 vertebral fractures.

  1. Massaal rectaal bloedverlies na colonoscopie

    NARCIS (Netherlands)

    Kampschreur, M T Milou; Kats-Ugurlu, Gursah; van Suylen, Robert Jan; De Schryver, Anneke M P

    2012-01-01

    A 70-year-old man presented with acute lower gastrointestinal bleeding. A colonoscopy performed one and a half months prior had revealed diverticulosis in the sigmoid colon; a small polyp located 10 cm from the anal margin had been removed at that time. The presenting patient was haemodynamically un

  2. Comparison of virtual colonoscopy and colonoscopy in diagnosis of colorectal neoplasia

    Institute of Scientific and Technical Information of China (English)

    戴宁; 忻莹; 邹立秋; 王建国; 高敏; 章士正; 姒健敏

    2002-01-01

    The diagnostic value of virtual colonoscopy versus colon oscopy was compared in detection of colorectal neoplasia. Virtual colonoscopy wa s performed on 29 patients with suspected colorectal diseases, Results were comp ared with colonoscopy for each case. Virtual colonoscopy was successfully perfor med on each patient. All patients tolerated virtual colonoscopy well, had no com plications. All colorectal malignance were identified both by virtual colonoscop y and colonoscopy. Twenty-five polyps were detected with colonoscopy, whereas o n ly 16 polyps were defined by virtual colonoscopy. Detection rates of polyps grea ter than 1.0 cm,between 0.5-0.9 cm and less than 0.5 cm in size were 90%,62.5% a nd 28.6% respectively. Virtual colonoscopy is fast, minimally invasive and well tolerated. This technique is a valuable clinical method in diagnosis of colorect al malignance and polyps larger than 0.5 cm in size.

  3. Patient experience of CT colonography and colonoscopy after fecal occult blood test in a national screening programme

    Energy Technology Data Exchange (ETDEWEB)

    Plumb, Andrew A.; Taylor, Stuart A.; Halligan, Steve [University College London, Centre for Medical Imaging, Division of Medicine, London (United Kingdom); Ghanouni, Alex; Von Wagner, Christian [University College London, Health Behaviour Research Centre, Department of Epidemiology and Public Health, London (United Kingdom); Rees, Colin J. [Durham University School of Medicine, Pharmacy and Health, Durham (United Kingdom); Hewitson, Paul [University of Oxford, Health Services Research Unit, Nuffield Department of Population Health, Oxford (United Kingdom); Nickerson, Claire; Wright, Suzanne [Fulwood House, NHS Cancer Screening Programmes, Sheffield (United Kingdom)

    2017-03-15

    To investigate patient experience of CT colonography (CTC) and colonoscopy in a national screening programme. Retrospective analysis of patient experience postal questionnaires. We included screenees from a fecal occult blood test (FOBt) based screening programme, where CTC was performed when colonoscopy was incomplete or deemed unsuitable. We analyzed questionnaire responses concerning communication of test risks, test-related discomfort and post-test pain, as well as complications. CTC and colonoscopy responses were compared using multilevel logistic regression. Of 67,114 subjects identified, 52,805 (79 %) responded. Understanding of test risks was lower for CTC (1712/1970 = 86.9 %) than colonoscopy (48783/50975 = 95.7 %, p < 0.0001). Overall, a slightly greater proportion of screenees found CTC unexpectedly uncomfortable (506/1970 = 25.7 %) than colonoscopy (10,705/50,975 = 21.0 %, p < 0.0001). CTC was tolerated well as a completion procedure for failed colonoscopy (unexpected discomfort; CTC = 26.3 %: colonoscopy = 57.0 %, p < 0.001). Post-procedural pain was equally common (CTC: 288/1970,14.6 %, colonoscopy: 7544/50,975,14.8 %; p = 0.55). Adverse event rates were similar in both groups (CTC: 20/2947 = 1.2 %; colonoscopy: 683/64,312 = 1.1 %), but generally less serious with CTC. Even though CTC was reserved for individuals either unsuitable for or unable to complete colonoscopy, we found only small differences in test-related discomfort. CTC was well tolerated as a completion procedure and was extremely safe. CTC can be delivered across a national screening programme with high patient satisfaction. (orig.)

  4. Retrospective Evaluation of Colonoscopy Results

    Directory of Open Access Journals (Sweden)

    Yaşar M et al.

    2010-09-01

    Full Text Available Aim: The aim of this study is the retrospective evaluation of colonoscopy results between 2005 January- 2009 December in General Surgery Department of Düzce University.Materials and Methods: Admitted to our department with lower gastrointestinal symptoms, and colonoscopy is indicated 500 male and 538 female total 1038 patients were performed flexible colonoscopic examinations after bowel cleansing.Results: According to results of colonoscopic findings, 42.9% No pathology, 32.5% Hemorrhoids, 17.6% Anal fissures were detected.Conclusion: As a result of this study, half of patients admitted to our surgical clinic with lower gastrointestinal complaints have no pathology and in the other half of patients have various pathologies such as hemorrhoids and anal fissures.

  5. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... ACG Obesity Initiative IBS Awareness IBD Awareness Colorectal Cancer ... the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients ...

  6. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... ACG Obesity Initiative IBS Awareness IBD Awareness Colorectal ... the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients ...

  7. Improving the Quality of Colonoscopy Bowel Preparation Using an Educational Video

    Directory of Open Access Journals (Sweden)

    Sateesh R Prakash

    2013-01-01

    Full Text Available Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P = 0.0029, mid-colon (P = 0.0027, rectosigmoid (P = 0.0008, fluid content (P = 0.03 and aggregate score (median score 4 versus 5; P = 0.0002. There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.

  8. Improving the quality of colonoscopy bowel preparation using an educational video.

    Science.gov (United States)

    Prakash, Sateesh Reddy; Verma, Siddharth; McGowan, John; Smith, Betsy E; Shroff, Anjali; Gibson, Gregory H; Cheng, Michael; Lowe Ii, Douglas; Gopal, Kavitha; Mohanty, Smruti R

    2013-12-01

    Colonoscopy is the preferred modality for colon cancer screening. A successful colonoscopy requires proper bowel preparation. Adequate bowel preparation continues to remain a limiting factor. One hundred thirty-three patients scheduled for an outpatient colonoscopy were prospectively randomized in a single-blinded manner to video or nonvideo group. In addition to written bowel preparation instructions, patients in the video group viewed a brief instructional video. Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale, while patient satisfaction with preparation was evaluated using a questionnaire. Statistical analyses were used to evaluate the impact of the instructional colonoscopy video. There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups. Participants who watched the video had better preparation scores in the right colon (P=0.0029), mid-colon (P=0.0027), rectosigmoid (P=0.0008), fluid content (P=0.03) and aggregate score (median score 4 versus 5; P=0.0002). There was no difference between the two groups with regard to patient satisfaction. Income, education level, sex, age and family history of colon cancer had no impact on quality of colonoscopy preparation or patient satisfaction. The addition of an instructional bowel preparation video significantly improved the quality of colon preparation.

  9. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Pouw, M.H.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of

  10. A Smartphone App for Improvement of Colonoscopy Preparation (ColoprAPP): Development and Feasibility Study.

    Science.gov (United States)

    Walter, Benjamin; Schmid, Roland; von Delius, Stefan

    2017-09-20

    Optimal bowel preparation is one of the major cornerstones for quality of colonoscopy. But poor bowel preparation still occurs in 10% to 25% of all patients. To optimize patient guidance, we developed a new smartphone app (ColoprAPP) for Android smartphones which guides and accompanies the patient starting 4 days before colonoscopy throughout the whole colonoscopy preparation procedure. The objective of this study was to assess the function of a newly developed smartphone app for supporting colonoscopy preparation. We carried out a prospective feasibility study including 25 patients undergoing outpatient colonoscopy at our hospital. As a control, we retrieved the data of 25 patients undergoing outpatient colonoscopy matching in age, sex, and indication for colonoscopy from our colonoscopy database. Patients were asked to download the smartphone app, ColoprAPP, in addition to being given the regular colonoscopy preparation leaflet. All colonoscopies were performed in the morning after using a split-dose preparation containing a polyethlene glycol-based purgative. The study was designed to test feasibility of the prototype, evaluate grade of bowel cleanliness (Boston bowel preparation scale [BBPS]), and assess patient satisfaction with the app. The smartphone app use was feasible in all patients. BBPS count as a marker for grade of bowel preparation was significantly higher in the smartphone app-supported group (mean 8.1 [SD 0.3] vs 7.1 [SD 0.4], P=.02). Left (mean 2.8 [SD 0.1] vs 2.4 [SD 0.11], P=.02) and transverse colon (mean 2.8 [SD 0.07] vs 2.4 [SD 0.11], Psmartphone app-supported group than in controls. Patient satisfaction with a smartphone app-supported colonoscopy preparation was high with an average numeric rating scale score for usefulness of 8.2 (visual analog scale 1-10). A novel developed smartphone app for reinforced education of bowel cleansing was feasible and led to high BBPS scores and patient satisfaction. ClinicalTrials.gov NCT02512328; https

  11. Enhanced flat adenoma detection rate with high definition colonoscopy plus i-scan for average-risk colorectal cancer screening

    Directory of Open Access Journals (Sweden)

    Antonio Rodríguez-D'Jesús

    Full Text Available Background and aim: The usefulness of high definition colonoscopy plus i-scan (HD+i-SCAN for average-risk colorectal cancer screening has not been fully assessed. The detection rate of adenomas and other measurements such as the number of adenomas per colonoscopy and the flat adenoma detection rate have been recognized as markers of colonoscopy quality. The aim of the present study was to compare the diagnostic performance of an HD+i-SCAN with that of standard resolution white-light colonoscope. Methods: This is a retrospective analysis of a prospectively collected screening colonoscopy database. A comparative analysis of the diagnostic yield of an HD+i-SCAN or standard resolution colonoscopy for average-risk colorectal screening was conducted. Results: During the period of study, 155/163 (95.1% patients met the inclusion criteria. The mean age was 56.9 years. Sixty of 155 (39% colonoscopies were performed using a HD+i-SCAN. Adenoma-detection-rates during the withdrawal of the standard resolution versus HD+i-SCAN colonoscopies were 29.5% and 30% (p = n.s.. Adenoma/colonoscopy values for standard resolution versus HD+i-SCAN colonoscopies were 0.46 (SD = 0.9 and 0.72 (SD = 1.3 (p = n.s.. A greater number of flat adenomas were detected in the HD+i-SCAN group (6/60 vs. 2/95 (p < .05. Likewise, serrated adenomas/polyps per colonoscopy were also higher in the HD+i-SCAN group. Conclusions: A HD+i-SCAN colonoscopy increases the flat adenoma detection rate and serrated adenomas/polyps per colonoscopy compared to a standard colonoscopy in average-risk screening population. HD+i-SCAN is a simple, available procedure that can be helpful, even for experienced providers. The performance of HD+i-SCAN and substantial prevalence of flat lesions in our average-risk screening cohort support its usefulness in improving the efficacy of screening colonoscopies.

  12. Intestinal obstruction from diaphragmatic hernia following colonoscopy.

    Science.gov (United States)

    Rustagi, Tarun

    2011-05-01

    Diaphragmatic hernias caused or exacerbated by colonoscopy are rare with only few cases reported. The author reports here an unusual case of herniation and incarceration of the colon into the left thoracic cavity without bowel perforation after an uneventful screening colonoscopy, through an occult focal diaphragmatic weakness from the patient's prior trauma.

  13. Simulation-based training for colonoscopy

    DEFF Research Database (Denmark)

    Preisler, Louise; Svendsen, Morten Bo Søndergaard; Nerup, Nikolaj

    2015-01-01

    The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models. Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonosc...

  14. Feasibility of joystick guided colonoscopy.

    Science.gov (United States)

    Rozeboom, Esther D; Broeders, Ivo A M J; Fockens, Paul

    2015-09-01

    The flexible endoscope is increasingly used to perform minimal invasive interventions. A novel add-on platform allows single-person control of both endoscope and instrument at the site of intervention. The setup changes the current routine of handling the endoscope. This study aims to determine if the platform allows effective and efficient manipulation to position the endoscope at potential intervention sites throughout the bowel. Five experts in flexible endoscopy first performed three colonoscopies on a computer simulator using the conventional angulation wheels. Next they trained with the joystick interface to achieve their personal level of intubation time with low pain score. 14 PhD students (novices) without hands-on experience performed the same colonoscopy case using either the conventional angulation wheels or joystick interface. Both novice groups trained to gain the average expert level. The cecal intubation time, pain score and visualization performance (% of bowel wall) were recorded. All experts reached their personal intubation time in 6 ± 6 sessions. Three experts completed their learning curve with low pain score in 8 ± 6 sessions. The novices required 11 ± 6 sessions using conventional angulation wheels, and 12 ± 6 sessions using the joystick interface. There was no difference in the visualization performance between the novice and between the expert groups. This study shows that the add-on platform enables endoscope manipulation required to perform colonoscopy. Experts need only a relatively short training period. Novices are as effective and as efficient in endoscope manipulation when comparing the add-on platform with conventional endoscope control.

  15. Formalizing Incomplete Knowledge in Incomplete Databases

    Institute of Scientific and Technical Information of China (English)

    沈一栋

    1992-01-01

    Up to now,no satisfactory theory has been established for formalizing incomplete knowledge in incomplete databases.In this paper,we clarify why existing closed world approaches,such as the CWA,the GCWA,the ECWA,circumscription,predicate completion and the PWA,fail to do so,and propose a new method,The method is an augmentation of both the ECWA and circumscription with the mechanism to discriminate implicitly expressed positive knowledge,negative knowledge and truly unknown knowledge.

  16. Performance of different categories of operators in simulated diagnostic colonoscopy.

    Science.gov (United States)

    Fasoli, Renato; Pertile, Riccardo; Seligman, Sonia; de Pretis, Giovanni

    2015-01-01

    The possible involvement, although limited to the diagnostic phase of the procedure, of nonmedical staff (particularly endoscopy nurses) in lower digestive endoscopy has recently been suggested. Computer-based simulators have demonstrated objective evaluation of technical skills in digestive endoscopy. The aim of this study was to evaluate basic colonoscopy skills of endoscopy nurses (naive operators), as compared with junior physician staff and senior endoscopists, through a virtual reality colonoscopy simulator. In this single-center, prospective, nonrandomized study, 3 groups of digestive endoscopy operators (endoscopy nurses, junior doctors [500 previous colonoscopies and >200/year]) completed six diagnostic cases generated by an endoscopic simulator (AccuTouch, Immersion Medical, Gaithersburg, MD). The performance parameters, collected by the simulator, were compared between groups. Five parameters have been considered for statistical analysis: time spent to reach the cecum; pain of any degree; severe/extreme pain; amount of insufflated air; percentage of visualized mucosa. Statistical analysis to compare the three groups has been performed by means of Wilcoxon test for two independent samples and by means of Kruskal-Wallis test for three independent samples (p < .05). Sixteen operators have been studied (six endoscopy nurses, five junior doctors, and five senior doctors); 96 colonoscopic procedures have been evaluated. Statistically significant differences between experts and naive operators were observed regarding time to reach the cecum and induction of severe/extreme pain, with both Kruskal-Wallis and Wilcoxon test (p < .05); all other comparisons did not reach statistical significance. Although, as expected, expert doctors exceeded both junior doctors and naive operators in some relevant quality parameters of simulated diagnostic colonoscopies, the results obtained by less expert performers--and particularly by nursing staff--appear satisfactory as in

  17. Colonoscopy

    Science.gov (United States)

    ... that is clear and liquid. Stool inside your intestine can prevent your doctor from clearly seeing the lining. You may need to follow a clear liquid ... doctor slowly removes the scope and examines the lining of your large intestine again. For the procedure, you will lie on ...

  18. Colonoscopy

    Science.gov (United States)

    ... of the scope. If needed, procedures, such as laser therapy , are also done. ... that requires surgery to repair Infection needing antibiotic therapy (very rare) Reaction to the medicine you are given to relax, causing breathing problems or low blood pressure

  19. Simulation-based training for colonoscopy

    DEFF Research Database (Denmark)

    Preisler, Louise; Svendsen, Morten Bo Søndergaard; Nerup, Nikolaj;

    2015-01-01

    The aim of this study was to create simulation-based tests with credible pass/fail standards for 2 different fidelities of colonoscopy models.Only competent practitioners should perform colonoscopy. Reliable and valid simulation-based tests could be used to establish basic competency in colonosco...... reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients....

  20. Patients' perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden.

    Science.gov (United States)

    Denters, Maaike J; Schreuder, Marthe; Depla, Annekatrien C T M; Mallant-Hent, Rosalie C; van Kouwen, Mariette C A; Deutekom, Marije; Bossuyt, Patrick M; Fockens, Paul; Dekker, Evelien

    2013-08-01

    Colonoscopy is a frequently performed procedure worldwide with a negative perception, leading to reluctance to undergo the procedure. Perceptions could differ depending on the specific indication for the colonoscopy. To compare patient satisfaction with the colonoscopy procedure between five different patient groups: inflammatory bowel disease (IBD), familial predisposition for cancer, adenoma/carcinoma surveillance, symptoms suggestive of cancer, and irritable bowel syndrome (IBS). A prospective questionnaire study was carried out in two regional hospitals and two tertiary teaching hospitals in the Netherlands. A total of 797 consecutive patients scheduled for colonoscopy between October 2009 and June 2010, 146 (18%) IBD, 153 (19%) adenoma or carcinoma surveillance, 104 (13%) familial predisposition, 280 (35%) symptoms suggestive of cancer, and 114 (14%) IBS-like symptoms, were included. Two questionnaires were administered: one on the day of the procedure and another 6 weeks after the procedure. The main outcome measurements were embarrassment, pain, burden, most burdensome aspect, and overall level of satisfaction. Patients with IBD and IBS reported significantly more embarrassment and burden from the bowel preparation phase (P=0.040 and 0.018, respectively) and more pain during the colonoscopy procedure (P=0.018). This difference in pain was also observed when adjusting for volume of sedation administered, familiarity with the endoscopist, duration of the colonoscopy, or whether or not an intervention was performed. All patient groups were less satisfied with the procedure at 6 weeks than directly after the colonoscopy; they recalled more embarrassment and burden, but less pain. Patient groups, defined by indication for colonoscopy, experience the colonoscopy procedure differently.

  1. Polyp Segmentation in NBI Colonoscopy

    Science.gov (United States)

    Gross, Sebastian; Kennel, Manuel; Stehle, Thomas; Wulff, Jonas; Tischendorf, Jens; Trautwein, Christian; Aach, Til

    Endoscopic screening of the colon (colonoscopy) is performed to prevent cancer and to support therapy. During intervention colon polyps are located, inspected and, if need be, removed by the investigator. We propose a segmentation algorithm as a part of an automatic polyp classification system for colonoscopic Narrow-Band images. Our approach includes multi-scale filtering for noise reduction, suppression of small blood vessels, and enhancement of major edges. Results of the subsequent edge detection are compared to a set of elliptic templates and evaluated. We validated our algorithm on our polyp database with images acquired during routine colonoscopic examinations. The presented results show the reliable segmentation performance of our method and its robustness to image variations.

  2. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    Science.gov (United States)

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. Adenoma Prevalence and Distribution Among US Latino Subgroups Undergoing Screening Colonoscopy.

    Science.gov (United States)

    Chablani, Sumedha V; Jandorf, Lina; DuHamel, Katherine; Lee, Kristen K; Sriphanlop, Pathu; Villagra, Cristina; Itzkowitz, Steven H

    2017-06-01

    Colorectal cancer (CRC) is the second leading malignancy diagnosed among US Latinos. Latinos in the USA represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Little is known about the frequency of CRC precursor lesions found at screening colonoscopy among Latino subgroups. The aim was to determine the prevalence and distribution of histologically confirmed adenomas found at screening colonoscopy among average-risk, asymptomatic US Latinos according to their subgroup and socio-demographic background. Cross-sectional analysis of pathological findings resulting from screening colonoscopy among average-risk, asymptomatic US Latinos aged ≥50 in two prospective randomized controlled trials at an academic medical center. Among the 561 Latinos who completed screening colonoscopy, the two largest subgroups were Puerto Ricans and Dominicans. The findings among both subgroups were: adenomas 30.6%, proximal adenomas 23.5%, advanced adenomas 12.0%, and proximal advanced adenomas 8.9%. These rates are at least as high as those found at screening colonoscopy among US whites. While Puerto Ricans were more likely than Dominicans to be born in the USA, speak English, be acculturated, have a smoking history, and be obese, there were no significant differences in adenoma rates between these subgroups. The prevalence of adenomas, advanced adenomas, and proximal neoplasia was high among both subgroups. These findings have implications for CRC screening and surveillance among the increasingly growing Latino population in the USA.

  4. Can Technology Improve the Quality of Colonoscopy?

    Science.gov (United States)

    Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

    2016-07-01

    In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

  5. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... Earn your CME from the convenience of your home or office by accessing ACG's web-based educational ... ACG Blog Follow ACG on Twitter Patients ACG Home / Media / What to Expect During a Colonoscopy What ...

  6. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... her through the day of her exam. The video reviews all clinical information regarding colonoscopy and urges viewers to follow all instructions from their health care providers. It runs for ...

  7. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... the day of her exam. The video reviews all clinical information regarding colonoscopy and urges viewers to follow all instructions from their health care providers. It runs ...

  8. What to Expect During a Colonoscopy

    Medline Plus

    Full Text Available ... Patient Website Patient Assistance Programs Practice Management Practice Management From articles to educational programs, ACG provides you ... for Clinical Research and Education, underscores the lifesaving importance of colorectal screening by colonoscopy. The video instills ...

  9. Peri-colonic haematoma following routine colonoscopy

    Directory of Open Access Journals (Sweden)

    Felicity Page

    2016-02-01

    Conclusion: This case highlights an unusual but potentially life threatening complication following colonoscopy. Endoscopists and clinicians should be aware of the diagnosis to allow for early recognition and appropriate management.

  10. Colonoscopy Screening Information Preferences Among Urban Hispanics

    OpenAIRE

    Ellison, Jennie; Jandorf, Lina; DuHamel, Katherine

    2011-01-01

    Existing disparities are evident in colorectal cancer (CRC) screening. We sought to assess preferred sources of colonoscopy screening information among Hispanics in East Harlem, NY. Face-to-face interviews were conducted among average-risk for CRC, non-symptomatic Hispanics in community-based sites and health clinics. SPSS 16 analysis explored the relationships between sociodemographic and health care variables and preferred sources of colonoscopy information for 395 participants. The top fou...

  11. Low rate of postpolypectomy bleeding among patients who continue thienopyridine therapy during colonoscopy.

    Science.gov (United States)

    Feagins, Linda A; Iqbal, Ramiz; Harford, William V; Halai, Akeel; Cryer, Byron L; Dunbar, Kerry B; Davila, Raquel E; Spechler, Stuart J

    2013-10-01

    It is not clear whether the cardiovascular risk of discontinuing treatment with antiplatelet agents, specifically the thienopyridines, before elective colonoscopy outweighs the risks of postpolypectomy bleeding (PPB). We studied the rate of PPB in patients who continue thienopyridine therapy during colonoscopy. We performed a prospective study of 516 patients not taking warfarin who received polypectomies during elective colonoscopies; 219 were receiving thienopyridines, and 297 were not (controls). The occurrence of immediate PPB and delayed PPB was recorded. Delayed PPB was categorized as clinically important if it resulted in repeat colonoscopy, hospitalization, or blood transfusion. Patients receiving thienopyridines were older and had significantly more comorbid diseases than controls; the mean number of polyps removed per patient was significantly higher (3.9 vs 2.9) in the thienopyridine group. Immediate PPB developed in 16 patients in the thienopyridine group (7.3%) and in 14 in the control group (4.7%, P = .25). Among patients who completed a 30-day follow-up analysis (96% of patients enrolled), clinically important, delayed bleeding occurred in 2.4% of patients receiving thienopyridines and in none of the controls (P = .01). All PPB events in both groups were resolved without surgery, angiography, or death. Although a significantly higher percentage of patients who continue thienopyridine therapy during colonoscopy and polypectomy develop clinically important delayed PPB than patients who discontinue therapy, the rate of PPB events is low (2.4%), and all are resolved without sequelae. The risk for catastrophic cardiovascular risks among patients who discontinue thienopyridine therapy before elective colonoscopies could therefore exceed the risks of PPB. ClinicalTrials.gov, Number NCT01647568. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  12. Safety and effectiveness of propofol sedation during and after outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Akira Horiuchi; Yoshiko Nakayama; Masashi Kajiyama; Naoyuki Kato; Tetsuya Kamijima; Yasuyuki Ichise; Naoki Tanaka

    2012-01-01

    AIM:To study the safety and effectiveness of propofol sedation for outpatient colonoscopy.METHODS:Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 60 mg for patients < 70 years old,40 mg for patients age 70-89 years,and 20 mg for those ≥ 90 years,and additional injections of 20 mg propofol were given up to a maximum of 200 mg.The principal parameters were the occurrence of adverse events within 24 h after colonoscopy and overall satisfaction for this procedure.Secondary parameters included successful procedure,respiratory depression,and other complications.RESULTS:Consecutive patients were entered prospectively and all 2101 entered successfully completed outpatient colonoscopy.The mean dose of propofol used was 96.4 mg (range 40-200 mg).Younger patients required higher doses of propofol than older patients (20-40 years vs ≥ 61 years:115.3±32 mg vs 89.7 ± 21 mg,P < 0.001).Transient supplemental oxygen supply was needed by five patients (0.2%);no other complications occurred.The questionnaires were completed by 1820 (87%) of 2101 patients and most rated their overall satisfaction as excellent (80%)or good (17%).The majority (65%) of patients drove home or to their office after their colonoscopy.Most (99%) were willing,to repeat the same procedure.No incidents occurred within 24 h after colonoscopy.CONCLUSION:Propofol sedation using a dose < 200 mg proved both safe and practical for outpatient colonoscopy.

  13. Virtual colonoscopy. A practical guide. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Lefere, Philippe; Gryspeerdt, Stefaan (eds.) [Stedelijk Ziekenhuis Roeselare (Belgium). Dept. of Radiology

    2010-07-01

    Virtual colonoscopy, or CT colonography, is a rapidly evolving technique for the detection of tumoral lesions in the colon. It is now accepted by the American Cancer Society as a valuable screening tool for both colorectal cancer and its adenomatous precursor. Virtual colonoscopy requires state-of-the-art technique with rigorous preparation, colonic distension, and optimization of scanning parameters. Dedicated reading, analysis, and reporting of the data sets are mandatory. With contributions from a number of leaders in the field, this book addresses all the important issues relating to virtual colonoscopy. There is a particular focus on practical aspects: how to start virtual colonoscopy in your department, the regular preparation, the importance of fecal tagging, how to reduce the preparation, how to obtain optimal colonic distension, and the correct scanning parameters. Imaging characteristics and pitfalls are considered in detail, with an extensive pictorial review of difficult lesions; the importance of computer-aided diagnosis is also discussed. In this second edition the text has been updated with the latest study results and developments in technology and new illustrations have been included. This book will be invaluable to every radiologist seeking information on how to perform the exciting technique of virtual colonoscopy. (orig.)

  14. Production in Incomplete Markets

    DEFF Research Database (Denmark)

    Crès, Hervé; Tvede, Mich

    Abstract In the present paper we study voting-based corporate control in a general equilibrium model with incomplete financial markets. Since voting takes place in a multi-dimensional setting, super-majority rules are needed to ensure existence of equilibrium. In a linear-quadratic setup we show ...

  15. Production in Incomplete Markets

    DEFF Research Database (Denmark)

    Crès, Hervé; Tvede, Mich

    Abstract In the present paper we study voting-based corporate control in a general equilibrium model with incomplete financial markets. Since voting takes place in a multi-dimensional setting, super-majority rules are needed to ensure existence of equilibrium. In a linear-quadratic setup we show...

  16. Production in incomplete markets

    DEFF Research Database (Denmark)

    Crès, Hervé; Tvede, Mich

    2009-01-01

    In the present paper we study voting-based corporate control in a general equilibrium model with incomplete financial markets. Since voting takes place in a multi-dimensional setting, super-majority rules are needed to ensure existence of equilibrium. In a linear-quadratic setup we show that the ...

  17. Colonoscopia: morbidade negligenciada Colonoscopy: neglected morbidity

    Directory of Open Access Journals (Sweden)

    Fernanda Bellotti Formiga

    2009-09-01

    Full Text Available OBJETIVO: Avaliar fatores de risco que determinam morbidade ao exame de colonoscopia. MÉTODOS: No período de março a junho de 2009 foram analisados prospectivamente 170 pacientes submetidos a exame colonoscópico. Fatores de risco como idade, sexo, indicação, exame ambulatorial/internado, efeitos adversos e qualidade do preparo intestinal, procedimento endoscópico, diagnóstico e intercorrência peri-procedimento foram relacionados. RESULTADOS: A média de idade da amostra foi 60,16 ± 14,69 anos, com predominância do sexo feminino. A indicação mais prevalente do exame foi seguimento pós-operatório. Três exames foram inconclusivos por mau preparo. Do restante, 36,53% foram normais e a maioria dos alterados apresentou pólipos, adenomatosos predominantemente. Quanto as comorbidades, 48,82% dos pacientes possuíam alguma comorbidade, sendo Hipertensão Arterial Sistêmica a mais prevalente. Apenas 22,94% dos pacientes apresentaram algum efeito adverso ao preparo. O preparo foi limpo em 65,88% dos exames, mostrando significância quando comparado a morbidade. Outro fator de significância estatística foi a realização de procedimentos (44,7% dos exames, sendo a maioria polipectomias. A morbidade chegou a 16,47%, sendo a desidratação a mais prevalente. Não houve mortalidade. CONCLUSÃO: A qualidade do preparo intestinal e a realização de procedimento endoscópico são fatores diretamente relacionados a morbidade do exame de colonoscopia.OBJECTIVE: The objective of this study is to analyze risks factors of morbidity on colonoscopy. METHOD: From March to June of 2009, 170 patients were examined and analyzed prospectively. Risks factors as age, sex, indication of exam, ambulatory or hospital exam, adverse events and quality of intestinal preparation, endoscopic procedure, diagnoses and incident before, during or after procedure were analyzed. RESULTS: The average age was 60,16±14,69 years old, with majority of female. The prevalent

  18. Patient Non-adherence and Cancellations Are Higher for Screening Colonoscopy Compared with Surveillance Colonoscopy.

    Science.gov (United States)

    Greenspan, Michael; Chehl, Navdeep; Shawron, Krista; Barnes, Lisa; Li, Hong; Avery, Elizabeth; Sims, Shannon; Losurdo, John; Mobarhan, Sohrab; Melson, Joshua

    2015-10-01

    A significant proportion of the eligible population is non-adherent to colonoscopy for colorectal cancer (CRC) screening. To define the demographic and clinical variables associated with non-adherence and multiple cancellations to scheduled colonoscopy within 1 year in a CRC screening and adenomatous polyp surveillance population. This was an observational cohort study of 617 consecutive patients scheduled to undergo colonoscopy at an outpatient academic tertiary care center for CRC screening or adenomatous polyp surveillance from January 2012 to September 2012. Overall, 551 patients (89.3%) were adherent and 66 (10.7%) were non-adherent to scheduled colonoscopy at 1 year. The relative risk for non-adherence was 5.42 [95% confidence interval (CI) 2.74-10.75] in patients undergoing colonoscopy for screening compared to those for surveillance (16.7 vs. 3.5% non-adherence, respectively, P non-adherence [odds ratio (OR) 12.69, 95% CI 4.18-38.51] and multiple cancellations (OR 2.33, 95% CI 1.27-4.31) by multiple regression analysis. Patients undergoing colonoscopy for CRC screening are significantly less likely to attend their scheduled procedure within a year and have more procedure cancellations than those undergoing surveillance colonoscopy.

  19. Quality of colonoscopy in Lynch syndrome.

    Science.gov (United States)

    Niv, Yaron; Moeslein, Gabriela; Vasen, Hans F A; Karner-Hanusch, Judith; Lubinsky, Jan; Gasche, Christoph

    2014-12-01

    Lynch syndrome (LS) accounts for 2 - 4 % of all colorectal cancers. Affected family members have a germline mutation in one of the DNA mismatch repair genes MLH1, PMS2, MSH2, or MSH6, and a lifetime risk for development of colorectal cancer of 25 - 75 %. Current guidelines recommend annual to biannual surveillance colonoscopy in mutation carriers. Several factors may predict failure to prevent interval cancer in LS: more lesions in the right colon; more flat ("non polypoid") and lateral growing polyps; small adenomas may already harbor high grade dysplasia or a high percentage of villous component and become advanced adenomas; there is a short duration of the adenoma - carcinoma sequence; synchronous lesions have high prevalence; patients are younger and less tolerant to colonoscopy (need more sedation); and repeated colonoscopies are needed for lifelong surveillance (patient experience is important for compliance). In order to prevent cancer in LS patients, surveillance colonoscopy should be performed in an endoscopic unit experienced with LS, every 1 - 2 years, starting at age 20 - 25 years, or 10 years younger than the age of first diagnosis in the family (whichever is first), and yearly after the age of 40 years. Colonoscopy in LS patients should be a very meticulous and precise procedure (i. e. taking sufficient withdrawal time, documentation of such warranted), with removal of all of the polyps, special attention to the right colon and alertness to flat lesions. Following quality indicators such as successful cleansing of the colon and removal of every polyp will probably improve prevention of interval cancers. At this moment, none of the new endoscopic techniques have shown convincing superiority over conventional high resolution white light colonoscopy.

  20. ORIGINAL ARTICLE: Will An Additional Observer Enhance Adenoma Detection During Colonoscopy?

    Directory of Open Access Journals (Sweden)

    Kevin D Mullen

    2012-07-01

    , increased rate of adenoma detection was seen for the adenomas of size 0.5 to 1.00 cm in the fellow and attending group (7.2% as compared to attending alone group (4.0%. There was no difference in the number of colonoscopies aborted due to poor bowel preparations There was no statistically significant difference in the number of colonoscopies aborted due to poor bowel prep, 91(5.9% Vs 32(4.5%. Conclusions: Our retrospective study has shown no improvement in the rate of adenoma detection when fellows performed colonoscopy with a supervising attending in comparison to procedures performed by attending alone. In fact, Adenoma Detection Rate (ADR and caecal intubation rates are increasingly seen as important quality measure. We propose that ADR needs to be used as a tool to assess trainee competency and should be a marker to evaluate proper training. These could be evaluated in randomized prospective trials in future.

  1. Repeat Colonoscopy within 6 Months after Initial Outpatient Colonoscopy in Ontario: A Population-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Lawrence Paszat

    2017-01-01

    Full Text Available Background. The goal of this study is to examine utilization of early repeat colonoscopy ≤ 6 months after an index procedure. Methods. We identified persons having repeat colonoscopy ≤ 6 months following outpatient colonoscopy without prior colonoscopy ≤ 5 years or prior diagnosis of colorectal cancer (CRC. We modeled repeat colonoscopy using a generalized estimating equation with an exchangeable correlation structure to account for clustering of patients by endoscopist. Results. The population included 334,663 persons, 7,892 (2.36% of whom had an early repeat colonoscopy within 6 months. Overall, endoscopist prior year colonoscopy volume was inversely related to repeat ≤ 6 months. Repeat colonoscopy ≤ 6 months varied by the clinical setting of the index colonoscopy (adjusted OR = 1.41 (95% CI 1.29–1.55 at nonhospital facilities compared to teaching or community hospitals. Among those who had polypectomy or biopsy, the adjusted OR for early repeat ≤ 6 months was elevated among those whose index colonoscopy was at a nonhospital facility (OR 1.44, 95% CI 1.30–1.60, compared to those at a teaching hospital or community hospital. Conclusions. Repeat colonoscopy ≤ 6 months after an index procedure is associated with the clinical setting of the index colonoscopy.

  2. [Colonoscopy with carbon dioxide insufflation: luxury or neccesity?].

    Science.gov (United States)

    Herráiz, Maite

    2013-01-01

    Colonoscopy is an essential diagnostic and therapeutic tool for many gastrointestinal diseases and is also a key element in the prevention and early diagnosis of colon cancer. Despite numerous technical advances, colonoscopy continues to be uncomfortable for patients, both during and after the procedure. To a large extent, the discomfort of colonoscopy depends on the need to distend the colon, which usually produces abdominal pain. Although ambient air is usually employed to expand and inflate the colon, in the last few years devices that allow carbon dioxide (CO(2)) insufflation in colonoscopy have been developed. This gas is a highly attractive option for pain-free colonoscopy.

  3. Virtual colonoscopy-induced perforation in a patient with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Sunny H Wong; Vincent WS Wong; Joseph JY Sung

    2007-01-01

    We report a case of sigmoid colon perforation in a patient with Crohn's disease undergoing computed-tomographic (CT) colonography. A 70-year-old patient with Crohn's disease with terminal ileitis and sigmoid stricture underwent CT colonography after incomplete conventional colonoscopy. During the procedure, the colon was inflated by air insufflation and the patient developed abdominal pain with radiological evidence of retroperitoneal and intraperitoneal free gas. Hartmann's operation was performed. This case highlights that CT colonography is not risk-free. The risk of perforation may be higher in patients with inflammatory bowel disease.

  4. Simulation-based training for colonoscopy

    DEFF Research Database (Denmark)

    Preisler, Louise; Svendsen, Morten Bo Søndergaard; Nerup, Nikolaj;

    2015-01-01

    simulations-based modalities provided reliable and valid assessments of competence in colonoscopy and credible pass/fail standards were established for both the tests. We propose to use these standards in simulation-based training programs before proceeding to supervised training on patients....

  5. [Massive rectal blood loss after colonoscopy

    NARCIS (Netherlands)

    Kampschreur, M.T.; Kats-Ugurlu, G.; Suylen, R.J. van; Schryver, A.M. de

    2012-01-01

    A 70-year-old man presented with acute lower gastrointestinal bleeding. A colonoscopy performed one and a half months prior had revealed diverticulosis in the sigmoid colon; a small polyp located 10 cm from the anal margin had been removed at that time. The presenting patient was haemodynamically un

  6. Outpatient Provider Concentration and Commercial Colonoscopy Prices

    Directory of Open Access Journals (Sweden)

    Alexis Pozen PhD

    2015-04-01

    Full Text Available The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178 433 claims from 169 providers (104 systems. The mean system market share was 76% (SD = 0.34 and the mean real (deflated price was US$1363 (SD = 374, ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility’s bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  7. Monitoring and improving quality of colonoscopy

    NARCIS (Netherlands)

    S.C. van Doorn

    2015-01-01

    Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the western world. High quality colonoscopy has the potential to reduce CRC mortality by detecting carcinomas in early stages and reduce its incidence by detecting and removing its main precursor lesions, adenomas. Variability

  8. Outpatient provider concentration and commercial colonoscopy prices.

    Science.gov (United States)

    Pozen, Alexis

    2015-01-01

    The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  9. Incomplete invention of drugs.

    Science.gov (United States)

    Hisa, Tomoyuki

    2007-02-01

    Scientists seldom know the differences between "rejected invention", "non-invention", "incomplete invention", "invention yet to be completed" and "defective invention". The Japanese Supreme Court appointed me as a specialist member (Article 92-2, Code of Civil Procedure) of intellectual property division for medical and biological patents. Herein, I present scientists to the differences and which of them are patentable. In order to prevent oneself from being taken for granted for the scientists' noblesse oblige by clever business administrations, the scientists must know the borderline between patentable or non-patentable.

  10. Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: a prospective, pre-post intervention, proof-of-concept study.

    Directory of Open Access Journals (Sweden)

    Rüdiger Rupp

    Full Text Available The compact Motorized orthosis for home rehabilitation of Gait (MoreGait was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern.Prospective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI.Twenty-five (5 tetraplegia, 20 paraplegia participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD years sensorimotor iSCI (7 ASIA Impairment Scale (AIS C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II: Interquartile range 9 to 16 completed the training (45 minutes / day, at least 4 days / week, 8 weeks. Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy.After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100% for both self-selected (Mean 139.4% ± 35.5% (SD and maximum (Mean 143.1% ± 40.6% (SD speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD. One device-related adverse event (pressure sore on the big toe occurred in over 800 training sessions.Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation

  11. Carbon dioxide insufflation during screening unsedated colonoscopy: a randomised clinical trial.

    Science.gov (United States)

    Szura, Miroslaw; Pach, Radoslaw; Matyja, Andrzej; Kulig, Jan

    2015-01-01

    One of the methods used to reduce pain and discomfort during colonoscopy is insufflation of carbon dioxide instead of air. However, the actual benefit of carbon dioxide insufflation is not unequivocally proven. The aim of the study was to evaluate the advantages of carbon dioxide insufflation during screening colonoscopy. A total of 200 patients undergoing screening colonoscopy between 2010 and 2011 were included in the prospective, randomized study carried out in a surgical referral center. Screening unsedated colonoscopy with either air or carbon dioxide insufflation was performed; patients were randomly assigned to air or carbon dioxide group by means of computer-generated randomization lists. All examinations were performed in an ambulatory setting with standard videocolonoscopes. The main outcomes analyzed were (a) duration of the entire procedure, (b) cecal intubation time, and (c) pain severity immediately, 15, and 60 min after the procedure. Group I included 59 women and 41 men and group II included 51 women and 49 men. The duration of the procedure was circa 10 min in both groups. Pain score values immediately and 15 min after the procedure were similar in both groups (P=0.624 and 0.305, respectively). A lower pain score was observed only after 60 min in patients insufflated with carbon dioxide (1.28 vs. 1.54, P=0.008). No pain reduction was observed in women and in obese patients (BMI>30). Carbon dioxide insufflation during unsedated screening colonoscopy does not decrease the duration of the procedure and appears to reduce pain intensity at 60 min after examination to an extent without clinical significance. The study was registered at ClinicalTrials.gov, number NCT01461564.

  12. Value of patient time invested in the colonoscopy screening process: time requirements for colonoscopy study.

    Science.gov (United States)

    Jonas, Daniel E; Russell, Louise B; Sandler, Robert S; Chou, Jon; Pignone, Michael

    2008-01-01

    Previous cost-effectiveness analyses of colorectal cancer screening have not considered the value of patient time despite consensus recommendations to do so. The authors sought to estimate the amount and value of patient time required for screening colonoscopy. Patients who were scheduled to undergo screening colonoscopy were recruited from a university endoscopy center. Participants completed a time diary for the screening colonoscopy process, including time spent in preparation, travel, waiting, colonoscopy, and recovery. The authors defined several time intervals and estimated their value. The primary time interval of interest, called occupied time, included preparation, travel, waiting, the colonoscopy procedure, and on-site recovery. Time was valued at the 2005 average wage rate. The authors performed sensitivity analyses to test other time intervals and wage rates. They then incorporated patient time costs into a previously published cost-effectiveness analysis of colorectal cancer screening to examine their impact. One hundred ten subjects completed the study. The sample was 57% female, 85% Caucasian, and 90% insured (40% Medicare, 4% Medicaid). The mean occupied time was 23.2 hours, worth $432 at the average wage rate. The authors estimate that including patient time costs in cost-effectiveness analysis would increase the cost per life-year saved with screening colonoscopy by 68%, from $13,100 to $22,000. Sensitivity analyses showed that the increase could range from 17% to 224% depending on the time interval valued. Patient time constitutes an important cost in colonoscopy screening and should be included in cost-effectiveness analyses.

  13. How many meals should you skip before undergoing a colonoscopy? A randomized controlled trial: association between duration of abstinence from solid food to cleanliness of the bowel in patients undergoing elective colonoscopy

    Directory of Open Access Journals (Sweden)

    Aziz DA

    2015-01-01

    Full Text Available Dayang A Abdul Aziz,1 Loh H Peow,2 Jasiah Zakaria,2 Mahmud M Nor,3 Zarina A Latiff41Pediatric Surgery Unit, Department of Surgery, UKM Medical Center, Kuala Lumpur, Malaysia; 2Department of Surgery, Hospital Tuanku Jaafar, Seremban, Malaysia; 3Department of Surgery, Universiti Sains Islam, 4Department of Pediatrics, UKM Medical Center, Kuala Lumpur, Malaysia Purpose: An ideal cleansing regime to prepare a clean colon is important for yielding best results during colonoscopy. Many centers practice strict dietary modifications – ie, skipping more than one solid meal 1 or 2 days before the procedure with the consumption of a bowel cleansing agent. No formal studies have been performed to determine how long a patient should withhold solid meals during bowel preparation prior to an outpatient colonoscopy. Materials and methods: A randomized prospective controlled trial was carried out with patients who underwent elective colonoscopy at a tertiary general hospital in Malaysia for 7 months’ duration. Patients were randomized into one of two groups. Group A patients abstained from a solid diet for 24 hours (the last solid meal was breakfast the day before the colonoscopy. Group B patients abstained from a solid diet 14 hours prior to the colonoscopy (the last solid meal was dinner the day before the colonoscopy. We standardized the time for the oral intake of sodium phosphosoda in both groups. The Boston Bowel Preparation Scale was used to grade the cleanliness between the two groups and a score ≥2 was taken as clean bowel preparation. Results: A total of 178 patients (each arm had 89 patients were recruited for this study. Group A showed a mean bowel cleanliness score of 3. Group B showed a mean bowel cleanliness score of 2.5. However, there was a significant difference in bowel cleanliness between the groups (P≤0.05. Conclusion: Abstinence of solid food for either 24 hours or 14 hours prior to the colonoscopy both produced clean bowel

  14. Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Oliver J. Ziff

    2013-01-01

    Full Text Available Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD revealed large gastric fundal varices and computed tomography (CT revealed splenic vein thrombosis. The ensuing left-sided (sinistral hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications.

  15. Computed tomographic colography and virtual colonoscopy.

    Science.gov (United States)

    Ahlquist, D A; Hara, A K; Johnson, C D

    1997-07-01

    CT colography (CTC) is a powerful new approach to imaging the colorectum and a promising screening tool for the detection of colorectal neoplasia. From data generated by a helical CT scan, CTC uses virtual reality technology to produce highly discriminant two- and three-dimensional images that permit a thorough and minimally invasive evaluation of the entire colorectum. A dynamic CTC display technique from the endoluminal perspective, called cf2virtual colonoscopy,cf1 simulates colonoscopy by "flying" through the three-dimensional colon image. CTC offers potential advantages in diagnostic performance, safety, and patient acceptance over current screening approaches. Although early data suggest excellent colorectal polyp detection rates, this nascent technology will require rigorous clinical investigation and further refinements to assess adequately its place in the endoscopist's armamentarium.

  16. Development of a continuum robot for colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Hu Haiyan; Li Mantian; Wang Pengfei; Feng Yuan; Sun Lining

    2009-01-01

    A novel continuum robot for colonoscopy is presented. The aim is to develop a robot for colonoscopy which can provide the same functions as conventional colonoscope, but much less pain and discomfort for patient. In contrast to traditional rigid-link robot, the robot features a continuous backbone with no joints. The continuum robot is 300 mm in total length and 12 mm in diameter that is less than the average diameter of human colon (20 mm). The robot has a total of 4 DOF (degrees of freedom) and is actuated remotely by 6 hybrid step motors through super-elastic NiTi wires. Its shape can be changed with high dexterity, therefore ensuring its adaptability to the tortuous shape of human colon. The mechanical structure, kinematics and DSP-based control system are discussed; prototype experiments are carried out to validate the kinematics model and to show the motion performances.

  17. Torsion of Wandering Gallbladder following Colonoscopy

    Directory of Open Access Journals (Sweden)

    Sean R. Warfe

    2013-01-01

    Full Text Available Torsion of the gallbladder is an uncommon condition that may present as an acute abdomen. Its preoperative diagnosis can often be challenging due to its variable presentation, with specific sonographic signs seen infrequently. We describe, to our knowledge, the first case of torsion of a wandering gallbladder following a colonoscopy in a 69-year-old female who presented with acute abdominal pain after procedure. This was discovered intraoperatively, and after a subsequent cholecystectomy, she had an uncomplicated recovery.

  18. Preliminary development of the Active Colonoscopy Training Model

    Directory of Open Access Journals (Sweden)

    Choi J

    2011-06-01

    Full Text Available JungHun Choi1, Kale Ravindra1, Randolph Robert1, David Drozek21Mechanical Engineering, Ohio University, Athens, OH, USA; 2College of Osteopathic Medicine, Ohio University, Athens, OH, USAAbstract: Formal colonoscopy training requires a significant amount of time and effort. In particular, it requires actual patients for a realistic learning experience. The quality of colonoscopy training varies, and includes didactic courses and procedures proctored by skilled surgeons. A colonoscopy training model is occasionally used as part of the training method, but the effects are minute due to both the simple and tedious training procedures. To enhance the educational effect of the colonoscopy training model, the Active Colonoscopy Training Model (ACTM has been developed. ACTM is an interactive colonoscopy training device which can create the environment of a real colonoscopy procedure as closely as possible. It comprises a configurable rubber colon, a human torso, sensors, a display, and the control part. The ACTM provides audio and visual interaction to the trainee by monitoring important factors, such as forces caused by the distal tip and the shaft of the colonoscope and the pressure to open up the lumen and the localization of the distal tip. On the computer screen, the trainee can easily monitor the status of the colonoscopy, which includes the localization of the distal tip, maximum forces, pressure inside the colon, and surgery time. The forces between the rubber colon and the constraints inside the ACTM are measured and the real time display shows the results to the trainee. The pressure sensors will check the pressure at different parts of the colon. The real-time localized distal tip gives the colonoscopy trainee easier and more confident operation without introducing an additional device in the colonoscope. With the current need for colonoscopists and physicians, the ACTM can play an essential role resolving the problems of the current

  19. Repeat colonoscopy after a colonoscopy with a negative result in Ontario: a population-based cohort study.

    Science.gov (United States)

    Hol, Lieke; Sutradhar, Rinku; Gu, Sumei; Baxter, Nancy N; Rabeneck, Linda; Tinmouth, Jill M; Paszat, Lawrence F

    2015-01-01

    Data suggest the overuse of repeat colonoscopies, especially in patients at low risk for colorectal cancer. Our objective was to evaluate the time to repeat colonoscopies in low-risk patients aged 50-79 years old and the associated patient- and endoscopist-related factors. All patients aged 50-79 years of age who underwent a complete outpatient colonoscopy with a negative result between 2000 and 2007 were identified from the Ontario Health Insurance Plan database. A colonoscopy performed within 5.5 years of follow-up after the index colonoscopy was considered an early repeat colonoscopy. Patient, endoscopist and endoscopy setting characteristics were recorded and their association with an early repeat colonoscopy was determined using an extended Cox proportional hazards regression model. The cohort consisted of 546 467 patients: 55.4% of the patients were female with a mean age of 61.1 years (95% confidence interval [CI] 61.1-61.2). The cumulative percentage of early repeat colonoscopy after 5.5 years was 33.7%. The rate decreased significantly between 2000 and 2007 (hazard ratio [HR] 0.35, 95% CI 0.34-0.36). General surgeons were associated with a higher risk of early repeat colonoscopy than gastroenterologists (HR 1.27, 95% CI 1.25-1.28). Endoscopists practising in a nonhospital setting were more likely to perform an early repeat colonoscopy (HR 1.26, 95% CI 1.22-1.30) than endoscopists at a hospital. This study showed that there was overuse of early repeat colonoscopy in more than 30% of patients who were at low risk for colorectal cancer. The risk decreased significantly between 2000 and 2007 but was still greater than 20% in 2007. Our findings can be used to develop targeted educational interventions among subgroups of endoscopists with a higher rate of early repeat colonoscopy.

  20. Patient satisfaction with colonoscopy: A literature review and pilot study

    Science.gov (United States)

    Chartier, Lucas; Arthurs, Erin; Sewitch, Maida J

    2009-01-01

    BACKGROUND: Current guidelines recommend that colonoscopic colorectal cancer screening be undertaken every 10 years after the age of 50 years. However, because the procedure does not meet criteria that promote screening uptake, patient satisfaction with colonoscopy may encourage repeat screening. OBJECTIVE: To systematically review the literature and conduct a pilot study of patient satisfaction with the colonoscopy experience. METHODS: All cohort studies from January 1997 to August 2008 in the MEDLINE database that measured either patient satisfaction with colonoscopy, patient willingness to return for colonoscopy under the same conditions or patient preference for colonoscopy compared with other large bowel procedures were identified. The search was supplemented by journal citation lists in the retrieved articles. RESULTS: Of the 29 studies identified, 15 met the inclusion criteria. Consistently, the vast majority of patients (approximately 95%) were very satisfied with their colonoscopy experience. Patient satisfaction was similar for screening and nonscreening colonoscopy. Patient willingness to return for the procedure ranged from 73% to 100%. Of the five studies that examined modality preference, three studies reported the majority of patients preferred colonography to colonoscopy and two studies reported the reverse. Our pilot study findings mirrored those of other studies that were conducted in the United States. The major limitation of the included studies was that patients who were most dissatisfied may have gone elsewhere to have their colonoscopy. CONCLUSIONS: Patients were very satisfied with colonoscopy. The majority were willing to return for repeat testing under the same conditions, and colonoscopy was not preferred over other modalities. However, studies were limited by methodological shortcomings. PMID:19319384

  1. Towards continuous improvement of endoscopy standards: Validation of a colonoscopy assessment form.

    LENUS (Irish Health Repository)

    2012-02-01

    Aim: Assessment of procedural colonoscopy skills is an important and topical. The aim of this study was to develop and validate a competency-based colonoscopy assessment form that would be easy to use, suitable for the assessment of junior and senior endoscopists and potentially be a useful instrument to detect differences in performance standards following different training interventions. Method: A standardised assessment form was developed incorporating a checklist with dichotomous yes\\/no responses and a global assessment section incorporating several different elements. This form was used prospectively to evaluate colonoscopy cases during the period of the study in several university teaching hospitals. Results were analysed using ANOVA with Bonferroni corrections for post-hoc analysis. Results: 81 procedures were assessed, performed by eight consultant and 19 trainee endoscopists. There were no serious errors. When divided into three groups based on previous experience (novice, intermediate and expert) the assessment form demonstrated statistically significant differences between all three groups (p<0.05). When separate elements were taken into account, the global assessment section was a better discriminator of skill level than the checklist. Conclusion: This form is a valid, easy to use assessment method. We intend to use it to assess the value of simulator training in trainee endoscopists. It also has the potential to be a useful training tool when feedback is given to the trainee.

  2. Listening to music decreases need for sedative medication during colonoscopy: a randomized, controlled trial.

    Science.gov (United States)

    Harikumar, R; Raj, Mehroof; Paul, Antony; Harish, K; Kumar, Sunil K; Sandesh, K; Asharaf, Syed; Thomas, Varghese

    2006-01-01

    Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. A prospective randomized, controlled trial was undertaken to determine whether music decreases the requirement for midazolam during colonoscopy and makes the procedure more comfortable and acceptable. Patients undergoing elective colonoscopy between October 2003 and February 2004 were randomized to either not listen to music (Group 1; n=40) or listen to music of their choice (Group 2; n=38) during the procedure. All patients received intravenous midazolam on demand in aliquots of 2 mg each. The dose of midazolam, duration of procedure, recovery time, pain and discomfort scores and willingness to undergo a repeat procedure using the same sedation protocol were compared. Patients in Group 2 received significantly less midazolam than those in Group 1 (p=0.007). The pain score was similar in the two groups, whereas discomfort score was lower in Group 2 (p=0.001). Patients in the two groups were equally likely to be willing for a repeat procedure. Listening to music during colonoscopy helps reduce the dose of sedative medications and decreases discomfort experienced during the procedure.

  3. Diagnosis of incomplete Kawasaki disease

    Directory of Open Access Journals (Sweden)

    Jeong Jin Yu

    2012-03-01

    Full Text Available Several authors suggested that the clinical characteristics of incomplete presentation of Kawasaki disease are similar to those of complete presentation and that the 2 forms of presentation are not separate entities. Based on this suggestion, a diagnosis of incomplete Kawasaki disease in analogy to the findings of complete presentation is reasonable. Currently, the diagnosis of incomplete Kawasaki disease might be made in cases with fewer classical diagnostic criteria and with several compatible clinical, laboratory or echocardiographic findings on the exclusion of other febrile illness. Definition of incomplete presentation in which coronary artery abnormalities are included as a necessary condition, is restrictive and specific. The validity of the diagnostic criteria of incomplete presentation by the American Heart Association should be thoroughly tested in the immediate future.

  4. Automatic and unbiased assessment of competence in colonoscopy

    DEFF Research Database (Denmark)

    Preisler, Louise; Søndergaard Svendsen, Morten Bo; Søndergaard, Bo;

    2016-01-01

    Background and aims: Colonoscopy is a difficult procedure to master. Increasing demands for colonoscopy, due to screening and surveillance programs, have highlighted the need for competent performers. Valid methods for assessing technical skills are pivotal for training and assessment. This study...

  5. Recent advances in colonoscopy [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Thomas J.W. Lee

    2016-03-01

    Full Text Available Colonoscopy is an important and frequently performed procedure. It is effective in the prevention of colorectal cancer and is an important test in the investigation of many gastrointestinal symptoms. This review focuses on developments over the last 5 years that have led to changes in aspects of colonoscopy, including patient preparation, technical factors, therapeutic procedures, safety, and quality.

  6. Role of colonoscopy in patients with persistent acute diverticulitis

    Institute of Scientific and Technical Information of China (English)

    Adi Lahat; Henit Yanai; Emad Sakhnini; Yoram Menachem; Simon Bar-Meir

    2008-01-01

    AIM:To identify patients with persistent acute diverticulitis who might benefit from an early colonoscopy during their first hospitalization.METHODS:All patients hospitalized between July 2000 and December 2006 for acute diverticulitis who underwent colonoscopy were included in the study.Patients were followed during hospitalization and after discharge.Patients were considered to have a persistent course of acute diverticulitis if symptoms continued after 1 wk of conventional treatment with IV antibiotics,or if symptoms recurred within 2 mo after discharge.Patients were considered to benefit from an early colonoscopy if the colonoscopy was therapeutic or if it changed a patient's outcome.RESULTS:Three hundred and six patients were hospitalized between July 2000 and December 2006 with the diagnosis of acute diverticulitis.Two hundred and twenty four of these were included in the study group.Twenty three patients (10.3%) fulfilled the criteria for a persistent course of acute diverticulitis.Of them,four patients (17.4%) clearly benefited from an early colonoscopy;these patients' clinical course is described.None of the patients with a regular non-persistent course demonstrated any benefit from colonoscopy.CONCLUSION:Early colonoscopy detected other significant pathology,which accounted for the clinical presentation in 17% of patients with persistent acute diverticulitis.Therefore,we believe an early colonoscopy should be considered in all patients with a persistent clinical course.

  7. Colonoscopy training for nurse endoscopists : A feasibility study

    NARCIS (Netherlands)

    Koornstra, Jan J.; Corporaal, Sietske; Giezen-Beintema, Wiesje M.; de Vries, Sietske E.; van Dullemen, Hendrik M.

    2009-01-01

    Background: Screening by using colonoscopy is recommended in many countries to reduce the risk of death from colorectal cancer. Given the limited supply of medical endoscopists, nurse endoscopists may represent an economic alternative. Objective: To develop a colonoscopy training program for nurse e

  8. Improving the Quality of Color Colonoscopy Videos

    Directory of Open Access Journals (Sweden)

    Dahyot Rozenn

    2008-01-01

    Full Text Available Abstract Colonoscopy is currently one of the best methods to detect colorectal cancer. Nowadays, one of the widely used colonoscopes has a monochrome chipset recording successively at 60 Hz and components merged into one color video stream. Misalignments of the channels occur each time the camera moves, and this artefact impedes both online visual inspection by doctors and offline computer analysis of the image data. We propose to restore this artefact by first equalizing the color channels and then performing a robust camera motion estimation and compensation.

  9. Improving the quality of colonoscopy bowel preparation using a smart phone application: a randomized trial.

    Science.gov (United States)

    Lorenzo-Zúñiga, Vicente; Moreno de Vega, Vicente; Marín, Ingrid; Barberá, Marta; Boix, Jaume

    2015-07-01

    Getting ready for a colonoscopy is difficult and involves many steps. Information given to patients is very important for adherence to treatment. We created a novel smart phone application (SPA) aimed to increase bowel preparation quality and patient satisfaction. We carried out a prospective, endoscopist-blinded, randomized, controlled trial. We enrolled 260 outpatient (58% female, age range 21-75 years) owners of a smartphone. Patients were allocated to two different protocols: instructions provided by SPA (SPA group; n = 108) or written instructions with visual aids (control group; n = 152). All procedures were carried out in the afternoon and patients received the same purgative regimen (2 L polyethylene glycol (PEG) solution plus ascorbic acid), in a full-dose same-day regimen. The study was designed to detect an improvement in quality of bowel preparation using the Harefield Cleansing Scale (HCS) scale. Effect of protocol on patient satisfaction was assessed with a specific questionnaire at the time of colonoscopy. Proportion of patients who obtained successful bowel preparation for colonoscopy (HCS A or B) was significantly higher in the SPA group than in the control group (100% vs 96.1%, respectively; P = 0.037). Mean global HCS scores were similar in both groups. Patient-reported tolerability and overall experience with the prescribed bowel preparation were significantly higher for the SPA group than for the control group. Successful cleansing and patient acceptability with the use of SPA were superior to written instructions in outpatients submitted for colonoscopy using 2 L PEG solution plus ascorbic acid. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

  10. Effect Supermint oil (Peppermint oil on children's pain during Colonoscopy

    Directory of Open Access Journals (Sweden)

    M Najafi

    2014-04-01

    Full Text Available Introduction: Pain during colonoscopy, especially in children, including the challenges faced by the medical team. The aim of study was investigation the analgesic effect Supermint oil (peppermint oil on pain in children during colonoscopy. Methods and Materials: In this clinical trial study, 101 children (7-14 years old candidate colonoscopy were randomly divided into two groups, respectively. About half an hour before the colonoscopy case group (n=51 was administrated oral drops Supermint oil (peppermint oil. Patients were filled a pediatric pain questionnaire. In control group (n=50 filled a questionnaire without any administration. Data were analyzed using SPSS version 11.5 and (T-test and Paired sample t-test, Corraletion,Man withney. Results: Mean value of pain, duration of colonoscopy in control group was 5/60+1/85 and in case group was 4/20+1/70 and this diference was significant (P

  11. A centrally generated primary care physician audit report does not improve colonoscopy uptake after a positive result on a fecal occult blood test in Ontario's ColonCancerCheck program.

    Science.gov (United States)

    Stock, D; Rabeneck, L; Baxter, N N; Paszat, L F; Sutradhar, R; Yun, L; Tinmouth, J

    2017-02-01

    Timely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. In the present study, we evaluated the effectiveness of centrally generated, physician-targeted audit and feedback to improve colonoscopy uptake after a positive fecal occult blood test (fobt) result within Ontario's population-wide ColonCancerCheck Program. This prospective cohort study used data sets from Ontario's ColonCancerCheck Program (2008-2011) that were linked to provincial administrative health databases. Cox proportional hazards regression was used to estimate the effect of centralized, physician-targeted audit and feedback on colonoscopy uptake in an Ontario-wide fobt-positive cohort. A mailed physician audit and feedback report identifying individuals outstanding for colonoscopy for 3 or more months after a positive fobt result did not increase the likelihood of colonoscopy uptake (hazard ratio: 0.95; 95% confidence interval: 0.79 to 1.13). Duration of positive fobt status was strongly inversely associated with the hazard of follow-up colonoscopy (p for linear trend: result outstanding for 3 or more months. Mailed physician-targeted screening audit and feedback reports alone are unlikely to improve compliance with follow-up colonoscopy in Ontario. Other interventions such as physician audits or automatic referrals, demonstrated to be effective in other jurisdictions, might be warranted.

  12. Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy.

    Science.gov (United States)

    Becerra, Lino; Aasted, Christopher M; Boas, David A; George, Edward; Yücel, Meryem A; Kussman, Barry D; Kelsey, Peter; Borsook, David

    2016-04-01

    Colonoscopy is an invaluable tool for the screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of this study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8 ± 9.1; 6 female) undergoing routine colonoscopy (ie, no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. Near-infrared spectroscopy data captured during the procedure was analyzed offline to evaluate the brains' responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients' facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. Although some patients report recollection of procedural pain after the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

  13. The analysis of incomplete data.

    Science.gov (United States)

    Hartley, H. O.; Hocking, R. R.

    1971-01-01

    In this paper, we attempt to provide a simple taxonomy for incomplete-data problems and at the same time develop unified methods of analysis. The emphasis is on techniques which are natural extensions of the complete-data analysis and which will handle rather general classes of incomplete-data problems as opposed to custom-made techniques for special problems. The principle of estimation is either maximum likelihood or is at least based on maximum likelihood.

  14. Standard forward-viewing colonoscopy versus full-spectrum endoscopy: an international, multicentre, randomised, tandem colonoscopy trial

    Science.gov (United States)

    Gralnek, Ian M.; Siersema, Peter D.; Halpern, Zamir; Segol, Ori; Melhem, Alaa; Suissa, Alain; Santo, Erwin; Sloyer, Alan; Fenster, Jay; Moons, Leon M. G.; Dik, Vincent K.; D’Agostino, Ralph B.; Rex, Douglas K.

    2014-01-01

    Summary Background Although colonoscopy is the accepted standard for detection of colorectal adenomas and cancers, many adenomas and some cancers are missed. To avoid interval colorectal cancer, the adenoma miss rate of colonoscopy needs to be reduced by improvement of colonoscopy technique and imaging capability. We aimed to compare the adenoma miss rates of full-spectrum endoscopy colonoscopy with those of standard forward-viewing colonoscopy. Methods We did an international, multicentre, randomised trial at three sites in Israel, one site in the Netherlands, and two sites in the USA between Feb 1, 2012, and March 31, 2013. Patients aged 18–70 years referred for colorectal cancer screening, polyp surveillance, or diagnostic assessment underwent same-day, back-to-back tandem colonoscopy with standard forward-viewing colonoscope and the full-spectrum endoscopy colonoscope. The patients were randomly assigned (1:1), via computer-generated randomisation with block size of 20, to which procedure was done first. The endoscopist was masked to group allocation until immediately before the start of colonoscopy examinations; patients were not masked. The primary endpoint was adenoma miss rates. We did per-protocol analyses. This trial is registered with ClinicalTrials.gov, number NCT01549535. Findings 197 participants were enrolled. 185 participants were included in the per-protocol analyses: 88 (48%) were randomly assigned to receive standard forward-viewing colonoscopy first, and 97 (52%) to receive full-spectrum endoscopy colonoscopy first. By per-lesion analysis, the adenoma miss rate was significantly lower in patients in the full-spectrum endoscopy group than in those in the standard forward-viewing procedure group: five (7%) of 67 vs 20 (41%) of 49 adenomas were missed (p<0·0001). Standard forward-viewing colonoscopy missed 20 adenomas in 15 patients; of those, three (15%) were advanced adenomas. Full-spectrum endoscopy missed five adenomas in five patients in

  15. Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location.

    Science.gov (United States)

    Blum-Guzman, Juan Pablo; Wanderley de Melo, Silvio

    2017-07-01

     Recent studies suggest that differences in biological characteristics and risk factors across cancer site within the colon and rectum may translate to differences in survival. It can be challenging at times to determine the precise anatomical location of a lesion with a luminal view during colonoscopy. The aim of this study is to determine if there is a significant difference between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative and pathology reports after colon surgery.  A single-center retrospective analysis of colonoscopies of patient with reported colonic masses from January 2005 to April 2014 (n = 380) was carried. Assessed data included demography, operative and pathology reports. Findings were compared: between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative reports or pathology samples.  We identified 380 colonic masses, 158 were confirmed adenocarcinomas. Of these 123 underwent surgical resection, 27 had to be excluded since no specific location was reported on their operative or pathology report. An absolute difference between endoscopic and surgical location was found in 32 cases (33 %). Of these, 22 (23 %) differed by 1 colonic segment, 8 (8 %) differed by 2 colonic segments and 2 (2 %) differed by 3 colonic segments.  There is a significant difference between the location of colorectal cancers reported by gastroenterologists during endoscopy and the actual anatomical location noted on operative or pathology reports after colon surgery. Endoscopic tattooing should be used when faced with any luminal lesions of interest.

  16. Automatic and unbiased assessment of competence in colonoscopy

    DEFF Research Database (Denmark)

    Preisler, Louise; Svendsen, Morten Bo Søndergaard; Søndergaard, Bo

    2016-01-01

    . The Generalizability coefficient (G-coefficient) was 0.80, and a Decision-study (D-study) revealed that four recordings were sufficient to ensure a G-coefficient above 0.80. We showed a positive correlation between CoPS and experience with Pearson's r of 0.61 (P ... is the first clinical descriptive report of a novel colonoscopy assessment tool based on Magnetic Endoscopic Imaging (MEI) data and the aim was to gather validity evidence based on the data collected using the "Colonoscopy Progression Score" (CoPS). Methods: We recorded 137 colonoscopy procedures performed...

  17. Comparison of 64-Detector CT Colonography and Conventional Colonoscopy in the Detection of Colorectal Lesions

    Directory of Open Access Journals (Sweden)

    Devir

    2016-01-01

    Full Text Available Background Colon cancer is a leading cause of morbidity and mortality in developed countries. The early detection of colorectal cancer using screening programs is important for managing early-stage colorectal cancers and polyps. Modalities that allow examination of the entire colon are conventional colonoscopy, double contrast barium enema examination and multi-detector computed tomography (MDCT colonography. Objectives To compare CT colonography and conventional colonoscopy results and to evaluate the accuracy of CT colonography for detecting colorectal lesions. Patients and Methods In a prospective study performed at Gastroenterology and Radiology Departments of Medical Faculty of Eskisehir Osmangazi University, CT colonography and colonoscopy results of 31 patients with family history of colorectal carcinoma, personal or family history of colorectal polyps, lower gastrointestinal tract bleeding, change in bowel habits, iron deficiency anemia and abdominal pain were compared. Regardless of the size, CT colonography and conventional colonoscopy findings for all the lesions were cross - tabulated and the sensitivity, specificity, and positive and negative predictive values were calculated. To assess the agreement between CT colonography and conventional colonoscopy examinations, the Kappa coefficient of agreementt was used. Statistical analysis was performed by SPSS ver 15.0. Results Regardless of the size, MDCT colonography showed 83% sensitivity and 95% specificity, with a positive predictive value of 95% and a negative predictive value of 83% for the detection of colorectal polyps and masses. MDCT colonography displayed 92% sensitivity and 95% specificity, with a positive predictive value of 92% and a negative predictive value of 95% for polyps ≥ 10 mm. For polyps between 6mm and 9 mm, MDCT colonography displayed 75% sensitivity and 100% specificity, with a positive predictive value of 100% and a negative predictive value of 90%. For polyps

  18. Item calibration in incomplete testing designs

    NARCIS (Netherlands)

    Eggen, Theo J.H.M.; Verhelst, Norman D.

    2011-01-01

    This study discusses the justifiability of item parameter estimation in incomplete testing designs in item response theory. Marginal maximum likelihood (MML) as well as conditional maximum likelihood (CML) procedures are considered in three commonly used incomplete designs: random incomplete, multis

  19. Study: Colonoscopy After 75 May Not Be Worth It

    Science.gov (United States)

    ... Study: Colonoscopy After 75 May Not Be Worth It But, expert says age shouldn't be only ... and remove cancerous growths in the colon, but it may not provide much cancer prevention benefit after ...

  20. Audit of colonoscopy practice in Lagos University Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Adedapo Osinowo

    2016-01-01

    Full Text Available Introduction: Recent procurement of new endoscopies and accessories led to the reactivation of diagnostic and therapeutic colonoscopy services at our center. A preliminary audit is deemed necessary after a 2-year period of open access colonoscopy. Objective: To assess the pattern of indications, diagnostic yield, and selected key performance indicators in the practice of colonoscopy at our tertiary hospital. Patients and Methods: The endoscopy reports of all patients that underwent colonoscopy from January 2012 to April 2014 were reviewed. The demographic data, indications, and endoscopic findings were recorded. Information on cecal intubation, colonoscopy withdrawal time, polyp detection, adverse events, and bowel preparation quality were also extracted and analyzed. Results: Colonoscopy was performed in 149 patients. They were 81 males and 68 females, aged between 18 and 101 years with a mean of 46.9 ± 22.7 years. 126 (84.5% patients had a colonoscopy for symptomatic conditions while 5 (4% were for screening. Bowel preparation was assessed to be excellent in 81 (54.4%, adequate in 42 (28.2%, and inadequate in 26 (17.4% patients, respectively. The cecal intubation rate (CIR was 80.2%, polyp detection rate 7.4%, average colonoscopy withdrawal time was 6 min 53 s, overall diagnostic yield 55.9% and there were no adverse events. Tumors were seen in 19 patients (10.1%; 13 were located in the rectum, three in the sigmoid and three in the descending colon. Conclusion: The audit revealed that our CIR could be improved by a more effective bowel preparation, increased expertise, and procedure volume of endoscopists. Tumors of the colorectum were detected in 10.1% of patients.

  1. Colonoscopy Practice in Lagos, Nigeria: A Report of an Audit

    Directory of Open Access Journals (Sweden)

    C. A. Onyekwere

    2013-01-01

    Full Text Available Background. Colonoscopy effectiveness depends on the quality of the examination. Community-based report of quality of colonoscopy practice in a developing country will help in determining standard and also serve as a stimulus for improvement in service. Aim. To review the quality of colonoscopy practice and document pattern of colonic disease including polyp detection rate in Lagos, Nigeria. Method. A protocol that captured the patients’ demographics, indication, and some quality indices of colonoscopy was developed and sent to all the identified colonoscopy units in Lagos to complete for all procedures performed between January 2011 and June 2012. All data were collated and analyzed. The quality indices studied were compared with guideline standard. Results. Twelve colonoscopy centers were identified but only nine centers responded. The gastroenterologist/endoscopists were physicians (3 and surgeons (5. Six hundred and seven colonoscopy procedures were performed during this period (M : F = 333 : 179 while the sex was not disclosed in 95 subjects. The examination indications were lower GI bleeding (24.2%, altered bowel habits (9.2%, lower abdominal pain (9.1%, screening for CRC (4.3% and unspecified (46.8%. Conscious sedation was generally used while bowel preparation (good in 81.4% was done with low residue diet and stimulant laxatives. Caecal intubation rate was 81.2%. Common endoscopic findings were haemorrhoids (43.2%, polyps/masses (13.4%, diverticulosis (11.1%, and no abnormality (23.4%. Polyp was detected in 6.8% of cases. Conclusion. Colonoscopy utilization is low, and the quality of practice is suboptimal; although limited resources could partly explain this, however it is not clear if the low rate of polyp detection is due to missed lesions or low population incidence.

  2. Appropriateness of colonoscopy: Diagnostic yield and safety in guidelines

    Institute of Scientific and Technical Information of China (English)

    Mario Grassini; Carlo Verna; Paolo Niola; Monica Navino; Edda Battaglia; Gabrio Bassotti

    2007-01-01

    AIM:To evaluate if the guidelines for the appropriateness of performing colonoscopy by American Society for Gastrointestinal Endoscopy (AGSE) and Italian Society of Digestive Endoscopy (SIED) yield a good diagnostic efficacy and do not present risks of missing important colonic pathologies in an Italian population sample.METHODS:A total of 1017 consecutive patients (560 men and 457 women; mean age 64.4 ± 16 years)referred to an open-access endoscopy unit for colonoscopy from July 2004 to May 2006 were evaluated according to ASGE and SIED guidelines for appropriateness of performing the procedure. Diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of colonoscopies performed.RESULTS:About 85.2% patients underwent colonoscopy that was considered appropriate based on at least one ASGE or SIED criterion,while it was considered inappropriate for 14.8% of patients. The diagnostic yield of colonoscopy was significantly higher for appropriate colonoscopies (26.94% vs 10.6%,P<0.001) than for inappropriate colonoscopies (5.3%). There was no missed colorectal cancer following the ASGE/SIED criteria.CONCLUSION:ASGE/SIED guidelines have shown a good diagnostic yield and the rate of missing relevant colonic pathologies seems very low. Unfortunately,the percentage of inappropriate referrals for colonoscopy in an open-access endoscopy system is still high,despite the number of papers published on the issue and the definition of international guidelines. Further steps are required to update and standardize the guidelines toincrease their diffusion and to promote educational programs for general practitioners.

  3. Image Retrieval Method for Multiscale Objects from Optical Colonoscopy Images

    Directory of Open Access Journals (Sweden)

    Hirokazu Nosato

    2017-01-01

    Full Text Available Optical colonoscopy is the most common approach to diagnosing bowel diseases through direct colon and rectum inspections. Periodic optical colonoscopy examinations are particularly important for detecting cancers at early stages while still treatable. However, diagnostic accuracy is highly dependent on both the experience and knowledge of the medical doctor. Moreover, it is extremely difficult, even for specialist doctors, to detect the early stages of cancer when obscured by inflammations of the colonic mucosa due to intractable inflammatory bowel diseases, such as ulcerative colitis. Thus, to assist the UC diagnosis, it is necessary to develop a new technology that can retrieve similar cases of diagnostic target image from cases in the past that stored the diagnosed images with various symptoms of colonic mucosa. In order to assist diagnoses with optical colonoscopy, this paper proposes a retrieval method for colonoscopy images that can cope with multiscale objects. The proposed method can retrieve similar colonoscopy images despite varying visible sizes of the target objects. Through three experiments conducted with real clinical colonoscopy images, we demonstrate that the method is able to retrieve objects of any visible size and any location at a high level of accuracy.

  4. Incomplete contract and divisional structures

    NARCIS (Netherlands)

    T. Bao; Y. Wang

    2009-01-01

    In this paper we want to analyze the internal divisional structure within an organi- zation in the framework of incomplete contract theory. We use the framework of Aghion and Tirole (1997) and define the managerial control structure as \\sequence of search". A key feature of this paper which differen

  5. Clostridium Difficile, Colitis, and Colonoscopy: Pediatric Perspective.

    Science.gov (United States)

    McConnie, Randolph; Kastl, Arthur

    2017-08-01

    Review tests available for detection of Clostridium difficile (C. Diff) induced disease, including when such tests should be done in children and how they should be interpreted. Multiple tests are available for detecting disease due to C. diff. These include colonoscopy and stool analysis. Colonoscopy with biopsy is the most sensitive test for detecting the presence of colitis. The toxins produced by the C. diff. (toxin A, toxin B, and binary toxin) are the agents that cause injury and disease. Only toxin producing C. diff. Strains will cause disease. Binary toxin by itself is not thought to produce disease. Binary toxin causes disease in humans when present with toxin A and B producing bacteria, and has been implicated with fulminant life threatening disease. Stool analyses vary in sensitivity and specificity depending on the assay used. The presence of toxin producing strains of C diff. in the stool does not equate with disease. The presence of a toxin-producing bacteria or toxins (A or B) only equates with disease if diarrhea or a diseased colon (toxic megacolon, ileus, and sepsis) is present. Nucleic acid amplification testing (NAAT), when used in the stool from patients with diarrhea, appears to be the most efficient study to detect the gene that encodes for toxin A and B and thus to diagnose C. diff.-induced disease. Infants have a high carriage rate of C. diff. and are believed not to develop disease from it or its toxins. Infants should not be tested for C. difficile. The NAAT is most specific when done on patients with diarrhea with liquid stools. Testing for C. difficile should only be done on patients with diarrhea. One can assume that a patient who has no diarrhea and is not ill does not have C. diff.-induced disease. Treatment should be limited to patients with diarrhea who test positive for C. diff. toxin (A or B) or toxin-producing bacteria. Direct testing for binary toxin is not commercially available. Binary toxin is only thought to cause disease

  6. Patients' perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden

    NARCIS (Netherlands)

    Denters, M.J.; Schreuder, M.; Depla, A.C.; Mallant-Hent, R.C.; Kouwen, M.C.A. van; Deutekom, M.; Bossuyt, P.M.; Fockens, P.; Dekker, E. den

    2013-01-01

    BACKGROUND: Colonoscopy is a frequently performed procedure worldwide with a negative perception, leading to reluctance to undergo the procedure. Perceptions could differ depending on the specific indication for the colonoscopy. AIMS: To compare patient satisfaction with the colonoscopy procedure be

  7. Patients' perception of colonoscopy: patients with inflammatory bowel disease and irritable bowel syndrome experience the largest burden

    NARCIS (Netherlands)

    Denters, M.J.; Schreuder, M.; Depla, A.C.; Mallant-Hent, R.C.; Kouwen, M.C.A. van; Deutekom, M.; Bossuyt, P.M.; Fockens, P.; Dekker, E. den

    2013-01-01

    BACKGROUND: Colonoscopy is a frequently performed procedure worldwide with a negative perception, leading to reluctance to undergo the procedure. Perceptions could differ depending on the specific indication for the colonoscopy. AIMS: To compare patient satisfaction with the colonoscopy procedure be

  8. Incomplete Bivariate Fibonacci and Lucas -Polynomials

    Directory of Open Access Journals (Sweden)

    Dursun Tasci

    2012-01-01

    Full Text Available We define the incomplete bivariate Fibonacci and Lucas -polynomials. In the case =1, =1, we obtain the incomplete Fibonacci and Lucas -numbers. If =2, =1, we have the incomplete Pell and Pell-Lucas -numbers. On choosing =1, =2, we get the incomplete generalized Jacobsthal number and besides for =1 the incomplete generalized Jacobsthal-Lucas numbers. In the case =1, =1, =1, we have the incomplete Fibonacci and Lucas numbers. If =1, =1, =1, =⌊(−1/(+1⌋, we obtain the Fibonacci and Lucas numbers. Also generating function and properties of the incomplete bivariate Fibonacci and Lucas -polynomials are given.

  9. Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy

    Science.gov (United States)

    Triant, Virginia A.; Ehrenfeld, Jesse M.; Lu, Zhigang; Arpino, Paul; Losina, Elena

    2014-01-01

    Summary Concerns regarding possible interactions between midazolam and antiretroviral medicines have caused clinicians to use second-line sedatives, such as diazepam, instead. We demonstrated that patients who received midazolam during colonoscopy had similar clinical outcomes as those who received diazepam. Background Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (IV) midazolam versus IV diazepam, a second-line agent, during colonoscopy. Methods We conducted a retrospective analysis of adult HIV-infected patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure, nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. Results We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (48 versus 45.7 minutes, P = 0.68), nadir systolic blood pressure (97 versus 101.6 mmHg, P = 0.06), nadir oxygen saturation (94.6 versus 94.8%, P = 0.72), or rate of abnormal cardiac rhythm (11.4 versus 19.7%, P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91 versus 74%, P = 0.0075), but no patient required reversal of sedation or became unresponsive. Conclusions Although IV midazolam interacts with ART, we did not find evidence that patients who received this agent for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be

  10. Factors influencing quality of bowel preparation for colonoscopy.

    Science.gov (United States)

    Romero, Ronald V; Mahadeva, Sanjiv

    2013-02-16

    Recent technological advances in colonoscopy have led to improvements in both image enhancement and procedural performance. However, the utility of these technological advancements remain dependent on the quality of bowel preparation during colonoscopy. Poor bowel preparation has been shown to be associated with lower quality indicators of colonoscopy performance, such as reduced cecal intubation rates, increased patient discomfort and lower adenoma detection. The most popular bowel preparation regimes currently used are based on either Polyethylene glycol-electrolyte, a non-absorbable solution, or aqueous sodium phosphate, a low-volume hyperosmotic solution. Statements from various international societies and several reviews have suggested that the efficacy of bowel preparation regimes based on both purgatives are similar, although patients' compliance with these regimes may differ somewhat. Many studies have now shown that factors other than the type of bowel preparation regime used, can influence the quality of bowel preparation among adult patients undergoing colonoscopy. These factors can be broadly categorized as either patient-related or procedure-related. Studies from both Asia and the West have identified patient-related factors such as an increased age, male gender, presence of co-morbidity and socio-economic status of patients to be associated with poor bowel preparation among adults undergoing routine out-patient colonoscopy. Additionally, procedure-related factors such as adherence to bowel preparation instructions, timing of bowel purgative administration and appointment waiting times for colonoscopy are recognized to influence the quality of colon cleansing. Knowledge of these factors should aid clinicians in modifying bowel preparation regimes accordingly, such that the quality of colonoscopy performance and delivery of service to patients can be optimised.

  11. Screening colonoscopy tests in acromegaly patients – authors’ observations

    Directory of Open Access Journals (Sweden)

    Joanna Elżbieta Malicka

    2016-09-01

    Full Text Available Background . The prevalence of adenomas which cause acromegaly is estimated at 50–70 mln people. They secrete excess of growth hormone and increase the risk of benign and malignant tumours. Intestinal tumours are considered the most common types of lesion. In order to diagnose them early, a colonoscopic examination should be performed every 2–3 years. Objectives. The aim of the study was to estimate the frequency of the performed colonoscopies in acromegaly patients, and to assess their applicability in the detection of neoplastic lesions of the colon. Material and methods . The study involved 69 patients with acromegaly (26 M, 43 F, aged 26–83 years (mean 58.9 ± 11.0. The authors analyzed medical records and the results of additional tests. Results . Colonoscopy was performed in 30 patients (43.5% of cases, was well tolerated and without serious complications. 70% of colonoscopies revealed polyps of the colon and 6.7% revealed colon carcinoma. In 9 patients (30% of conducted studies colonoscopy examination showed no pathological changes. Only in 4 cases the test was performed more than once. Conclusions . Current recommendations regarding colonoscopic examinations in all acromegaly patients are implemented in less than half of the cases. Recommendations relating to colonoscopy being repeated every 2–3 years are followed occasionally. Colonoscopy is a diagnostic test of great significance. In 70% of cases it enables the detection and removal of pathological lesions of the colon. As a low-invasive, safe and well-tolerated examination it should be performed in all patients. GPs should make acromegaly patients aware of the importance of colonoscopy and refer them for periodic follow-up examinations.

  12. Uncertainty, incompleteness, chance, and design

    CERN Document Server

    Sols, Fernando

    2013-01-01

    The 20th century has revealed two important limitations of scientific knowledge. On the one hand, the combination of Poincar\\'e's nonlinear dynamics and Heisenberg's uncertainty principle leads to a world picture where physical reality is, in many respects, intrinsically undetermined. On the other hand, G\\"odel's incompleteness theorems reveal us the existence of mathematical truths that cannot be demonstrated. More recently, Chaitin has proved that, from the incompleteness theorems, it follows that the random character of a given mathematical sequence cannot be proved in general (it is 'undecidable'). I reflect here on the consequences derived from the indeterminacy of the future and the undecidability of randomness, concluding that the question of the presence or absence of finality in nature is fundamentally outside the scope of the scientific method.

  13. Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

    Institute of Scientific and Technical Information of China (English)

    Iqbal Siddique; Krishna Mohan; Fuad Hasan; Anjum Memon; Istvan Patty; Basil Al-Nakib

    2005-01-01

    AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered"generally indicated"; it was "generally not indicated" for20%, and it was "not listed" for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the "generally indicated" (38%) followed by "not listed"(13%) and "generally not indicated" (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was "generally indicated" (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications "not listed" in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.

  14. Transition Complexity of Incomplete DFAs

    Directory of Open Access Journals (Sweden)

    Yuan Gao

    2010-08-01

    Full Text Available In this paper, we consider the transition complexity of regular languages based on the incomplete deterministic finite automata. A number of results on Boolean operations have been obtained. It is shown that the transition complexity results for union and complementation are very different from the state complexity results for the same operations. However, for intersection, the transition complexity result is similar to that of state complexity.

  15. Colonoscopy tutorial software made with a cadaver's sectioned images.

    Science.gov (United States)

    Chung, Beom Sun; Chung, Min Suk; Park, Hyung Seon; Shin, Byeong-Seok; Kwon, Koojoo

    2016-11-01

    Novice doctors may watch tutorial videos in training for actual or computed tomographic (CT) colonoscopy. The conventional learning videos can be complemented by virtual colonoscopy software made with a cadaver's sectioned images (SIs). The objective of this study was to assist colonoscopy trainees with the new interactive software. Submucosal segmentation on the SIs was carried out through the whole length of the large intestine. With the SIs and segmented images, a three dimensional model was reconstructed. Six-hundred seventy-one proximal colonoscopic views (conventional views) and corresponding distal colonoscopic views (simulating the retroflexion of a colonoscope) were produced. Not only navigation views showing the current location of the colonoscope tip and its course, but also, supplementary description views were elaborated. The four corresponding views were put into convenient browsing software to be downloaded free from the homepage (anatomy.co.kr). The SI colonoscopy software with the realistic images and supportive tools was available to anybody. Users could readily notice the position and direction of the virtual colonoscope tip and recognize meaningful structures in colonoscopic views. The software is expected to be an auxiliary learning tool to improve technique and related knowledge in actual and CT colonoscopies. Hopefully, the software will be updated using raw images from the Visible Korean project. Copyright © 2016 Elsevier GmbH. All rights reserved.

  16. Ileoscopy in 39 hematochezia patients with normal colonoscopy

    Institute of Scientific and Technical Information of China (English)

    SP Misra; M Dwivedi; V Misra

    2006-01-01

    AIM: To assess the role of retrograde terminal ileoscopy in hematochezia patients with normal colonoscopy.METHODS: Between January 1997 and March 2005,39 hematochezia patients (males 36, females 3, mean age 44.7 years) with a reported normal colonoscopy underwent a repeat colonoscopy. After reaching the cecum, attempt was made to localize the ileocecal valve and intubate the terminal ileum. Any abnormality in the mucosa of the terminal ileum was carefully recorded and biopsies were obtained from suspiciouslooking lesions.RESULTS: During the study period there were 39 patients admitted for hematochezia in whom colonoscopy till cecum did not reveal any abnormality. Fulllength colonoscopy till the cecum could be performed in all the patients. The terminal ileum could be intubated in 36 patients. No abnormality was noted in 31 patients. Ileal ulcers were noted in two patients.Nodularity along with ulceration of the ileal mucosa, a Dieulafoy's lesion, and an angiomatous malformation were noted in one patient each. Histological examination of the biopsies obtained from the ulcers revealed typical tuberculous lesion in the patient with nodularity and ulceration. One of the patients had typhoid ulcers and another had non-specific ulcers.CONCLUSION: Retrograde terminal ileoscopy gives limited but valuable information, in patients with hematochezia and should be attempted in all such patients.

  17. Quality indicators for colonoscopy: Current insights and caveats

    Institute of Scientific and Technical Information of China (English)

    Hendrikus; JM; Pullens; Peter; D; Siersema

    2014-01-01

    Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them,as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequatebowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.

  18. Laparoscopic Splenectomy for Traumatic Splenic Injury after Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Salim Abunnaja

    2012-09-01

    Full Text Available Colonoscopy is a widespread diagnostic and therapeutic procedure. The most common complications include bleeding and perforation. Splenic rupture following colonoscopy is rarely encountered and is most likely secondary to traction on the splenocolic ligament. Exploratory laparotomy and splenectomy is the most commonly employed therapeutic intervention for this injury reported in the literature. We present the case of a patient with this potentially fatal complication who was treated successfully at our institution. To our knowledge it is the first report in the literature of laparoscopic splenectomy as a successful minimally invasive treatment of splenic rupture following colonoscopy. The patient was a 62-year-old female who underwent screening colonoscopy with polypectomies at the cecum, descending colon and rectum. Immediately following the procedure she developed abdominal pain and had a syncopal episode. Clinical, laboratory and imaging findings were suggestive of hemoperitoneum and a ruptured spleen. A diagnostic laparoscopy was emergently performed and revealed a grade IV splenic laceration and hemoperitoneum. Laparoscopic splenectomy was completed safely and effectively. The patient’s postoperative recovery was uneventful. We conclude that splenic rupture after colonoscopy is a rare but dangerous complication. A high index of suspicion is required to recognize it early. Awareness of this potential complication can lead to optimal patient outcome. Laparoscopic splenectomy may be a feasible treatment option.

  19. Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

    Directory of Open Access Journals (Sweden)

    Desmond Leddin

    2013-01-01

    Full Text Available BACKGROUND: Differences between American (United States [US] and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.

  20. Impact of Intestinal Ultrasound on Classification and Management of Crohn's Disease Patients with Inconclusive Colonoscopy.

    Science.gov (United States)

    Wilkens, Rune; Novak, Kerri L; Lebeuf-Taylor, Eleonore; Wilson, Stephanie R

    2016-01-01

    Background and Aims. We aim to evaluate the benefit of ultrasound in the assessment of Crohn's disease and to demonstrate its potential contribution to disease management. Methods. We conduct a retrospective review of adult patients with Crohn's disease examined with sonography and colonoscopy within 30 days. Study patients were identified in whom colonoscopy did not access a pathological segment, detected and evaluated by ultrasonography. Changes in management were predominantly attributed to ultrasound in those cases where the diseased segment was not assessed on endoscopy. Results. From 115 patients with temporally related ileocolonoscopy and ultrasound, 41 had disease fully assessed on ultrasound only, with complications in 26/41. Twenty-nine of 41 had mild or no endoscopic inflammation with moderate or severe disease on ultrasound at the same segment or at a segment proximal to the reach of the endoscope. Changes in management were significantly attributed to ultrasound in 22 of these 29 patients. Conclusion. The benefit of cross-sectional imaging is invaluable for the comprehensive assessment of bowel not shown on ileocolonoscopy. Ultrasound may make a significant contribution to correct classification of disease extent and severity of Crohn's disease. Prospective studies are needed to further understand the contribution of US in patient management.

  1. Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

    Institute of Scientific and Technical Information of China (English)

    Sasinee Tongprasert; Abhasnee Sobhonslidsuk; Sasivimol Rattanasiri

    2009-01-01

    AIM: To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS: A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared. RESULTS: Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles (100.00% vs 42.37%, P < 0.0001) but simethicone failed to demonstrate improvement in adequacy of colon preparation (90.16% vs 81.36%, P = 0.17). Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication. CONCLUSION: The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.

  2. Addition of senna improves quality of colonoscopy preparation with magnesium citrate

    Institute of Scientific and Technical Information of China (English)

    Stergios Vradelis; Evangelos Kalaitzakis; Yalda Sharifi; Otto Buchel; Satish Keshav; Roger W Chapman; Barbara Braden

    2009-01-01

    AIM: To prospectively investigate the effectiveness and patient's tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. METHODS: A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone ( n = 160) or magnesium citrate and senna granules ( n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. RESULTS: The percentage of procedures rescheduled because of insufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group ( P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen ( P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or headache. However, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). CONCLUSION: The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome.

  3. Automatic classification of images with appendiceal orifice in colonoscopy videos.

    Science.gov (United States)

    Cao, Yu; Liu, Danyu; Tavanapong, Wallapak; Wong, Johnny; Oh, JungHwan; de Groen, Piet C

    2006-01-01

    Colonoscopy is an endoscopic technique that allows a physician to inspect the inside of the human colon. In current practice, videos captured from colonoscopic procedures are not routinely stored for either manual or automated post-procedure analysis. In this paper, we introduce new algorithms for automated detection of the presence of the shape of the opening of the appendix in a colonoscopy video frame. The appearance of the appendix in colonoscopy videos indicates traversal of the colon, which is an important measurement for evaluating the quality of colonoscopic procedures. The proposed techniques are valuable for (1) establishment of an effective content-based retrieval system to facilitate endoscopic research and education; and (2) assessment and improvement of the procedural skills of endoscopists, both in training and practice.

  4. Procedural Skills Education – Colonoscopy as a Model

    Directory of Open Access Journals (Sweden)

    Maitreyi Raman

    2008-01-01

    Full Text Available Traditionally, surgical and procedural apprenticeship has been an assumed activity of students, without a formal educational context. With increasing barriers to patient and operating room access such as shorter work week hours for residents, and operating room and endoscopy time at a premium, alternate strategies to maximizing procedural skill development are being considered. Recently, the traditional surgical apprenticeship model has been challenged, with greater emphasis on the need for surgical and procedural skills training to be more transparent and for alternatives to patient-based training to be considered. Colonoscopy performance is a complex psychomotor skill requiring practioners to integrate multiple sensory inputs, and involves higher cortical centres for optimal performance. Colonoscopy skills involve mastery in the cognitive, technical and process domains. In the present review, we propose a model for teaching colonoscopy to the novice trainee based on educational theory.

  5. Syncope as the Presenting Feature of Splenic Rupture after Colonoscopy

    Directory of Open Access Journals (Sweden)

    Daniel Jamorabo

    2014-01-01

    Full Text Available Splenic rupture is a rare, catastrophic complication of colonoscopy and an exceptional cause of syncope. This injury is believed to be from direct trauma or tension on the splenocolic ligament with subsequent capsule avulsion or else from direct instrument-induced splenic injury. Diagnosis requires a high index of suspicion that may be absent because presentation can be subtle, nonspecific, and delayed anywhere from hours to days and therefore not easily attributed to a recent endoscopy. We describe a case of syncope as the initial manifestation of splenic rupture after colonoscopy. Our patient’s pain was delayed; his discomfort was mild and not localized to the left upper quadrant. Clinicians should consider syncope, lightheadedness, and drop in hemoglobin in absence of rectal bleeding following a colonoscopy as possible warning signs of imminent or emergent splenic injury.

  6. Assessment of colonoscopy by use of magnetic endoscopic imaging

    DEFF Research Database (Denmark)

    Nerup, Nikolaj; Preisler, Louise; Svendsen, Morten Bo Søndergaard;

    2015-01-01

    BACKGROUND: Yield and safety of colonoscopy are highly dependent on operator competence. Existing tools for assessing competence is time-consuming and based on direct observation, making them prone for bias. There is a need for an easily accessible, reliable, and valid measure of endoscopic...... performance. OBJECTIVE: The aim of this study was to develop and explore the validity of an automated, unbiased assessment tool. DESIGN: We tested 10 experienced endoscopists and 11 trainees in colonoscopy on a physical simulator (Kagaku Colonoscope Training Model). Participants were tested with an easy...... and a difficult case. SETTING: Center for Clinical Education, Capital Region of Denmark. MAIN OUTCOME MEASUREMENTS: By using magnetic endoscopic imaging, we developed a colonoscopy progression score (CoPS). A pass/fail score was established by using the contrast-group method. RESULTS: We found significant...

  7. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

    Directory of Open Access Journals (Sweden)

    Benjamin E Levitzky

    2008-09-01

    Full Text Available Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP, a prodrug of propofol with a slower pharmacokinetic profi le, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.Keywords: fospropofol, Aquavan, propofol, sedation, colonoscopy

  8. Accuracy of 99mTc (V)-Dimercaptosuccinic Acid Scintigraphy and Fecal Calprotectin Compared with Colonoscopy in Localizing Active Lesions in Inflammatory Bowel Disease

    Science.gov (United States)

    Basirat, Vahid; Azizi, Zahra; Javid Anbardan, Sanam; Taghizadeh Asl, Mina; Farbod, Yasaman; Teimouri, Azam; Ebrahimi Daryani, Nasser

    2016-01-01

    INTRODUCTION Due to limitation of colonoscopy in assessing the entire bowel and patients’ intolerance in inflammatory bowel disease (IBD), in the current study, we aimed to prospectively compare the accuracy of 99mTc(V)-dimercaptosuccinic acid (DMSA) and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations. METHODS Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent 99mTc (V)-DMSA scintigraphy and colonoscopy. The accuracy of 99mTc (V)-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated. RESULTS A total of 22 patients with ulcerative colitis (UC) and 8 patients with Crohn’s disease (CD) were evaluated in our study. Sensitivity, positive likelihood ratio (PLR), and positive predictive value (PPV) of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio (NLR)=0.41, PPV=84.21%, and negative predictive value (NPV)= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively. CONCLUSION The 99mTc (V)-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC. PMID:27698971

  9. Incomplete Contract and Divisional Structures

    OpenAIRE

    Bao, T.; Wang, Y.

    2009-01-01

    In this paper we want to analyze the internal divisional structure within an organi- zation in the framework of incomplete contract theory. We use the framework of Aghion and Tirole (1997) and define the managerial control structure as \\sequence of search". A key feature of this paper which differentiate it from other works in the literature is that we add add an ex post bargaining phase in which the managers can agree on the project which maximize their joint private benefit. Our model shows...

  10. A Case of Taenia asiatica Infection Diagnosed by Colonoscopy

    Science.gov (United States)

    Kim, Heung Up; Chung, Young-Bae

    2017-01-01

    A case of Taenia asiatica infection detected by small bowel series and colonoscopy is described. The patient was a 42-year-old Korean man accompanied by discharge of movable proglottids via anus. He used to eat raw pig liver but seldom ate beef. Small bowel series radiologic examinations showed flat tape-like filling defects on the ileum. By colonoscopy, a moving flat tapeworm was observed from the terminal ileum to the ascending colon. The tapeworm was identified as T. asiatica by mitochondrial DNA sequencing. The patient was prescribed with a single oral dose (16 mg/kg) of praziquantel. PMID:28285508

  11. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy.

    Science.gov (United States)

    Levitzky, Benjamin E; Vargo, John J

    2008-08-01

    Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokinetic profile, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.

  12. Item Calibration in Incomplete Testing Designs

    Science.gov (United States)

    Eggen, Theo J. H. M.; Verhelst, Norman D.

    2011-01-01

    This study discusses the justifiability of item parameter estimation in incomplete testing designs in item response theory. Marginal maximum likelihood (MML) as well as conditional maximum likelihood (CML) procedures are considered in three commonly used incomplete designs: random incomplete, multistage testing and targeted testing designs.…

  13. Semantic Borders and Incomplete Understanding.

    Science.gov (United States)

    Silva-Filho, Waldomiro J; Dazzani, Maria Virgínia

    2016-03-01

    In this article, we explore a fundamental issue of Cultural Psychology, that is our "capacity to make meaning", by investigating a thesis from contemporary philosophical semantics, namely, that there is a decisive relationship between language and rationality. Many philosophers think that for a person to be described as a rational agent he must understand the semantic content and meaning of the words he uses to express his intentional mental states, e.g., his beliefs and thoughts. Our argument seeks to investigate the thesis developed by Tyler Burge, according to which our mastery or understanding of the semantic content of the terms which form our beliefs and thoughts is an "incomplete understanding". To do this, we discuss, on the one hand, the general lines of anti-individualism or semantic externalism and, on the other, criticisms of the Burgean notion of incomplete understanding - one radical and the other moderate. We defend our understanding that the content of our beliefs must be described in the light of the limits and natural contingencies of our cognitive capacities and the normative nature of our rationality. At heart, anti-individualism leads us to think about the fact that we are social creatures, living in contingent situations, with important, but limited, cognitive capacities, and that we receive the main, and most important, portion of our knowledge simply from what others tell us. Finally, we conclude that this discussion may contribute to the current debate about the notion of borders.

  14. Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy

    Science.gov (United States)

    Sathananthan, Dharshan; Young, Edward; Nind, Garry; George, Biju; Ashby, Angelie; Drummond, Sharon; Redel, Kasia; Green, Neville; Singh, Rajvinder

    2017-01-01

    Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Patients and methods This study was conducted at a single tertiary teaching hospital in Adelaide, Australia. It was a prospective study involving 1000 patients with an ASA score of 1 – 3 presenting with any indication for endoscopy, colonoscopy or both. A total of 981 patients (451 male) with a mean age of 53 years (range: 16 – 87) were recruited from January 2010 to October 2012. 440 endoscopies, 420 colonoscopies, and 121 combined procedures were performed. The intra-procedural adverse events (AEs) were recorded. Results There were no major intra-procedural adverse events. Minor AEs occurred in 6.42 % of patients, and resolved spontaneously or with intravenous fluid boluses in all cases. Conclusion PhD NAPS is safe when the proceduralist and nursing staff are adequately trained and strict patient selection criteria are used. PMID:28210707

  15. Technical interventions to increase adenoma detection rate in colonoscopy.

    Science.gov (United States)

    Rondonotti, Emanuele; Andrealli, Alida; Amato, Arnaldo; Paggi, Silvia; Conti, Clara Benedetta; Spinzi, Giancarlo; Radaelli, Franco

    2016-12-01

    Adenoma detection rate (ADR) is the most robust colonoscopy quality metric and clinical studies have adopted it as the ideal method to assess the impact of technical interventions. Areas covered: We reviewed papers focusing on the impact of colonoscopy technical issues on ADR, including withdrawal time and technique, second evaluation of the right colon, patient positional changes, gastrointestinal assistant participation during colonoscopy, water-aided technique, optimization of bowel preparation and antispasmodic administration. Expert commentary: Overall, technical interventions are inexpensive, available worldwide and easy to implement. Some of them, such as the adoption of split dose regimen and slow scope withdrawal to allow a careful inspection, have been demonstrated to significantly improve ADR. Emerging data support the use of water-exchange colonoscopy. According to published studies, other technical interventions seem to provide only marginal benefit to ADR. Unfortunately, the available evidence has methodological limitations, such as small sample sizes, the inclusion of expert endoscopists only and the evaluation of single technical interventions. Additionally, larger studies are needed to clarify whether these interventions might have a higher benefit on low adenoma detectors and whether the implementation of a bundle of them, instead of a single technical maneuver, might have a greater impact on ADR.

  16. Polyp detection at colonoscopy: Endoscopist and technical factors.

    Science.gov (United States)

    Rex, Douglas K

    2017-08-01

    The adenoma detection rate (ADR) has emerged as the most important quality measure in colonoscopy, as it predicts the risk of interval cancer after colonoscopy. Measuring and improving ADR is the central focus of the current quality movement in colonoscopy. High ADRs can be achieved by a colonoscopist with a thorough understanding of the wide range of endoscopic appearances of precancerous lesions in the colorectum, effective bowel preparation, and meticulous technique using high definition colonoscopes. The knowledgeable and effective examiner needs no adjunctive devices or techniques to achieve master level ADRs. However, measurement reveals that many colonoscopists have ADRs that are below recommended minimum thresholds or below master levels. These colonoscopists, and even master level performers, can choose from a variety of adjunctive tools to improve ADR. This review describes these tools according to whether they are non-device methods (e.g. double right colon examination, patient position change, water exchange), mucosal exposure devices (wide angle colonoscopy, fold flattening devices), and lesion highlighting techniques (e.g. chromoendoscopy, electronic chromoendoscopy). Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Management of anticoagulants and antiplatelet agents during colonoscopy.

    Science.gov (United States)

    Feagins, Linda Anne

    2017-03-23

    Colonoscopy frequently is performed for patients who are taking aspirin, NSAIDs, antiplatelet agents and other anticoagulants. These colonoscopies often involve polypectomy, which can be complicated by bleeding. The risks of precipitating thromboembolic complications if anticoagulants are stopped must be weighed against the risk of postpolypectomy bleeding if these agents are continued. This article systematically reviews the management of anticoagulation during elective and emergency colonoscopy. For patients undergoing colonoscopic polypectomy, the overall of risk of postpolypectomy bleeding is less than 0.5%. Risk factors for postpolypectomy bleeding include large polyp size and anticoagulant use, especially warfarin and thienopyridines. For patients who do not stop aspirin or other NSAIDs prior to colonoscopy, the rate of postpolypectomy bleeding is not significantly different than that for patients who do not take those medications. For patients who continue thienopyridines and undergo polypectomy, the risk of delayed postpolypectomy bleeding is approximately 2.4%. Even for patients who interrupt warfarin, the risk of postpolypectomy bleeding is increased. The direct oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) have a rapid onset and offset of action, and periprocedural bridging generally is not necessary. For the thienopyridines, warfarin and the direct oral anticoagulants, the decision to interrupt or continue these agents for endoscopy will involve considerable exercise of clinical judgment.

  18. Towards clinically translatable NIR fluorescence molecular guidance for colonoscopy

    NARCIS (Netherlands)

    Garcia-Allende, P. Beatriz; Glatz, Juergen; Koch, Maximilian; Tjalma, Jolien J.; Hartmans, Elmire; Terwisscha Van Scheltinga, Anton G. T.; Symvoulidis, Panagiotis; van Dam, Gooitzen M.; Nagengast, Wouter B.; Ntziachristos, Vasilis

    2014-01-01

    White-light surveillance colonoscopy is the standard of care for the detection and removal of premalignant lesions to prevent colorectal cancer, and the main screening recommendation following treatment for recurrence detection. However, it lacks sufficient diagnostic yield, exhibits unacceptable ad

  19. [Colonoscopy quality control as a requirement of colorectal cancer screening].

    Science.gov (United States)

    Quintero, Enrique; Alarcón-Fernández, Onofre; Jover, Rodrigo

    2013-11-01

    The strategies used in population-based colorectal screening strategies culminate in colonoscopy and consequently the success of these programs largely depends on the quality of this diagnostic test. The main factors to consider when evaluating quality are scientific-technical quality, safety, patient satisfaction, and accessibility. Quality indicators allow variability among hospitals, endoscopy units and endoscopists to be determined and can identify those not achieving recommended standards. In Spain, the working group for colonoscopy quality of the Spanish Society of Gastroenterology and the Spanish Society of Gastrointestinal Endoscopy have recently drawn up a Clinical Practice Guideline that contains the available evidence on the quality of screening colonoscopy, as well as the basic requirements that must be met by endoscopy units and endoscopists carrying out this procedure. The implementation of training programs and screening colonoscopy quality controls are strongly recommended to guarantee the success of population-based colorectal cancer screening. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  20. Does type of instrument influence colonoscopy performance and sedation practice?

    Institute of Scientific and Technical Information of China (English)

    Ramesh P Arasaradnam; Paul D Hurlstone

    2007-01-01

    @@ TO THE EDITOR In the UK, clear guidelines exist as to the expected levelof competence an individual endoscopist should achieve.This is of utmost importance given the variance inpractice among endoscopic departments as highlightedby the National Colonoscopy audit in 2002[1]. The auditedvariables included sedation practice, caecal completion andcomtlication rates, but not the Wpe of instrument used.

  1. The consequences of incomplete disclosure

    Energy Technology Data Exchange (ETDEWEB)

    Macfarlane, J.H. [Osler Hoskin and Harcourt, Calgary, AB (Canada)

    1998-12-01

    The disclosure requirements imposed on Canadian public companies are discussed. The basis of the capital market system in Canada is the integrity of full and true disclosure of all material facts in a prospectus and continuous disclosure of material changes and information, including financial results. Securities regulators have the right to report to the appropriate law enforcement agencies any company director who intentionally files misleading financial statements or press releases. The fundamental policy of Canadian stock exchanges is that all persons investing in securities listed on an exchange have equal access to information that may affect their investment decisions. Canadian stock exchanges have developed by-laws, rules and regulations relating to listed companies disclosure obligations, breach of which may lead to suspension of trading, delisting of the securities of the offending issuer, and substantial fines. Details of civil and criminal liability, current and proposed, for incomplete or inaccurate disclosure under Canadian securities legislation are explained. 59 refs.

  2. Assessment of quality in screening colonoscopy for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Gonçalves AR

    2011-12-01

    Full Text Available Ana Rita Gonçalves, Carlos Ferreira, António Marques, Luís Carrilho Ribeiro, José VelosaDepartment of Gastroenterology and Hepatology, Hospital Santa Maria-CHLN, Lisboa 1068, PortugalIntroduction: The effectiveness of screening colonoscopy in decreasing the incidence of colorectal cancer (CRC is largely dependent on the detection of polyps and the quality of the procedure. Several key quality measures have been proposed to improve the effectiveness of screening colonoscopies.Aim: To evaluate quality indicators of screening colonoscopy in a tertiary hospital.Methods: All CRC screening colonoscopies performed between 2005 and 2009 in a single tertiary center were reviewed for internationally accepted quality measures.Results: Of the 1545 individuals who underwent first-time screening colonoscopy 38% were male and 62% were female. The mean age of the patients was 60.4 years and the mean difference in ages was ± 10.3 years. Cecal intubation rate was 91% (1336, however ileocecal valve photo documentation was performed in only 81% (1248 colonoscopies. The quality of bowel preparation was classified as: good 76% (1171, reasonable 11% (174, and poor 13% (200. Polyp detection rate (PDR was 33% (503. The prevalence of polyps ≥1 cm in size was 5% (82. PDR was significantly higher in men than in women (44% [260] vs 25% [243], P = 0.0001. Other factors significantly influencing PDR were quality of bowel preparation (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 0.9–1.6 and age over 50 (OR: 1.9, 95% CI: 1.3–2.9. Left colonic polyps were associated with a risk ratio of 2.3 (95% CI: 1.8–2.9 of lesions in the other colonic segments compared to no polyps in the left colon. None of the colonoscopists reported withdrawal time.Conclusion: Cecal intubation rate and quality of bowel preparation were suboptimal. The polyp detection rate compares favorably to accepted standards and its main determinants are male sex, age >50 years, quality of bowel

  3. Indications and findings at colonoscopy in Ilorin, Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulfatai Bamidele Olokoba

    2013-01-01

    Full Text Available Background: Colonoscopy is a safe and effective means of visual inspection of the large bowel from the distal rectum to the caecum. It may be carried out for diagnostic and or therapeutic reasons. There is a paucity of data on this procedure in Nigeria. We, therefore, determined the indications, findings, and diagnostic yield in Nigerians at colonoscopy. Materials and Methods: This was a hospital-based cross-sectional study carried out at the Endoscopy unit of Crescent hospital, Ilorin from January 2010 to May, 2012. The endoscopy register was reviewed, and the biodata, indications and colonoscopic findings were recorded on a pro forma. Results: A total of 103 patients had colonoscopy. Seventy (68.0% were males while 33 (32.0% were females. The indications for colonoscopy were rectal bleeding 41 (39.8%, suspected colon cancer 32 (31.1%, chronic constipation and chronic diarrhoea nine each (8.7%, abdominal/anal pain five (4.9%, suspected anorectal cancer and enterocutaneous fistula two each (1.9%, faecal incontinence, occult gastrointestinal bleeding, post-colostomy for Hirschsprung disease one each (1.0%. Endoscopic findings were normal findings 21 (20.4%, diverticulosis 17 (16.5%, polyps 16 (15.5%, haemorrhoids 16 (15.5%, anorectal cancer 13 (12.6%, angiodysplasia 12 (11.7%, colon cancer eight (7.8%, colitis 7 (6.8%, anorectal ulcer 4 (3.9%, anal warts two (1.9%, anal fissure, caecal tumour, faecal impaction and proctitis one each (1.0%. The diagnostic yield was 79.6%. Conclusions: The commonest indication for colonoscopy was rectal bleeding, while the most frequent pathology was diverticulosis. The diagnostic yield was high.

  4. Safety and efficacy of aspartame-based liquid versus sucrose-based liquids used for dilution in oral sodium phosphate solutions for colonoscopy preparations.

    Science.gov (United States)

    Chamberlain, Sherman M; Balart, J Carter; Sideridis, Kostas; Salek, Jefrey; Sridhar, Subbaramiah; Thompson, William O

    2007-11-01

    The aim of this study was to investigate whether an oral sodium phosphate solution (OSPS) mixed with aspartame-based clear liquids as the diluent would yield improved colon cleansing results compared to an OSPS mixed with sucrose-based liquids as the diluent. Fifty-one patients undergoing colonoscopy were prospectively randomized into two groups to receive different OSPS colonoscopy preparations, with sucrose-based or aspartame-based liquids used as diluents. The primary end point was the quality of the colonoscopy preparation and secondary end points were serum electrolytes before and after preparations. No significant difference in colonoscopy preparation quality was seen between the two OSPS diluent groups (Mantel-Haenzel chi (2) = 0.795, P = 0.484). There were no significant differences in mean electrolyte shifts of sodium, potassium, blood urea nitrogen (BUN), creatinine (Cr), or BUN/Cr ratios between the two groups. There was a statistically significant increase in serum phosphorous in the aspartame-based group compared to the sucrose-based diluent group (P = 0.021). In conclusion, there was no clinically detectable difference in colonoscopy preparation quality between the two OSPS diluent groups. This study suggests that passive fluid transport by aquaporins may well be the major mediator of fluid shifts in the study subjects. This result suggests the potential importance of aquaporins and minimizes the importance of sodium glucose cotransporter SGLT1 in fluid and electrolyte transport in the human gastrointestinal tract. Aspartame or its constituent amino acids may enhance phosphate absorption across the human small intestine.

  5. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals.

    Science.gov (United States)

    Chandran, S; Parker, F; Lontos, S; Vaughan, R; Efthymiou, M

    2015-12-01

    Polyps identified at colonoscopy are predominantly diminutive (1%) of high-grade dysplasia or carcinoma; however, the cost of histological assessment is substantial. The aim of this study was to determine whether prediction of colonoscopy surveillance intervals based on real-time endoscopic assessment of polyp histology is accurate and cost effective. A prospective cohort study was conducted across a tertiary care and private community hospital. Ninety-four patients underwent colonoscopy and polypectomy of diminutive (≤5 mm) polyps from October 2012 to July 2013, yielding a total of 159 polyps. Polyps were examined and classified according to the Sano-Emura classification system. The endoscopic assessment (optical diagnosis) of polyp histology was used to predict appropriate colonoscopy surveillance intervals. The main outcome measure was the accuracy of optical diagnosis of diminutive colonic polyps against the gold standard of histological assessment. Optical diagnosis was correct in 105/108 (97.2%) adenomas. This yielded a sensitivity, specificity and positive and negative predictive values (with 95%CI) of 97.2% (92.1-99.4%), 78.4% (64.7-88.7%), 90.5% (83.7-95.2%) and 93% (80.9-98.5%) respectively. Ninety-two (98%) patients were correctly triaged to their repeat surveillance colonoscopy. Based on these findings, a cut and discard approach would have resulted in a saving of $319.77 per patient. Endoscopists within a tertiary care setting can accurately predict diminutive polyp histology and confer an appropriate surveillance interval with an associated financial benefit to the healthcare system. However, limitations to its application in the community setting exist, which may improve with further training and high-definition colonoscopes. © 2015 Royal Australasian College of Physicians.

  6. Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion

    NARCIS (Netherlands)

    I.C.D. Westendorp (Iris); W.M. Ankum (Willem); B.W.J. Mol (Ben); J. Vonk (Jan)

    1998-01-01

    textabstractThis prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of

  7. Cost Effectiveness of Screening Colonoscopy Depends on Adequate Bowel Preparation Rates – A Modeling Study

    Science.gov (United States)

    Kingsley, James; Karanth, Siddharth; Revere, Frances Lee

    2016-01-01

    Background Inadequate bowel preparation during screening colonoscopy necessitates repeating colonoscopy. Studies suggest inadequate bowel preparation rates of 20–60%. This increases the cost of colonoscopy for our society. Aim The aim of this study is to determine the impact of inadequate bowel preparation rate on the cost effectiveness of colonoscopy compared to other screening strategies for colorectal cancer (CRC). Methods A microsimulation model of CRC screening strategies for the general population at average risk for CRC. The strategies include fecal immunochemistry test (FIT) every year, colonoscopy every ten years, sigmoidoscopy every five years, or stool DNA test every 3 years. The screening could be performed at private practice offices, outpatient hospitals, and ambulatory surgical centers. Results At the current assumed inadequate bowel preparation rate of 25%, the cost of colonoscopy as a screening strategy is above society’s willingness to pay (<$50,000/QALY). Threshold analysis demonstrated that an inadequate bowel preparation rate of 13% or less is necessary before colonoscopy is considered more cost effective than FIT. At inadequate bowel preparation rates of 25%, colonoscopy is still more cost effective compared to sigmoidoscopy and stool DNA test. Sensitivity analysis of all inputs adjusted by ±10% showed incremental cost effectiveness ratio values were influenced most by the specificity, adherence, and sensitivity of FIT and colonoscopy. Conclusions Screening colonoscopy is not a cost effective strategy when compared with fecal immunochemical test, as long as the inadequate bowel preparation rate is greater than 13%. PMID:27936028

  8. Intravenous contrast enhanced computed tomography colonoscopy in children with suspected colonic polyps

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Anmol, E-mail: anmol_bhatia26@yahoo.co.in [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Saxena, Akshay K., E-mail: fatakshay@yahoo.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Kalra, Naveen, E-mail: navkal2004@yahoo.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Sodhi, Kushaljit S., E-mail: sodhiks@gmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Thapa, Babu R., E-mail: brthapa1@yahoo.co.in [Division of Pediatric Gastroenterology, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Rao, Katragadda L.N., E-mail: klnrao@hotmail.com [Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India); Khandelwal, Niranjan, E-mail: khandelwaln@hotmail.com [Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160 012 (India)

    2013-06-15

    Objective: The purpose of this study was to evaluate the diagnostic performance of intravenous contrast enhanced computed tomographic colonoscopy (IVCTC) in the diagnosis of clinically suspected colorectal polyps in children, using conventional colonoscopy (CC) as the gold standard. Methods: This was a prospective study conducted between July 2008 and June 2010. 30 pediatric patients with history of rectal bleeding and clinically suspected to have colorectal polyps were enrolled. All of the patients underwent IVCTC followed by CC. 30 IVCTC and 31 CC were performed in 30 patients. The findings of IVCTC were compared with those of CC. Statistical analysis was performed to obtain diagnostic performance values of IVCTC on per polyp (sensitivity and positive predictive value) and per patient (sensitivity, specificity, positive predictive value and negative predictive value) basis. Results: By IVCTC, 63 polyps were detected in 28 patients of which 53 polyps were eligible for inclusion in the statistical analysis. 60 polyps were detected by CC in 28 patients of which 50 polyps were eligible for inclusion in the statistical analysis. The per polyp sensitivity and positive predictive values were 94% and 88.6% respectively. The per patient sensitivity, specificity, positive predictive value, and negative predictive values were 96.4, 50, 96.4, and 50% respectively. Twenty polyps, in 10 patients, were visualized only after intravenous contrast administration of which 5 polyps, in 5 patients, were likely to have been missed in the absence of the intravenous contrast injection as these polyps were submerged in fluid. Four patients would have had a false negative CTC examination if the intravenous contrast had not been injected; while in another patient, the number of polyps would have been underestimated. Conclusion: CTC is capable of serving as a safe and efficient non-invasive tool for evaluating children with clinically suspected colorectal polyps. Administration of

  9. Fecal microbiota transplantation via colonoscopy for recurrent C. difficile Infection.

    Science.gov (United States)

    Allegretti, Jessica R; Korzenik, Joshua R; Hamilton, Matthew J

    2014-12-08

    Fecal Microbiota Transplantation (FMT) is a safe and highly effective treatment for recurrent and refractory C. difficile infection (CDI). Various methods of FMT administration have been reported in the literature including nasogastric tube, upper endoscopy, enema and colonoscopy. FMT via colonoscopy yields excellent cure rates and is also well tolerated. We have found that patients find this an acceptable and tolerable mode of delivery. At our Center, we have initiated a fecal transplant program for patients with recurrent or refractory CDI. We have developed a protocol using an iterative process of revision and have performed 24 fecal transplants on 22 patients with success rates comparable to the current published literature. A systematic approach to patient and donor screening, preparation of stool, and delivery of the stool maximizes therapeutic success. Here we detail each step of the FMT protocol that can be carried out at any endoscopy center with a high degree of safety and success.

  10. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

    OpenAIRE

    Levitzky, Benjamin E; Vargo, John J.

    2008-01-01

    Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokin...

  11. Accidental IV administration of epinephrine instead of midazolam at colonoscopy

    Directory of Open Access Journals (Sweden)

    Ahmed Gado

    2016-03-01

    Full Text Available Drug administration errors appear to be a major source of iatrogenic harm to hospitalized patients. They often, particularly in the case of epinephrine, have catastrophic consequences both for the patient and the well-meaning provider. The following incident is a medication error case report which illustrates one way that incorrect medication may be administered. IV epinephrine was accidentally administered instead of midazolam at colonoscopy.

  12. Effective colonoscopy training techniques: strategies to improve patient outcomes

    OpenAIRE

    Papanikolaou IS; Karatzas PS; Varytimiadis LT; Tsigaridas A; Galanopoulos M; Viazis N; Karamanolis DG

    2016-01-01

    Ioannis S Papanikolaou,1 Pantelis S Karatzas,2 Lazaros T Varytimiadis,2 Athanasios Tsigaridas,2 Michail Galanopoulos,2 Nikos Viazis,2 Dimitrios G Karamanolis21Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, 2Gastroenterology Department, Evangelismos Hospital, Athens, GreeceAbstract: Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to i...

  13. Incomplete convolutions in production and inventory models

    NARCIS (Netherlands)

    Houtum, van G.J.; Zijm, W.H.M.

    1997-01-01

    In this paper, we study incomplete convolutions of continuous distribution functions, as they appear in the analysis of (multi-stage) production and inventory systems. Three example systems are discussed where these incomplete convolutions naturally arise. We derive explicit, nonrecursive formulae f

  14. Reiki as a pain management adjunct in screening colonoscopy.

    Science.gov (United States)

    Bourque, Alda L; Sullivan, Mary E; Winter, Michael R

    2012-09-01

    The purpose of this study was to determine whether the use of Reiki decreases the amount of meperidine administered to patients undergoing screening colonoscopy. The literature review reveals limited studies to show whether Reiki has been able to decrease the amount of opioid the patient receives during screening colonoscopy. A chart review of 300 patients was conducted to obtain baseline average doses of meperidine patients received as the control. Following the chart review, 30 patients were recruited to the Reiki study. Twenty-five of the study arm patients received Reiki in conjunction with meperidine. Five randomly chosen study arm patients received placebo Reiki in conjunction with meperidine in an attempt to blind the clinicians to the treatment received by the patients. Results showed that there were no significant differences in meperidine administration between the patients in the chart review group (control) and the Reiki group. The study revealed that 16% who received Reiki, together with intravenous administration of conscious sedation, received less than 50 mg of meperidine. All the patients in the chart review group received more than 50 mg of meperidine. Results from this pilot study suggest that there may be a decrease in meperidine needed during screening colonoscopy when patients receive Reiki treatments before the procedure. A larger study powered to detect smaller medication differences is the next step in more accurately determining the effect of Reiki on pain management.

  15. Colonoscopy ‘My Way’: Preparation, Anticoagulants, Antibiotics and Sedation

    Directory of Open Access Journals (Sweden)

    Jerome D Waye

    1999-01-01

    Full Text Available Colonoscopy was introduced in the 1960s. The facility with which this technique is performed has been enhanced by vast improvements in instrumentation. In spite of this, physician attitudes concerning colonoscopy have changed little over the past several decades. The diet for precolonoscopic preparation has not been altered for 30 years. Colonoscopists have a great reluctance to use a new preparation instead of the 4 L electrolyte solution, perhaps because this was such a significant advance in colonoscopic cleansing, its predecessor being castor oil and enemas. Physicians continue to be wary of the patient who is taking acetylsalicylic acid in the absence of any studies that show that this is detrimental for polypectomy. The management of the patient on warfarin anticoagulation remains a subject for debate. As for antibiotic prophylaxis, most endoscopy units do not have a standardized approach, although there are good guidelines that, if followed, should decrease the risk of infective endocarditis. Sedation for the endoscopic examination is usually administered by the colonoscopist, although anesthesiologists may, in some countries (and in some defined areas of the United States be the primary administrators of sedation and analgesia. The present article is a personal approach to the following issues: the preparation of the colon for an examination, current thoughts about anticoagulation and acetylsalicylic acid, antibiotic prophylaxis for colonoscopy and the technique for sedation out of the hospital.

  16. Debt renegotiation with incomplete contract

    Directory of Open Access Journals (Sweden)

    Paulo de Melo Jorge Neto

    2005-09-01

    Full Text Available A debt contract usually does not include a provision about renegotiation. The right to seize the borrower’s asset and the rules of this process are usually stipulated in the contract. Such a promise not to renegotiate is not credible since renegotiation can mitigate the dead-weight loss of liquidating insolvent borrowers. Once the initial contract may not consider the renegotiation procedure and renegotiation may occur, this paper investigates why a complete contract is not offered. It shows that the lender does not need to stipulate the renegotiation procedure on the initial contract because he is indifferent about committing or not to the terms of a contract. This indicates that a complete contract gives the lender the same expected return as an incomplete contract, in which the renegotiation process is determined after the occurrence of default.Um contrato de débito geralmente não inclui uma cláusula sobre renegociação. O direito de liquidar os ativos do tomador e as regras do processo são habitualmente estipuladas no contrato. Tal promessa de não renegociar não é crível, já que a renegociação pode mitigar a perda bruta de se liquidar tomadores insolventes. Uma vez que o contrato inicial pode não considerar os procedimentos de renegociação, e esta pode, de fato, vir a ocorrer, este artigo investiga a razão de um contrato completo não ser ofertado. Mostra-se que o emprestador não precisa estipular os procedimentos de renegociação no contrato inicial porque ele é indiferente entre se comprometer ou não aos termos do contrato. Isto indica que um contrato completo dá ao emprestador o mesmo retorno esperado de um contrato incompleto, no qual os procedimentos de renegociação são determinados após a declaração de default.

  17. Colonoscopy Quality Assurance in Ontario: Systematic Review and Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Jill Tinmouth

    2014-01-01

    Full Text Available Colonoscopy is fundamental to the diagnosis and management of digestive diseases and plays a key role in colorectal cancer (CRC screening and diagnosis. Therefore, it is important to ensure that colonoscopy is of high quality. The present guidance document updates the evidence and recommendations in Cancer Care Ontario’s 2007 Colonoscopy Standards, and was conducted under the aegis of the Program in Evidence-Based Care. It is intended to support quality improvement for colonoscopies for all indications, including follow-up to a positive fecal occult blood test, screening for individuals who have a family history of CRC and those at average risk, investigation for symptomatic patients, and surveillance of those with a history of adenomatous polyps or CRC. A systematic review was performed to evaluate the existing evidence concerning the following three key aspects of colonoscopy: physician endoscopist training and maintenance of competency; institutional quality assurance parameters; and colonoscopy quality indicators and auditable outcomes. Where appropriate, indicators were designated quality indicators (where there was sufficient evidence to recommend a specific target and auditable outcomes (insufficient evidence to recommend a specific target, but which should be monitored for quality assurance purposes. The guidance document may be used to support colonoscopy quality assurance programs to improve the quality of colonoscopy regardless of indication. Improvements in colonoscopy quality are anticipated to improve important outcomes in digestive diseases, such as reduction of the incidence of and mortality from CRC.

  18. Editorial: On the Quality of Quality Metrics: Rethinking What Defines a Good Colonoscopy.

    Science.gov (United States)

    Dominitz, Jason A; Spiegel, Brennan

    2016-05-01

    The colonoscopy quality assurance movement has focused on a variety of process metrics, including the adenoma detection rate (ADR). However, the ADR only ascertains whether or not at least one adenoma is identified. Supplemental measures that quantify all neoplasia have been proposed. In this issue of the American Journal of Gastroenterology, Aniwan and colleagues performed tandem screening colonoscopies to determine the adenoma miss rate among high-ADR endoscopists. This permitted validation of supplemental colonoscopy quality metrics. This study highlights potential limitations of ADR and the need for further refinement of colonoscopy quality metrics, although logistic challenges abound.

  19. Determining the adenoma detection rate and adenomas per colonoscopy by photography alone: proof-of-concept study.

    Science.gov (United States)

    Rex, Douglas K; Hardacker, Kyle; MacPhail, Margaret; Rahmani, Farrah; Vemulapalli, Krishna C; Kahi, Charles J

    2015-03-01

    The adenoma detection rate (ADR) and adenomas detected per colonoscopy (APC) are measures of the quality of mucosal inspection during colonoscopy. In a resect and discard policy, pathologic assessment for calculation of ADR and APC would not be available. The aim of this study was to determine whether ADR and APC calculation based on photography alone is adequate compared with the pathology-based gold standard. A prospective, observational, proof-of-concept study was performed in an academic endoscopy unit. High definition photographs of consecutive polyps were taken, and pathology was estimated by the colonoscopist. Among 121 consecutive patients aged ≥ 50 years who underwent colonoscopy, 268 polyps were removed from 97 patients. Photographs of consecutive polyps were reviewed by a second endoscopist. The resect and discard policy applied to lesions that were ≤ 5 mm in size. When only photographs of lesions that were ultimately proven to be adenomas were included, the reviewer assessed ADR and APC to be lower than that determined by pathology (absolute reductions of 6.6 % and 0.17, and relative reductions of 12.6 % and 13.1 % in ADR and APC, respectively). When all photographs were included for calculation of ADR and APC, the reviewer determined the ADR to be 3.3 % lower (absolute reduction) and the APC to be the same as the rates determined by pathology. In a simulated resect and discard strategy, a high-level detector can document adequate ADR and APC by photography alone. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Expectant management of incomplete abortion in the first trimester.

    Science.gov (United States)

    Pauleta, Joana R; Clode, Nuno; Graça, Luís M

    2009-07-01

    To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.

  1. Prophylactic Nailing of Incomplete Atypical Femoral Fractures

    Directory of Open Access Journals (Sweden)

    Chang-Wug Oh

    2013-01-01

    Full Text Available Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures. Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7% patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM nail. The minimum followup was 12 months. Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging. Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

  2. Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule.

    LENUS (Irish Health Repository)

    Munson, Gregory W

    2011-03-01

    Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.

  3. Diagnostic accuracy and tolerability of contrast enhanced CT colonoscopy in symptomatic patients with increased risk for colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ozsunar, Yelda [Department of Radiology, School of Medicine, Adnan Menderes University, Aydin (Turkey)], E-mail: yozsunar@adu.edu.tr; Coskun, Guelten [Izmir Ataturk Egitim ve Arastirma Hastanesi, Izmir (Turkey); Delibas, Naciye; Uz, Burcin [Department of Radiology, School of Medicine, Adnan Menderes University, Aydin (Turkey); Yuekselen, Vahit [Department of Gastroenterology, School of Medicine, Adnan Menderes University, Aydin (Turkey)

    2009-09-15

    Objective: We compared the accuracy and tolerability of intravenous contrast enhanced spiral computed tomography colonography (CTC) and optical colonoscopy (OC) for the detection of colorectal neoplasia in symptomatic patients for colorectal neoplasia. Methods: A prospective study was performed in 48 patients with symptomatic patients with increased risk for colorectal cancer. Spiral CTC was performed in supine and prone positions after colonic cleansing. The axial, 2D MPR and virtual endoluminal views were analyzed. Results of spiral CTC were compared with OC which was done within 15 days. The psychometric tolerance test was asked to be performed for both CTC and colonoscopy after the procedure. Results: Ten lesions in 9 of 48 patients were found in CTC and confirmed with OC. Two masses and eight polyps, consisted of 1 tubulovillous, 1 tubular, 2 villous adenoma, 4 adenomatous polyp, 4 adenocarcinoma, were identified. Lesion prevalence was 21%. Sensitivity, specificity, accuracy, positive and negative predictive values were found 100%, 87%, 89%, 67% and 100%, respectively. Psychometric tolerance test showed that CTC significantly more comfortable comparing with OC (p = 0.00). CTC was the preferred method in 37% while OC was preferred in 6% of patients. In both techniques, the most unpleasant part was bowel cleansing. Conclusion: Contrast enhanced CTC is a highly accurate method in detecting colorectal lesions. Since the technique was found to be more comfortable and less time consuming compare to OE, it may be preferable in management of symptomatic patients with increased risk for colorectal cancer.

  4. Accuracy of Colon Capsule Endoscopy in Detecting Colorectal Polyps in Individuals with Familial Colorectal Cancer: Could We Avoid Colonoscopies?

    Science.gov (United States)

    Alvarez-Urturi, Cristina; Fernández-Esparrach, Gloria; Ibáñez, Inés Ana; Rodríguez De Miguel, Cristina; Dedeu, Josep Maria; Bessa, Xavier; Córdova, Henry; Pellisé, Maria; Balaguer, Francesc; Ginés, Angels; Barranco, Luis; Araujo, Isis K.; Andreu, Montserrat; Llach, Josep

    2017-01-01

    Background. Individuals with a family history of colorectal cancer (CRC) have an increased risk of CRC. We evaluated the diagnostic yield of CCE in the detection of lesions and also two different colon preparations. Methods. A prospective multicenter study was designed to assess CCE diagnostic yield in a cohort of asymptomatic individuals with a family history of CRC. CCE and colonoscopy were performed on the same day by 2 endoscopists who were blinded to the results of the other procedure. Results. Fifty-three participants were enrolled. The sensitivity, specificity, PPV, and NPV of CCE for detecting advanced adenomas were 100%, 98%, 67%, and 100%. Sensitivity, specificity, PPV, and NPV of CCE for the diagnosis of individuals with polyps were 87%, 97%, 93%, and 88%, respectively. CCE identify 100% of individuals with significant or advanced lesions. Overall cleanliness was adequate by 60.7% of them. The PEG-ascorbic boost seems to improve colon cleanliness, with similar colonic transit time. Conclusion. CCE is a promising tool, but it has to be considered as an alternative technique in this population in order to reduce the number of colonoscopies performed. More studies are needed to understand appropriate screening follow-up intervals and optimize the bowel preparation regimen. PMID:28265285

  5. Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Haan, Margriet C. de [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Amsterdam, Department of Radiology, G1-223.1, Amsterdam (Netherlands); Gelder, Rogier E. van; Bipat, Shandra; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Graser, Anno [University of Munich, Department of Clinical Radiology, Klinikum Grosshadern, Munich (Germany)

    2011-08-15

    Previous meta-analyses on CT-colonography included both average and high risk individuals, which may overestimate the diagnostic value in screening. A meta-analysis was performed to obtain the value of CT-colonography for screening. A search was performed using PubMed, Embase and Cochrane. Article selection and critical appraisal was done by two reviewers. Inclusion criteria: prospective, randomized trials or cohort studies comparing CT-colonography with colonoscopy ({>=}50 participants), {>=}95% average risk participants {>=}50 years. Study characteristics and 2 x 2 contingency Tables were recorded. Sensitivity and specificity estimates were calculated per patient and per polyp ({>=}6 mm, {>=}10 mm), using univariate and bivariate analyses. Five of 1,021 studies identified were included, including 4,086 participants (<1% high risk). I{sup 2}-values showed substantial heterogeneity, especially for 6-9 mm polyps and adenomas: 68.1% vs. 78.6% (sensitivity per patient). Estimated sensitivities for patients with polyps or adenomas {>=} 6 mm were 75.9% and 82.9%, corresponding specificities 94.6% and 91.4%. Estimated sensitivities for patients with polyps or adenomas {>=} 10 mm were 83.3% and 87.9%, corresponding specificities 98.7% and 97.6%. Estimated sensitivities per polyp for advanced adenomas {>=} 6 mm and {>=} 10 mm were 83.9% and 83.8%. Compared to colonoscopy, CT-colonography has a high sensitivity for adenomas {>=} 10 mm. For (advanced) adenomas {>=} 6 mm sensitivity is somewhat lower. (orig.)

  6. Angular momentum transfer in incomplete fusion

    Indian Academy of Sciences (India)

    B S Tomar; K Surendra Babu; K Sudarshan; R Tripathi; A Goswami

    2005-02-01

    Isomeric cross-section ratios of evaporation residues formed in 12C+93Nb and 16O + 89Y reactions were measured by recoil catcher technique followed by off-line -ray spectrometry in the beam energy range of 55.7-77.5 MeV for 12C and 68-81 MeV for 16O. The isomeric cross-section ratios were resolved into that for complete and incomplete fusion reactions. The angular momentum of the intermediate nucleus formed in incomplete fusion was deduced from the isomeric cross-section ratio by considering the statistical de-excitation of the incompletely fused composite nucleus. The data show that incomplete fusion is associated with angular momenta slightly smaller than critical angular momentum for complete fusion, indicating the deeper interpenetration of projectile and target nuclei than that in peripheral collisions.

  7. The Evolution of Conventions under Incomplete Information

    DEFF Research Database (Denmark)

    Whitta-Jacobsen, Hans Jørgen; Jensen, Mogens; Sloth, Birgitte

    We formulate an evolutionary learning process in the spirit of Young (1993a) for games of incomplete information. The process involves trembles. For many games, if the amount of trembling is small, play will be in accordance with the games' (semi- strict) Bayesian equilibria most of the time...... to incomplete information of the prototype strategic conflict known as Chicken. The second is an incomplete information bilateral monopoly, which is also an extension to incomplete information of Nash's demand game, or a simple version of the so-called sealed bid double auction. For both games selection...... by evolutionary learning is in favor of Bayesian equilibria where some types of players fail to coordinate, such that the outcome is inefficient...

  8. Revising incompletely specified convex probabilistic belief bases

    CSIR Research Space (South Africa)

    Rens, G

    2016-04-01

    Full Text Available International Workshop on Non-Monotonic Reasoning (NMR), 22-24 April 2016, Cape Town, South Africa Revising Incompletely Specified Convex Probabilistic Belief Bases Gavin Rens CAIR_, University of KwaZulu-Natal, School of Mathematics, Statistics...

  9. Suction v. conventional curettage in incomplete abortion

    African Journals Online (AJOL)

    Zimbabwe, over 4 000 patients undergo evacuation for ... 50% of the emergency gynaecological workload. Most patients ... Optimal surgical treatment of incomplete abortion requires a ... Analgesia was provided by intravenous pethidine. (50 ...

  10. Incomplete albinism in Discoglossus pictus (Otth, 1837

    Directory of Open Access Journals (Sweden)

    Filippo Spadola

    2010-12-01

    Full Text Available The authors present an incomplete albinism case in a Discoglossus pictus subject found in Sicily. This is the first note for Italian territory, the second for the species and the third for Discoglossus genus.

  11. Reasoning with Incomplete and Uncertain Information

    Science.gov (United States)

    1991-08-01

    the Bayesian and Confirmation theory approaches and to compare them with INFERNO , his proposed approach to uncertain inference [Qui83]. The...reasoning in medicine. Mathematical Biosciences, 23:351-379, 1975. [SBBG86] L. M. Sweet, P. P. Bonissone, A. L. Brown , and S. Gans. Reasoning with Incomplete...CA, October 1979. [SBBG86I L. M. Sweet, P. P. Bonissone, A. L. Brown , and S. Gans. Reasoning with Incomplete and Uncertain Information for Improved

  12. Impact of patient audio-visual re-education through a smartphone on quality of bowel preparation before colonoscopy; a single-blinded randomized study.

    Science.gov (United States)

    Back, Su Young; Kim, Hyun Gun; Ahn, Eu Mi; Park, Suyeon; Jeon, Seong Ran; Im, Hee Hyuk; Kim, Jin-Oh; Ko, Bong Min; Lee, Joon Seong; Lee, Tae Hee; Cho, Jun-Hyung

    2017-09-19

    Preparation education is essential for successful colonoscopy. This study aimed to evaluate the impact of audio-visual (AV) re-education through a smartphone before colonoscopy on bowel preparation quality. A prospective, endoscopist-blinded, randomized, controlled study was performed. Patients who underwent colonoscopy with 3 purgatives, including 4 L polyethylene glycol (4L-PEG), 2 L PEG with ascorbic acid (2L-PEG/Asc) and sodium picosulfate with magnesium citrate (SPMC), were enrolled, and randomized into AV re-education through smartphone group (AV group, n=160) and a control group (n=160). The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included instruction adherence using adherence score (AS) and patient satisfaction with education using a visual analogue scale (VAS). A total of 283 patients (AV group: n=139, control group: n=144) were analyzed per protocol. The mean BBPS (7.53 vs. 6.29, psmartphone was easy and convenient, and enhanced preparation quality, patient adherence to instructions, and patient satisfaction. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  13. Multicenter, randomized, tandem evaluation of EndoRings colonoscopy - results of the CLEVER study

    NARCIS (Netherlands)

    Dik, Vincent K; Gralnek, Ian M; Segol, Ori; Suissa, Alain; Belderbos, Tim D G; Moons, Leon M G; Segev, Meytal; Domanov, Sveta; Rex, Douglas K; Siersema, Peter D

    2015-01-01

    Background and study aims: Adenoma miss rate during colonoscopy has become a widely acknowledged proxy measure for post-colonoscopy colorectal cancer. Among other reasons, this can happen because of inadequate visualization of the proximal aspects of colonic folds and flexures. EndoRings (EndoAid Lt

  14. Multicenter, randomized, tandem evaluation of EndoRings colonoscopy - results of the CLEVER study

    NARCIS (Netherlands)

    Dik, V.K.; Gralnek, I.M.; Segol, O.; Suissa, A.; Belderbos, T.D.; Moons, L.M.; Segev, M.; Domanov, S.; Rex, D.K.; Siersema, P.D.

    2015-01-01

    BACKGROUND AND STUDY AIMS: Adenoma miss rate during colonoscopy has become a widely acknowledged proxy measure for post-colonoscopy colorectal cancer. Among other reasons, this can happen because of inadequate visualization of the proximal aspects of colonic folds and flexures. EndoRings (EndoAid Lt

  15. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach

    DEFF Research Database (Denmark)

    Houe, T; Thorböll, J E; Sigild, U;

    2000-01-01

    to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine.......to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....

  16. No increased risk of perforation during colonoscopy in patients undergoing Nurse Administered Propofol Sedation

    DEFF Research Database (Denmark)

    Okholm, Cecilie; Hadikhadem, Talie; Andersen, Lærke Toftegård

    2013-01-01

    colonoscopies performed with either NAPS or conventional sedation regimes. Material and methods. Data were retrospectively retracted from medical journals from 1 January 2007 to 31 December 2011. All journals were examined and cross-referenced to reveal any perforations. We analyzed all colonoscopies in regard...

  17. Leadership training to improve adenoma detection rate in screening colonoscopy: A randomised trial

    NARCIS (Netherlands)

    M.F. Kaminski (M.); J. Anderson (John); R.M. Valori (Roland ); E. Kraszewska (Ewa); M. Rupinski (Maciej); J. Pachlewski (Jacek); E. Wronska (Ewa); M. Bretthauer (Michael); S. Thomas-Gibson (Siwan); E.J. Kuipers (Ernst); J. Regula (J.)

    2016-01-01

    textabstractObjective Suboptimal adenoma detection rate (ADR) at colonoscopy is associated with increased risk of interval colorectal cancer. It is uncertain how ADR might be improved. We compared the effect of leadership training versus feedback only on colonoscopy quality in a countrywide randomis

  18. Combining different methods improves assessment of competence in colonoscopy

    DEFF Research Database (Denmark)

    Konge, Lars; Svendsen, Morten Bo Søndergaard; Preisler, Louise

    2017-01-01

    score calculations were used to explore different combinations of the measures. RESULTS: Twenty physicians were included in the study. The reliability (Cronbach's alpha) were 0.92, 0.57, 0.87 and 0.55 for the subjective score assessed under direct observation, time to cecum, distance between operator......'s hands and colonoscopy progression score, respectively. Equal weight (=25%) to all four methods resulted in a reliability of 0.91 and optimal weighting of the methods (55%, 10%, 25% and 10%, respectively) resulted in a maximum reliability of 0.95. CONCLUSION: Combining subjective expert ratings...

  19. Unsedation colonoscopy can be not that painful: Evaluation of the effect of “Lamaze method of colonoscopy”

    Institute of Scientific and Technical Information of China (English)

    Shao-Ping; Yu; Xiao-Dong; Lin; Guang-Yao; Wu; Song-Hu; Li; Zong-Quan; Wen; Xiao-Hong; Cen; Xian-Guang; Huang; Mei-Ting; Huang

    2015-01-01

    AIM: To evaluate the pain relieving effect of intervention with "Lamaze method of colonoscopy" in the process of colonoscopy.METHODS: Five hundred and eighty-five patients underwent colonoscopy were randomly divided into three groups, Lamaze group, anesthetic group and control group. Two hundred and twenty-four patients of Lamaze group, the "Lamaze method of colonoscopy" were practiced in the process of colonoscopy. The Lamaze method of colonoscopy is modified from the Lamaze method of childbirth, which helped patients to relieve pain through effective breathing control. One hundred and seventy-eight patients in anesthetic group accepted sedation colonoscopy. For 183 patients in control group, colonoscopy was performed without any intervention. The satisfactory of colon cleaning, intestinal lesions, intubation time, success ratio, pain grading and complications were recorded. All data were statistically analyzed.RESULTS: There were no significant differences at base line of the three groups(P > 0.05). Anesthetic group shows advantage in intubation time than the other two groups(P 0.05). The anesthetic group showed an apparent advantage in relieving pain(P < 0.01). Therefore, the "Lamaze method of colonoscopy" performed in colonoscopy could relieve pain effectively comparing with control group(P < 0.05). The patients in anesthetic group had the highest incidence of complications(P < 0.05).CONCLUSION: The performance of the "Lamaze method of colonoscopy" in the process of colonoscopy could relieve patients’ pain, minimize the incidence of complications, and is worthy promotion in clinical practice.

  20. Social disparities in the use of colonoscopy by primary care physicians in Ontario

    Directory of Open Access Journals (Sweden)

    Moineddin Rahim

    2011-09-01

    Full Text Available Abstract Background It is unclear if all persons in Ontario have equal access to colonoscopy. This research was designed to describe long-term trends in the use of colonoscopy by primary care physicians (PCPs in Ontario, and to determine whether PCP characteristics influence the use of colonoscopy. Methods We conducted a population-based retrospective study of PCPs in Ontario between the years 1996-2005. Using administrative data we identified a screen-eligible group of patients aged 50-74 years in Ontario. These patients were linked to the PCP who provided the most continuous care to them during each year. We determined the use of any colonoscopy among these patients. We calculated the rate of colonoscopy for each PCP as the number of patients undergoing colonoscopies per 100 screen eligible patients. Negative binomial regression was used to identify factors associated with the rate of colonoscopy, using generalized estimating equations to account for clustering of patients within PCPs. Results Between 7,955 and 8,419 PCPs in Ontario per year (median age 43 years had at least 10 eligible patients in their practices. The use of colonoscopy by PCPs increased sharply in Ontario during the study period, from a median rate of 1.51 [inter quartile range (IQR 0.57-2.62] per 100 screen eligible patients in 1996 to 4.71 (IQR 2.70-7.53 in 2005. There was substantial variation between PCPs in their use of colonoscopy. PCPs who were Canadian medical graduates and with more years of experience were more likely to use colonoscopy after adjusting for their patient characteristics. PCPs were more likely to use colonoscopy if their patient populations were predominantly women, older, had more illnesses, and if their patients resided in less marginalized neighborhoods (lower unemployment, fewer immigrants, higher income, higher education, and higher English/French fluency. Conclusions There is substantial variation in the use of colonoscopy by PCPs, and this

  1. Social disparities in the use of colonoscopy by primary care physicians in Ontario.

    Science.gov (United States)

    Jacob, Binu J; Baxter, Nancy N; Moineddin, Rahim; Sutradhar, Rinku; Del Giudice, Lisa; Urbach, David R

    2011-09-28

    It is unclear if all persons in Ontario have equal access to colonoscopy. This research was designed to describe long-term trends in the use of colonoscopy by primary care physicians (PCPs) in Ontario, and to determine whether PCP characteristics influence the use of colonoscopy. We conducted a population-based retrospective study of PCPs in Ontario between the years 1996-2005. Using administrative data we identified a screen-eligible group of patients aged 50-74 years in Ontario. These patients were linked to the PCP who provided the most continuous care to them during each year. We determined the use of any colonoscopy among these patients. We calculated the rate of colonoscopy for each PCP as the number of patients undergoing colonoscopies per 100 screen eligible patients. Negative binomial regression was used to identify factors associated with the rate of colonoscopy, using generalized estimating equations to account for clustering of patients within PCPs. Between 7,955 and 8,419 PCPs in Ontario per year (median age 43 years) had at least 10 eligible patients in their practices. The use of colonoscopy by PCPs increased sharply in Ontario during the study period, from a median rate of 1.51 [inter quartile range (IQR) 0.57-2.62] per 100 screen eligible patients in 1996 to 4.71 (IQR 2.70-7.53) in 2005. There was substantial variation between PCPs in their use of colonoscopy. PCPs who were Canadian medical graduates and with more years of experience were more likely to use colonoscopy after adjusting for their patient characteristics. PCPs were more likely to use colonoscopy if their patient populations were predominantly women, older, had more illnesses, and if their patients resided in less marginalized neighborhoods (lower unemployment, fewer immigrants, higher income, higher education, and higher English/French fluency). There is substantial variation in the use of colonoscopy by PCPs, and this variation has increased as the overall use of colonoscopy

  2. Propofol for pediatric colonoscopy: the experience of a large, tertiary care pediatric hospital.

    Science.gov (United States)

    Cohen, Shlomi; Glatstein, Miguel M; Scolnik, Dennis; Rom, Liat; Yaron, Ayala; Otremski, Sorina; Ben-Tov, Amir; Reif, Shimon

    2014-01-01

    Successful colonoscopy includes full visualization of the terminal ileum, especially in inflammatory bowel disease when ileal biopsy is essential. In children, higher levels of anxiety and lack of cooperation often necessitate a deeper level of sedation. The aim of this study was to evaluate the effectiveness of propofol compared with midazolam and fentanyl for colonoscopy, and in accomplishing ileal and cecal intubation in particular. This was a retrospective cohort study comparing the rates of successful colonoscopy in patients receiving propofol with those receiving midazolam/fentanyl. Complete, successful, colonoscopy to the terminal ileum was achieved in 78% of propofol patients compared with 66% of the midazolam/fentanyl group (P=0.004). Endoscopy reaching the cecum, but not the terminal ileum, was achieved in 78% of propofol patients and 66% of midazolam/fentanyl patients. The use of propofol was associated with a statistically significant increase in the rate of successful colonoscopy reaching the terminal ileum.

  3. Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial.

    Science.gov (United States)

    Pohl, Heiko; Bensen, Steve P; Toor, Arifa; Gordon, Stuart R; Levy, L Campbell; Berk, Brian; Anderson, Peter B; Anderson, Joseph C; Rothstein, Richard I; MacKenzie, Todd A; Robertson, Douglas J

    2015-10-01

    Cap-assisted colonoscopy has improved adenoma detection in some but not other studies. Most previous studies have been limited by small sample sizes and few participating endoscopists. The aim of the current study was to evaluate whether cap-assisted colonoscopy improves adenoma detection in a two-center, multi-endoscopist, randomized trial. Consecutive patients who presented for an elective colonoscopy were randomized to cap-assisted colonoscopy (4-mm cap) or standard colonoscopy performed by one of 10 experienced endoscopists. Primary outcome measures were mean number of adenomas per patient and adenoma detection rate (ADR). Secondary outcomes included procedural measures and endoscopist variation; a logistic regression model was employed to examine predictors of increased detection with cap use. A total of 1113 patients (64 % male, mean age 62 years) were randomized to cap-assisted (n = 561) or standard (n = 552) colonoscopy. The mean number of adenomas detected per patient in the cap-assisted and standard groups was similar (0.89 vs. 0.82; P = 0.432), as was the ADR (42 % vs. 40 %; P = 0.452). Cap-assisted colonoscopy achieved a faster cecal intubation time (4.9 vs. 5.8 minutes; P Cap-assisted colonoscopy resulted in a 20 % increase in ADR for some endoscopists and in a 15 % decrease for others. Individual preference for the cap was an independent predictor of increased adenoma detection in adjusted analysis (P cap-assisted colonoscopy, adenoma detection was not. Cap-assisted colonoscopy may be beneficial for selected endoscopists. clinicalTrials.gov (NCT01935180). © Georg Thieme Verlag KG Stuttgart · New York.

  4. Limited life expectancy among a subgroup of medicare beneficiaries receiving screening colonoscopies.

    Science.gov (United States)

    Mittal, Sahil; Lin, Yu-Li; Tan, Alai; Kuo, Yong-Fang; El-Serag, Hashem B; Goodwin, James S

    2014-03-01

    Life expectancy is an important consideration when assessing appropriateness of preventive programs for older individuals. Most studies on this subject have used age cutoffs as a proxy for life expectancy. We analyzed patterns of utilization of screening colonoscopy in Medicare enrollees by using estimated life expectancy. We used a 5% random national sample of Medicare claims data to identify average-risk patients who underwent screening colonoscopies from 2008 to 2010. Colonoscopies were considered to be screening colonoscopies in the absence of diagnoses for nonscreening indications, which were based on either colonoscopies or any claims in the preceding 3 months. We estimated life expectancies by using a model that combined age, sex, and comorbidity. Among patients who underwent screening colonoscopies, we calculated the percentage of those with life expectancies <10 years. Among the 57,597 Medicare beneficiaries 66 years old or older who received at least 1 screening colonoscopy, 24.8% had an estimated life expectancy of <10 years. There was a significant positive association between total Medicare per capita costs in hospital referral regions and the proportion of patients with limited life expectancies (<10 years) at the time of screening colonoscopy (R = 0.25; P < .001, Pearson correlation test). In a multivariable analysis, men were substantially more likely than women to have limited life expectancy at the time of screening colonoscopy (odds ratio, 2.25; 95% confidence interval, 2.16-2.34). Nearly 25% of Medicare beneficiaries, especially men, had life expectancies <10 years at the time of screening colonoscopies. Life expectancy should therefore be incorporated in decision-making for preventive services. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  5. Role of high definition colonoscopy in colorectal adenomaatous polyp detection

    Institute of Scientific and Technical Information of China (English)

    Tolga Erim; John M Rivas; Evelio Velis; Fernando Castro

    2011-01-01

    AIM: To investigate the rates of polyp detection in a mixed risk population using standard definition (SDC) vs high definition colonoscopes (HDC). METHODS: This was a retrospective cohort comparative study of 3 colonoscopists who each consecutively performed 150 SDC (307, 200 pixel) and 150 HDC (792, 576 pixels) in a community teaching hospital.RESULTS: A total of 900 colonoscopies were evaluated (mean age 56, 46.8% men), 450 with each resolution. Polyps of any type were detected in 46.0% of patients using SDC and 43.3% with HDC (P = 0.42). There was no significant difference between the overall number of polyps, HDC (397) and SDC (410), detected among all patients examined, (P = 0.73). One or more adenomatous polyps were detected in 24.2% of patients with HDC and 24.9% of patients with SDC colonoscopy (P = 0.82). There was no significant difference between HDC (M = 0.41) and SDC (M = 0.42) regarding adenomatous polyp (P = 0.88) or advanced adenoma (P = 0.56) detection rate among all patients examined.CONCLUSION: HDC did not improve yield of adenomatous polyp, advanced adenoma or overall polyp detection in a population of individuals with mixed risk for colorectal cancer.

  6. Digital bowel cleansing for virtual colonoscopy with probability map

    Science.gov (United States)

    Hong, Wei; Qiu, Feng

    2010-03-01

    Virtual colonoscopy (VC) is a noninvasivemethod for colonic polyp screening, by reconstructing three-dimensional models of the colon using computerized tomography (CT). Identifying the residual fluid retained inside the colon is a major challenge for 3D virtual colonoscopy using fecal tagging CT data. Digital bowel cleansing aims to segment the colon lumen from a patient abdominal image acquired using an oral contrast agent for colonic material tagging. After removing the segmented residual fluid, the clean virtual colon model can be constructed and visualized for screening. We present a novel automatic method for digital cleansing using probability map. The random walker algorithm is used to generate the probability map for air (inside the colon), soft tissue, and residual fluid instead of segment colon lumen directly. The probability map is then used to remove residual fluid from the original CT data. The proposed method was tested using VC study data at National Cancer Institute at NIH. The performance of our VC system for polyp detection has been improved by providing radiologists more detail information of the colon wall.

  7. Effective colonoscopy training techniques: strategies to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Papanikolaou IS

    2016-03-01

    Full Text Available Ioannis S Papanikolaou,1 Pantelis S Karatzas,2 Lazaros T Varytimiadis,2 Athanasios Tsigaridas,2 Michail Galanopoulos,2 Nikos Viazis,2 Dimitrios G Karamanolis21Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, 2Gastroenterology Department, Evangelismos Hospital, Athens, GreeceAbstract: Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.Keywords: endoscopy, colonoscopy, teaching techniques, simulator, endoscopists, colon, polyps

  8. Effect of music on patients undergoing outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Matthew L Bechtold; Rodney A Perez; Srinivas R Puli; John B Marshall

    2006-01-01

    AIM: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist.SETHODS: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played.RESULTS: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time,endoscopist assessment of scope insertion difficulty,endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure.The music group did report significantly better overall procedure satisfaction as compared to the non music group on two of our three different scales.CONCLUSION: While music does not result in shortened procedure times, lower doses of sedative medications or perceived patient pain, the patients who have music playing during their procedures report modestly greater satisfaction with their procedures.

  9. Narrative message targets within the decision-making process to undergo screening colonoscopy among Latinos: a qualitative study.

    Science.gov (United States)

    Hennelly, Marie Oliva; Sly, Jamilia R; Villagra, Cristina; Jandorf, Lina

    2015-06-01

    Colorectal cancer (CRC) is a preventable yet leading cause of cancer mortality among Latinos in the USA. Cultural targeting and narrative messaging are two strategies to increase the low screening colonoscopy rates among Latinos. This study identifies key messages for educational interventions aiming to increase screening colonoscopy used among Latinos and proposes a model to understand the relationship between factors involved in colonoscopy decision-making. Individual in-depth interviews were conducted with 12 Latino participants primarily of Puerto Rican descent on the topics of CRC knowledge, barriers and facilitators to colonoscopy use, and the use of narrative in colorectal health messaging. Knowledge about colorectal anatomy and the anesthesia component of colonoscopy procedure is low. Fear of procedure-related pain and fear of treatment-related burden following a cancer diagnosis are significant barriers to colonoscopy. Fear of disease-related suffering and death following a cancer diagnosis and fear of regret are strong facilitators and can be augmented by cancer narratives. Storytelling is commonly used in Latino culture and is an acceptable method to educate the Latino community about CRC screening via colonoscopy. Machismo is a unique barrier to colonoscopy for Latino men via homophobia and reluctance to seek healthcare. A preliminary model to understand factors in colonoscopy decision-making among Latinos is presented. Counseling practices and educational interventions that use culturally targeted narrative health messaging to mediate fears and increase colonoscopy knowledge may increase screening colonoscopy use among Latinos.

  10. CIMGS: An incomplete orthogonal factorization preconditioner

    Energy Technology Data Exchange (ETDEWEB)

    Wang, X.; Bramley, R. [Indiana Univ., Bloomington, IN (United States); Gallivan, K. [Univ. of Illinois, Urbana, IL (United States)

    1994-12-31

    This paper introduces, analyzes, and tests a preconditioning method for conjugate gradient (CG) type iterative methods. The authors start by examining incomplete Gram-Schmidt factorization (IGS) methods in order to motivate the new preconditioner. They show that the IGS family is more stable than IC, and they successfully factor any full rank matrix. Furthermore, IGS preconditioners are at least as effective in accelerating convergence of CG type iterative methods as the incomplete Cholesky (IC) preconditioner. The drawback of IGS methods are their high cost of factorization. This motivates finding a new algorithm, CIMGS, which can generate the same factor in a more efficient way.

  11. OAM beams from incomplete computer generated holograms

    CERN Document Server

    Zambale, Niña Angelica F; Hermosa, Nathaniel

    2016-01-01

    In this letter we show that optical beams with orbital angular momentum (OAM) can be generated even with incomplete computer generated holograms (CGH). These holograms are made such that random portions of it do not contain any information. We observe that although the beams produced with these holograms are less intense, these beams maintain their shape and that their topological charges are not affected. Furthermore, we show that superposition of two or more beams can be created using separate incomplete CGHs interspersed together. Our result is significant especially since most method to generate beams with OAM for various applications rely on pixelated devices or optical elements with imperfections.

  12. Pericoronal radiolucency associated with incomplete crown

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Kyung Soo [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan (Korea, Republic of)

    2013-12-15

    The author experienced 8 cases of pericoronal radiolucency involving an incomplete tooth crown that had not developed to form the cemento-enamel junction, and the underdeveloped crown sometimes appeared to be floating within the radiolucency radiographically. The first impression was that these cystic lesions had odontogenic keratocysts, but half of them turned out to be dentigerous cysts histopathologically. There has been no report concerning odontogenic cysts involving an incompletely developed crown. The purpose of this paper is to report that dentigerous cysts may develop before the completion of the cemento-enamel junction of a developing crown.

  13. Contractual Incompleteness, Unemployment, and Labour Market Segmentation

    DEFF Research Database (Denmark)

    Altmann, Steffen; Falk, Armin; Grunewald, Andreas;

    2014-01-01

    This article provides evidence that involuntary unemployment, and the segmentation of labour markets into firms offering "good" and "bad" jobs, may both arise as a consequence of contractual incompleteness.We provide a simple model that illustrates how unemployment and market segmentation may...... jointly emerge as part of a market equilibrium in environments where work effort is not third-party verifiable. Using experimental labour markets that differ only in the verifiability of effort, we demonstrate empirically that contractual incompleteness can cause unemployment and segmentation. Our data...

  14. Contractual Incompleteness, Unemployment, and Labour Market Segmentation

    DEFF Research Database (Denmark)

    Altmann, Steffen; Falk, Armin; Grunewald, Andreas

    2014-01-01

    This article provides evidence that involuntary unemployment, and the segmentation of labour markets into firms offering "good" and "bad" jobs, may both arise as a consequence of contractual incompleteness.We provide a simple model that illustrates how unemployment and market segmentation may...... jointly emerge as part of a market equilibrium in environments where work effort is not third-party verifiable. Using experimental labour markets that differ only in the verifiability of effort, we demonstrate empirically that contractual incompleteness can cause unemployment and segmentation. Our data...

  15. Cochlear implant in incomplete partition type I.

    Science.gov (United States)

    Berrettini, S; Forli, F; De Vito, A; Bruschini, L; Quaranta, N

    2013-02-01

    In this investigation, we report on 4 patients affected by incomplete partition type I submitted to cochlear implant at our institutions. Preoperative, surgical, mapping and follow-up issues as well as results in cases with this complex malformation are described. The cases reported in the present study confirm that cochlear implantation in patients with incomplete partition type I may be challenging for cochlear implant teams. The results are variable, but in many cases satisfactory, and are mainly related to the surgical placement of the electrode and residual neural nerve fibres. Moreover, in some cases the association of cochlear nerve abnormalities and other disabilities may significantly affect results.

  16. Misoprostol for treatment of incomplete abortion at the regional hospital level: results from Tanzania.

    Science.gov (United States)

    Shwekerela, B; Kalumuna, R; Kipingili, R; Mashaka, N; Westheimer, E; Clark, W; Winikoff, B

    2007-11-01

    To investigate the safety, efficacy, and acceptability of misoprostol versus manual vacuum aspiration (MVA) for treatment of incomplete abortion. A prospective open-label randomised trial. Kagera Regional Hospital, Bukoba, Tanzania. Three hundred women with a clinical diagnosis of incomplete abortion and a uterine size misoprostol or MVA. If abortion was clinically complete at 7-day follow up, the woman was released from the study. If it was still incomplete, the woman was offered the choice of an additional 1-week follow up or immediate MVA. Cases still incomplete after a further week were offered MVA. Incidence of successful abortion (success defined as no secondary surgical intervention provided), incidence of adverse effects, patient satisfaction. Success was very high in both arms (misoprostol: 99%; MVA: 100%; difference not significant). Most adverse effects were higher in the misoprostol arm, although the mean pain score was higher in the MVA arm (3.0 versus 3.5; P misoprostol (75%) than with MVA (55%, P = 0.001), and a higher proportion of women in the misoprostol arm said that they would recommend the treatment to a friend (95% versus 75%, P Misoprostol is as effective as MVA at treating incomplete abortion at uterine size of misoprostol appears higher. Given the many practical advantages of misoprostol over MVA in low-resource settings, misoprostol should be more widely available for treatment of incomplete abortion in the developing world.

  17. Carbon dioxide insufflation during colonoscopy in deeply sedated patients

    Institute of Scientific and Technical Information of China (English)

    Rajvinder Singh; Eu Nice Neo; Nazree Nordeen; Ganesananthan Shanmuganathan; Angelie Ashby; Sharon Drummond; Garry Nind

    2012-01-01

    AIM:To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubation rates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P =0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P =0.012).The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P =0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P =0.0228).The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P =0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insuffiation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

  18. Quantum Games of Continuous Distributed Incomplete Information

    Institute of Scientific and Technical Information of China (English)

    CHEN Xi; QIN Gan; ZHOU Xian-Yi; DU Jiang-Feng

    2005-01-01

    @@ We study two-player quantum games of incomplete information in which both the sides have partial information.The previous results of Du et al. [Phys. Rev. E 68 (2003) 016124] are incorporated in our more general formalism.Because of different roles played by the total information uncertainty and the information asymmetry, the game exhibits many interesting features.

  19. CLAIM HEDGING IN AN INCOMPLETE MARKET

    Institute of Scientific and Technical Information of China (English)

    SUN Wangui; WANG Chunfeng

    2005-01-01

    In this paper,we compare the performance of the optimal attainable payoffs (of a general claim) derived by the variance-optimal approach and the indifference argument under the mean-variance preference in an incomplete market.Both payoffs are expressed by the signed variance-optimal martingale measure.Our results are applied to the claim hedging under partial information.

  20. Incomplete Contracting Theory and EU Treaty Provisions

    DEFF Research Database (Denmark)

    Citi, Manuele; Jensen, Mads Dagnis

    This paper investigates interpretational ambiguity with reference to the ECC Treaty, and analyses its consequences. Theoretically, it suggests that incomplete contracts generate interpretational ambiguity, due to transaction costs but also to the inherent variability of language. Methodologically...... for studies arguing that supranational actors including the Commission and Court of Justice will utilize ambiguity to further their institutional and political agendas....

  1. Colonoscopy quality assessment Valoración de la calidad en la práctica de la colonoscopia

    Directory of Open Access Journals (Sweden)

    S. Morán Sánchez

    2009-02-01

    Full Text Available Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30 was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%, kappa 0.74 (95% CI: 0.48-0.99; cecal intubation rate (90% 0.74 (95% CI: 0.49-0.99; adenoma detection and removal rate (96%, kappa: 0.78 (95% CI: 0.53-0.99; withdrawal time: 13.36 min (95% CI: 10.48-16.11. Kappa: 0.78 (95% CI: 0.49-0.99. Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se

  2. Urinary excretion of polyethylene glycol 3350 during colonoscopy preparation

    DEFF Research Database (Denmark)

    Rothfuss, K. S.; Bode, J.C.; Stange, E.F.

    2006-01-01

    . In patients with inflammatory bowel disease (IBD), intestinal permeability and PEG absorption were previously reported to be higher than in normal subjects. In the current study, we investigated the absorption of PEG 3350 in patients undergoing routine gut lavage. METHODS AND RESULTS: Urine specimens were...... collected for 8 hours in 24 patients undergoing bowel cleansing with PEG 3350 for colonoscopy. The urinary excretion of PEG 3350, measured by size exclusion chromatography, ranged between 0.01 and 0.51 % of the ingested amount, corresponding to 5.8 and 896 mg in absolute amounts, respectively. Mean PEG...... excretion in patients with impaired mucosa such as inflammation or ulceration of the intestine (0.24 % +/- 0.19, n = 11) was not significantly higher (p = 0.173) compared to that in subjects with macroscopically normal intestinal mucosa (0.13 % +/- 0.13, n = 13). CONCLUSION: The results indicate...

  3. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy.

    Science.gov (United States)

    Singh, Mandeep; Mehta, Nilesh; Murthy, Uma K; Kaul, Vivek; Arif, Asma; Newman, Nancy

    2010-05-01

    The risk of postpolypectomy bleeding (PPB) in patients undergoing colonoscopy on uninterrupted clopidogrel therapy has not been established. To assess the PPB rate and outcome and identify risk factors associated with PPB in patients taking clopidogrel. Single-center, retrospective study. Demographics, clinical parameters, polyp characteristics, polypectomy techniques, and postpolypectomy events in the groups were compared by univariate analysis. Stepwise logistic regression analyses identified independent risk factors associated with PPB. Veterans Affairs Medical Center. A total of 142 patients (375 polypectomies) taking clopidogrel (cases) and 1243 patients (3226 polypectomies) not taking clopidogrel (controls). None. Postpolypectomy bleeding, hospitalization, and mortality. The immediate (intraprocedural) bleeding rate was similar in the 2 groups (2.1% vs 2.1%). Delayed (postprocedural) PPB rate was higher in the group taking clopidogrel (3.5% vs 1.0%, P = .02). Delayed bleeding of significance requiring hospitalization and transfusion/intervention was also higher in patients taking clopidogrel (2.1% vs 0.4%, P = .04). The length of hospital stay and interventions for PPB were comparable between the 2 groups. There was no mortality. Concomitant use of clopidogrel and aspirin/other nonsteroidal anti-inflammatory drugs (odds ratio 3.7; 95% CI, 1.6-8.5) and the number of polyps removed (OR 1.3; 95% CI, 1.2-1.4) were the only significant risk factors associated with PPB. Clopidogrel alone was not an independent risk factor for PPB. Retrospective study and small number of patients with PPB. The PPB rate is significantly higher in patients undergoing polypectomy while taking clopidogrel and concomitant aspirin/nonsteroidal anti-inflammatory drugs; however, the risk is small and the outcome is favorable. Routine cessation of clopidogrel in patients before colonoscopy/polypectomy is not necessary. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby

  4. Informed consent in colonoscopy: A comparative analysis of 2 methods.

    Science.gov (United States)

    Sanguinetti, J M; Lotero Polesel, J C; Iriarte, S M; Ledesma, C; Canseco Fuentes, S E; Caro, L E

    2015-01-01

    The manner in which informed consent is obtained varies. The aim of this study is to evaluate the level of knowledge about colonoscopy and comparing 2 methods of obtaining informed consent. A comparative, cross-sectional, observational study was conducted on patients that underwent colonoscopy in a public hospital (Group A) and in a private hospital (Group B). Group A received information verbally from a physician, as well as in the form of printed material, and Group B only received printed material. A telephone survey was carried out one or 2 weeks later. The study included a total of 176 subjects (group A [n=55] and group B [n=121]). As regards education level, 69.88% (n=123) of the patients had completed university education, 23.29% (n= 41) secondary level, 5.68% (n=10) primary level, and the remaining subjects (n=2) had not completed any level of education. All (100%) of the subjects knew the characteristics of the procedure, and 99.43% were aware of its benefits. A total of 97.7% received information about complications, 93.7% named some of them, and 25% (n=44) remembered major complications. All the subjects received, read, and signed the informed consent statement before the study. There were no differences between the groups with respect to knowledge of the characteristics and benefits of the procedure, or the receipt and reading of the consent form. Group B responded better in relation to complications (P=.0027) and group A had a better recollection of the major complications (P<.0001). Group A had a higher number of affirmative answers (P<.0001). The combination of verbal and written information provides the patient with a more comprehensive level of knowledge about the procedure. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  5. Evaluation of magnifying colonoscopy in the diagnosis of serrated polyps

    Institute of Scientific and Technical Information of China (English)

    Shinya Ishigooka; Masahito Nomoto; Nobuyuki Obinata; Yoshichika Oishi; Yoshinori Sato; Satoko Nakatsu; Midori Suzuki

    2012-01-01

    AIM:To elucidate the colonoscopic features of serrated lesions of the colorectum using magnifying colonoscopy.METHODS:Broad division of serrated lesions of the colorectum into hyperplastic polyps (HPs),traditional serrated adenomas (TSAs),and sessile serrated adenomas/polyps (SSA/Ps) has been proposed on the basis of recent molecular biological studies.However,few reports have examined the colonoscopic features of these divisions,including magnified colonoscopic findings.This study examined 118 lesions excised in our hospital as suspected serrated lesions after magnified observation between January 2008 and September 2011.Patient characteristics (sex,age),conventional colonoscopic findings (location,size,morphology,color,mucin) and magnified colonoscopic findings (pit pattern diagnosis) were interpreted by five colonoscopists with experience in over 1000 colonoscopies,and were compared with histopathological diagnoses.The pit patterns were categorized according to Kudo's classification,but a more detailed investigation was also performed using the subclassification [type Ⅱ-Open (type Ⅱ-O),type Ⅱ-Long (type Ⅱ-L),or type Ⅳ-Serrated (type Ⅳ-S)] proposed by Kimura T and Yamano H.RESULTS:Lesions comprised 23 HPs (23/118:19.5%),39 TSAs (39/118:33.1%:with cancer in one case),50 SSA/Ps (50/118:42.4%:complicated with cancer in three cases),and six others (6/118:5.1%).We excluded six others,including three regular adenomas,one hamartoma,one inflammatory polyp,and one juvenile polyp for further analysis.Conventional colonoscopy showed that SSA/Ps were characterized as larger in diameter than TSAs and HPs (SSA/P vs HP,13.62 ± 8.62 mm vs 7.74 ± 3.24 mm,P < 0.001; SSA/Ps vs TSA,13.62 ±8.62 mm vs 9.89 ± 5.73 mm,P < 0.01); common in the right side of the colon [HPs,30.4% (7/23):TSAs,20.5%(8/39):SSA/P,84.0% (42/50),P < 0.001]; fiat-elevated lesion [HPs,30.4% (7/23):TSAs,5.1% (2/39):SSA/Ps,90.0% (45/50),P < 0.001]; normal-colored or pale

  6. Propofol for sedation during colonoscopy- A survey of a Cochrane review

    DEFF Research Database (Denmark)

    Høj, Anders Thorsmark

    2010-01-01

    The Cochrane collaboration metaanalysis of propofol use during colonoscopy found a faster patient recovery, higher patient satisfaction and unchanged complication rate compared to traditional sedatives. Patient groups consisted mostly of ASA I-II-patients, therefore the study is inconclusive...

  7. Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy

    DEFF Research Database (Denmark)

    Holm, C; Christensen, M; Schulze, S

    1999-01-01

    through nasal prongs (2 L/min), and 20 patients breathed room air during colonoscopy. All patients were given conscious sedation and were monitored with a pulse oximeter during colonoscopy. MAIN OUTCOME MEASURES: Tachycardia (pulse rate>100 min(-1)) and arterial oxygen desaturation (SpO2... colonoscopy. RESULTS: There were no differences in the incidence of tachycardia or mean heart rate during endoscopy between the two groups, and no patient developed symptomatic cardiac arrhythmias or hypotensive episodes. 10 patients in the room air compared with none in the oxygen treatment group (p = 0.......0004) had one or more episodes during which arterial oxygen saturation fell below 90% during colonoscopy, and mean oxygen saturation was higher in the oxygen treatment group than in the room air group (p tachycardia...

  8. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

    DEFF Research Database (Denmark)

    Froehlich, F; Harris, JK; Wietlisbach, V;

    2006-01-01

    in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were......BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice...... included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood...

  9. Stress perception among patients in pre-colonoscopy period and those undergoing chemotherapy treatment

    Directory of Open Access Journals (Sweden)

    Graziela de Souza Alves da Silva

    2015-05-01

    Full Text Available Objective: comparing the perception of stress among patients with colorectal cancer undergoing chemotherapy with those in pre-colonoscopy period. Methods: a comparative descriptive study developed with 144 people receiving chemotherapy and 100 patients in the pre-colonoscopy period, using biosocial and clinical data, Stress Assessment Tool and Perceived Stress Scale. Results: a predominance of females (73%, aged over 65 (50% were predominant for the pre-colonoscopy period patients. In patients receiving chemotherapy, gender parity with ages ranging from 40-64 years (68.1% was observed. Pre-colonoscopy patients showed higher perceived stress compared to those receiving chemotherapy (p <0.001. Conclusion: the phase of diagnostic definition represents greater stress to patients in comparison to period of treatment, even despite the characteristic manifestations of chemotherapy.

  10. Neighborhood socioeconomic status and use of colonoscopy in an insured population--a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Chyke A Doubeni

    Full Text Available BACKGROUND: Low-socioeconomic status (SES is associated with a higher colorectal cancer (CRC incidence and mortality. Screening with colonoscopy, the most commonly used test in the US, has been shown to reduce the risk of death from CRC. This study examined if, among insured persons receiving care in integrated healthcare delivery systems, differences exist in colonoscopy use according to neighborhood SES. METHODS: We assembled a retrospective cohort of 100,566 men and women, 50-74 years old, who had been enrolled in one of three US health plans for ≥1 year on January 1, 2000. Subjects were followed until the date of first colonoscopy, date of disenrollment from the health plan, or December 31, 2007, whichever occurred first. We obtained data on colonoscopy use from administrative records. We defined screening colonoscopy as an examination that was not preceded by gastrointestinal conditions in the prior 6-month period. Neighborhood SES was measured using the percentage of households in each subject's census-tract with an income below 1999 federal poverty levels based on 2000 US census data. Analyses, adjusted for demographics and comorbidity index, were performed using Weibull regression models. RESULTS: The average age of the cohort was 60 years and 52.7% were female. During 449,738 person-years of follow-up, fewer subjects in the lowest SES quartile (Q1 compared to the highest quartile (Q4 had any colonoscopy (26.7% vs. 37.1% or a screening colonoscopy (7.6% vs. 13.3%. In regression analyses, compared to Q4, subjects in Q1 were 16% (adjusted HR = 0.84, 95% CI: 0.80-0.88 less likely to undergo any colonoscopy and 30%(adjusted HR = 0.70, CI: 0.65-0.75 less likely to undergo a screening colonoscopy. CONCLUSION: People in lower-SES neighborhoods are less likely to undergo a colonoscopy, even among insured subjects receiving care in integrated healthcare systems. Removing health insurance barriers alone is unlikely to eliminate

  11. 19 CFR 4.75 - Incomplete manifest; incomplete export declarations; bond.

    Science.gov (United States)

    2010-04-01

    ... attorney in fact of the vessel owner. The “Incomplete Manifest for Export” box in item 17 of the Vessel... Republic of Cuba Czechoslovakia Estonia German Democratic Republic (Soviet Zone of Germany and Soviet Zone...

  12. Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding

    Institute of Scientific and Technical Information of China (English)

    Dekey Y Lhewa; Lisa L Strate

    2012-01-01

    Acute lower gastrointestinal bleeding (LGIB) is a frequent gastrointestinal cause of hospitalization,particularly in the elderly,and its incidence appears to be on the rise.Endoscopic and radiographic measures are available for the evaluation and treatment of LGIB including flexible sigmoidoscopy,colonoscopy,angiography,radionuclide scintigraphy and multi-detector row computed tomography.Although no modality has emerged as the gold standard in the management of LGIB,colonoscopy is the current preferred initial test for the majority of the patients presenting with hematochezia felt to be from a colon source.Colonoscopy has the ability to diagnose all sources of bleeding from the colon and,unlike the radiologic modalities,does not require active bleeding at the time of the examination.In addition,therapeutic interventions such as cautery and endoclips can be applied to achieve hemostasis and prevent recurrent bleeding.Studies suggest that colonoscopy,particularly when performed early in the hospitalization,can decrease hospital length of stay,rebleeding and the need for surgery.However,results from available small trials are conflicting and larger,multicenter studies are needed.Compared to other management options,colonoscopy is a safe procedure with complications reported in less than 2% of patients,including those undergoing urgent examinations.The requirement of bowel preparation (typically 4 or more liters of polyethylene glycol),the logistical complexity of coordinating after-hours colonoscopy,and the low prevalence of stigmata of hemorrhage complicate the use of colonoscopy for LGIB,particularly in urgent situations.This review discusses the above advantages and disadvantages of colonoscopy in the management of acute lower gastrointestinal bleeding in further detail.

  13. A modular simulation framework for colonoscopy using a new haptic device.

    Science.gov (United States)

    Hellier, David; Samur, Evren; Passenger, Josh; Spälter, Ulrich; Frimmel, Hans; Appleyard, Mark; Bleuler, Hannes; Ourselin, Sébastien

    2008-01-01

    We have developed a multi-threaded framework for colonoscopy simulation utilising OpenGL with an interface to a real-time prototype colonoscopy haptic device. A modular framework has enabled us to support multiple haptic devices and efficiently integrate new research into physically based modelling of the colonoscope, colon and surrounding organs. The framework supports GPU accelerated algorithms as runtime modules, allowing the real-time calculations required for haptic feedback.

  14. Model for Incomplete Reconnection in Sawtooth Crashes

    CERN Document Server

    Beidler, Matthew T

    2011-01-01

    A model for incomplete reconnection in sawtooth crashes is presented. The reconnection inflow during the crash phase of sawteeth self-consistently convects the high pressure core toward the reconnection site, raising the pressure gradient there. Reconnection shuts off if the diamagnetic drift speed at the reconnection site exceeds a threshold, which may explain incomplete reconnection. The relaxation of magnetic shear after reconnection stops may explain the destabilization of ideal interchange instabilities reported previously. Proof-of-principle two-fluid simulations confirm this basic picture. Predictions of the model compare favorably to data from the Mega Ampere Spherical Tokamak. Applications to transport modeling of sawteeth are discussed. The results should apply across tokamaks, including ITER.

  15. Model for incomplete reconnection in sawtooth crashes.

    Science.gov (United States)

    Beidler, M T; Cassak, P A

    2011-12-16

    A model for incomplete reconnection in sawtooth crashes is presented. The reconnection inflow during the crash phase of sawteeth self-consistently convects the high pressure core toward the reconnection site, raising the pressure gradient there. Reconnection shuts off if the diamagnetic drift speed at the reconnection site exceeds a threshold, which may explain incomplete reconnection. The relaxation of magnetic shear after reconnection stops may explain the destabilization of ideal interchange instabilities reported previously. Proof-of-principle two-fluid simulations confirm this basic picture. Predictions of the model compare favorably to data from the Mega Ampere Spherical Tokamak. Applications to transport modeling of sawteeth are discussed. The results should apply across tokamaks, including ITER.

  16. Past incompleteness of a bouncing multiverse

    CERN Document Server

    Vilenkin, Alexander

    2014-01-01

    According to classical GR, Anti-de Sitter (AdS) bubbles in the multiverse terminate in big crunch singularities. It has been conjectured, however, that the fundamental theory may resolve these singularities and replace them by nonsingular bounces. This may have important implications for the beginning of the multiverse. Geodesics in cosmological spacetimes are known to be past-incomplete, as long as the average expansion rate along the geodesic is positive, but it is not clear that the latter condition is satisfied if the geodesic repeatedly passes through crunching AdS bubbles. We investigate this issue in a simple multiverse model, where the spacetime consists of a patchwork of FRW regions. The conclusion is that the spacetime is still past-incomplete, even in the presence of AdS bounces.

  17. Lossy Channel Games under Incomplete Information

    Directory of Open Access Journals (Sweden)

    Rayna Dimitrova

    2013-03-01

    Full Text Available In this paper we investigate lossy channel games under incomplete information, where two players operate on a finite set of unbounded FIFO channels and one player, representing a system component under consideration operates under incomplete information, while the other player, representing the component's environment is allowed to lose messages from the channels. We argue that these games are a suitable model for synthesis of communication protocols where processes communicate over unreliable channels. We show that in the case of finite message alphabets, games with safety and reachability winning conditions are decidable and finite-state observation-based strategies for the component can be effectively computed. Undecidability for (weak parity objectives follows from the undecidability of (weak parity perfect information games where only one player can lose messages.

  18. Past incompleteness of a bouncing multiverse

    Energy Technology Data Exchange (ETDEWEB)

    Vilenkin, Alexander; Zhang, Jun, E-mail: vilenkin@cosmos.phy.tufts.edu, E-mail: jun.zhang@tufts.edu [Institute of Cosmology, Department of Physics and Astronomy, Tufts University, Medford, MA 02155 (United States)

    2014-06-01

    According to classical GR, Anti-de Sitter (AdS) bubbles in the multiverse terminate in big crunch singularities. It has been conjectured, however, that the fundamental theory may resolve these singularities and replace them by nonsingular bounces. This may have important implications for the beginning of the multiverse. Geodesics in cosmological spacetimes are known to be past-incomplete, as long as the average expansion rate along the geodesic is positive, but it is not clear that the latter condition is satisfied if the geodesic repeatedly passes through crunching AdS bubbles. We investigate this issue in a simple multiverse model, where the spacetime consists of a patchwork of FRW regions. The conclusion is that the spacetime is still past-incomplete, even in the presence of AdS bounces.

  19. Advanced incomplete factorization algorithms for Stiltijes matrices

    Energy Technology Data Exchange (ETDEWEB)

    Il`in, V.P. [Siberian Division RAS, Novosibirsk (Russian Federation)

    1996-12-31

    The modern numerical methods for solving the linear algebraic systems Au = f with high order sparse matrices A, which arise in grid approximations of multidimensional boundary value problems, are based mainly on accelerated iterative processes with easily invertible preconditioning matrices presented in the form of approximate (incomplete) factorization of the original matrix A. We consider some recent algorithmic approaches, theoretical foundations, experimental data and open questions for incomplete factorization of Stiltijes matrices which are {open_quotes}the best{close_quotes} ones in the sense that they have the most advanced results. Special attention is given to solving the elliptic differential equations with strongly variable coefficients, singular perturbated diffusion-convection and parabolic equations.

  20. Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

    Directory of Open Access Journals (Sweden)

    Yutaro Hayashi

    2017-01-01

    Full Text Available Introduction. Xanthogranulomatous pyelonephritis (XGP is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells; thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

  1. Abigail’s Orphanhood and Incomplete Personality

    Institute of Scientific and Technical Information of China (English)

    徐孟婕

    2015-01-01

    Abigail, the protagonist and vil ain in The Crucible, is manipulative, charismatic, and would attack anyone who stands in her way. However, reflecting on her orphanhood and incomplete personality, Abigail and her diabolic actions make more sense. This paper analyzes three facets of Abigail’s personality with a focus on her orphanhood and concludes that her wretchedness is related to her early loss of parents.

  2. Association between the location of colon polyps at baseline and surveillance colonoscopy: a retrospective study

    Directory of Open Access Journals (Sweden)

    Ana Oliveira

    Full Text Available Introduction: Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. Methods: A retrospective study of patients submitted to colonoscopy with presence and excision of all polyps, followed by a surveillance colonoscopy. Polyp location was divided into proximal/distal to splenic flexure and rectum. Characteristics and recurrent rates at the same colon location were also evaluated. Results: Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4% had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0 and distal colon segments (OR 3.8; CI 2.1-6.8, followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6. No difference was found between the rates of recurrence at the same segment, taking into consideration the polyp morphology, size, polypectomy technique employed and histological classification. Conclusion: There seems to be a significant association between polyp location at baseline and surveillance colonoscopy.

  3. Characterizing Online Narratives About Colonoscopy Experiences: Comparing Colon Cancer "Screeners" Versus "Survivors".

    Science.gov (United States)

    McQueen, Amy; Arnold, Lauren D; Baltes, Michael

    2015-08-01

    Effective screening can reduce colorectal cancer mortality; however, screening uptake is suboptimal. Patients' stories about various health topics are widely available online and in behavioral interventions and are valued by patients. Although these narratives may be promising strategies for promoting cancer screening behavior, scant research has compared the influence of different role models. This study involving content analysis of online stories aimed to (a) describe the content of online experiential narratives about colonoscopy; (b) compare narratives from individuals who had a colonoscopy and either had colon cancer (survivors) or did not have colon cancer (screeners); and (c) generate hypotheses for future studies. The authors identified 90 narratives eligible for analysis from 15 websites. More stories were about White patients, men, and routine (vs. diagnostic) colonoscopy. A higher-than-expected number of narratives reported a family history of colorectal cancer or polyps (20%) and a colorectal cancer diagnosis (47%). Colorectal cancer survivor (vs. screener) stories were longer, mentioned symptoms and diagnostic reasons for getting a colonoscopy more often, and described the colonoscopy procedure or referred to it as easy or painless less often. Future studies should examine the effects of the role model's personal characteristics and the colonoscopy test result on reader's perceptions and intentions to have a colorectal cancer screening.

  4. Evaluating screening colonoscopy quality in an uninsured urban population following patient navigation.

    Science.gov (United States)

    Naylor, Keith; Fritz, Cassandra; Polite, Blase; Kim, Karen

    2017-03-01

    Patient navigation (PN) increases screening colonoscopy completion in minority and uninsured populations. However, colonoscopy quality is under-reported in the setting of PN and quality indicators have often failed to meet benchmark standards. This study investigated screening colonoscopy quality indicators after year-one of a PN initiative targeting the medically uninsured. This was a retrospective analysis of 296 outpatient screening colonoscopies. Patients were 45 to 75 years of age with no history of bowel cancer, inflammatory bowel disease, or colorectal surgery. The screening colonoscopy quality indicators: adenoma detection rate (ADR), cecal intubation rate (CIR), and bowel preparation quality were compared in 89 uninsured Federally Qualified Health Center (FQHC) patients who received PN and 207 University Hospital patients who received usual care. The FQHC PN and University Hospital cohorts were similar in female sex (69% vs. 70%; p = 0.861) and African American race (61% vs. 61%; p = 0.920). The FQHC PN cohort was younger (57 years vs. 60 years; p bench-mark standards for high-quality screening colonoscopy and were equivalent to those observed in an insured University Hospital patient population.

  5. Physician Perceptions on Colonoscopy Quality: Results of a National Survey of Gastroenterologists

    Directory of Open Access Journals (Sweden)

    Ziad F. Gellad

    2014-01-01

    Full Text Available Background. Quality indicators for colonoscopy have been developed, but the uptake of these metrics into practice is uncertain. Our aims were to assess physician perceptions regarding colonoscopy quality measurement and to quantify the perceived impact of quality measurement on clinical practice. Methods. We conducted in-person interviews with 15 gastroenterologists about their perceptions regarding colonoscopy quality. Results from these interviews informed the development of a 34-question web-based survey that was emailed to 1,500 randomlyselected members of the American College of Gastroenterology. Results. 160 invitations were undeliverable, and 167 out of 1340 invited physicians (12.5% participated in the survey. Respondents and nonrespondents did not differ in age, sex, practice setting, or years since training. 38.8% of respondents receive feedback on their colonoscopy quality. The majority of respondents agreed with the use of completion rate (90% and adenoma detection rate (83% as quality indicators but there was less enthusiasm for withdrawal time (61%. 24% of respondents reported usually or always removing diminutive polyps solely to increase their adenoma detection rate, and 20% reported prolonging their procedure time to meet withdrawal time standards. Conclusions. A minority of respondents receives feedback on the quality of their colonoscopy. Interventions to increase continuous quality improvement in colonoscopy screening are needed.

  6. Predicting advanced neoplasia at colonoscopy in a diverse population with the National Cancer Institute colorectal cancer risk-assessment tool.

    Science.gov (United States)

    Ladabaum, Uri; Patel, Ashley; Mannalithara, Ajitha; Sundaram, Vandana; Mitani, Aya; Desai, Manisha

    2016-09-01

    Tailoring screening to colorectal cancer (CRC) risk could improve screening effectiveness. Most CRCs arise from advanced neoplasia (AN) that dwells for years. To date, no available colorectal neoplasia risk score has been validated externally in a diverse population. The authors explored whether the National Cancer Institute (NCI) CRC risk-assessment tool, which was developed to predict future CRC risk, could predict current AN prevalence in a diverse population, thereby allowing its use in risk stratification for screening. This was a prospective examination of the relation between predicted 10-year CRC risk and the prevalence of AN, defined as advanced or multiple (≥3 adenomatous, ≥5 serrated) adenomatous or sessile serrated polyps, in individuals undergoing screening colonoscopy. Among 509 screenees (50% women; median age, 58 years; 61% white, 5% black, 10% Hispanic, and 24% Asian), 58 (11%) had AN. The prevalence of AN increased progressively from 6% in the lowest risk-score quintile to 17% in the highest risk-score quintile (P = .002). Risk-score distributions in individuals with versus without AN differed significantly (median, 1.38 [0.90-1.87] vs 1.02 [0.62-1.57], respectively; P = .003), with substantial overlap. The discriminatory accuracy of the tool was modest, with areas under the curve of 0.61 (95% confidence interval [CI], 0.54-0.69) overall, 0.59 (95% CI, 0.49-0.70) for women, and 0.63 (95% CI, 0.53-0.73) for men. The results did not change substantively when the analysis was restricted to adenomatous lesions or to screening procedures without any additional incidental indication. The NCI CRC risk-assessment tool displays modest discriminatory accuracy in predicting AN at screening colonoscopy in a diverse population. This tool may aid shared decision-making in clinical practice. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2663-2670. © 2016 American Cancer Society. © 2016 American Cancer Society.

  7. MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies.

    Science.gov (United States)

    Hjelkrem, Michael; Stengel, Joel; Liu, Mark; Jones, David P; Harrison, Stephen A

    2011-04-01

    Successful colonoscopies require good bowel preparations-poor bowel preparations can increase medical costs, rates of missed lesions, and procedure duration. The combination of polyethylene glycol (PEG) 3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products, Inc, Kenilworth, NJ) and 64 oz of Gatorade (PepsiCo, Inc, Purchase, NY) has gained popularity as a bowel preparation regimen. However, the efficacy and tolerability of this approach has not been compared with standard bowel preparations in clinical trials. We compared split-dose (PEG) 3350 with electrolytes (GoLytely; Braintree Laboratories, Inc, Braintree, MA) with split-dose MiraLAX alone and in combination with pretreatment medications (bisacodyl or lubiprostone) to determine the efficacy and patient tolerability of MiraLAX as an agent for bowel preparation. We performed a prospective, randomized, blinded, controlled trial at a tertiary care center. Patients (n=403) were randomly assigned to groups given GoLytely, MiraLAX, MiraLAX with bisacodyl (10 mg), or MiraLAX with lubiprostone (24 μg). MiraLAX was combined with 64 oz of Gatorade. All patients were surveyed regarding preparation satisfaction and tolerability. The Ottawa bowel preparation scale was used to grade colon cleanliness. GoLytely was more effective at bowel cleansing (average Ottawa score, 5.1) than MiraLAX alone (average Ottawa score, 6.9) or in combination with lubiprostone (average Ottawa score, 6.8), or bisacodyl (average Ottawa score, 6.3) (PGatorade is not as effective as 4 L split-dose GoLytely in bowel cleansing for screening colonoscopies. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. Visuo-spatial ability in colonoscopy simulator training

    NARCIS (Netherlands)

    Luursema, J.-M.; Buzink, S.N.; Verwey, W.B.; Jakimowicz, J.J.

    2010-01-01

    Visuo-spatial ability is associated with a quality of performance in a variety of surgical and medical skills. However, visuo-spatial ability is typically assessed using Visualization tests only, which led to an incomplete understanding of the involvement of visuo-spatial ability in these skills. To

  9. Applicable observation of butorphanol in painless colonoscopy examination

    Directory of Open Access Journals (Sweden)

    Li Xuefeng

    2017-01-01

    Full Text Available Objective:To summarize the clinical effect of butorphanol compound propofol in painless colonoscopy examination and its feasibility.Methods:100 colonoscopy examination patients (56 males and 44 females aged from 19 to 60 years old registered between August, 2016 and September, 2016 in the endoscopy center of our hospital were randomly selected. ASA classification is I or II level. Their body weight ranged from 55 kg to 75kg. They were randomly divided into two groups and each group included 50 cases. All patients went through conventional ambrosia and liquid fasting for 8 hours before the anesthesia and they drank magnesium sulfate liquid of 2500ml to clean their gastrointestinal tracts.After patients entered the operating room, their veins of upper limb were opened so as to monitor their HR, MAP and SPO2. After that, butorphanol of 20μg/kg was injected to patients of the experimental group while normal saline of the same amount of was injected to patients of the contrast group. After 60 seconds, propofol of 1~2 mg/kg was injected to both groups by the way of intravenous injection. The enteroscopy examination was started after patients had no eyelash reflection. Besides, actual application dose of propofol was adjusted according to clinical indications of patients and the adjusting frequency each time was controlled between 30 milligrams and 50 milligrams until the completion of the examination. SPSS 22.0 statistical software was used to analyze and handle research data of this group. Results:Anesthesia effect: The difference of inter-group comparison showed no statistical significance (P>0.05. The intra-group comparison and the inter-group comparison show that the difference in terms of changes of HR, MAP and SpO2 of patients in two groups before and after the anesthesia had no statistical significance (P>0.05.The awakening time, VAS score, postoperative vomiting times and the occurrence rate of respiratory depression of the observation group

  10. Clinical significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zhen-Jie Wu

    Full Text Available BACKGROUND: Some authors have studied the relationship between the presence of polyps, adenomas and cancers of upper gastrointestinal tract (stomach and duodenum and risk of colorectal polyps and neoplasms; however, the results are controversial, which may be due to study sample size, populations, design, clinical features, and so on. No meta-analysis, which can be generalized to a larger population and could provide a quantitative pooled risk estimate of the relationship, of this issue existed so far. METHODS: We performed a meta-analysis to evaluate risk of colorectal polyps or neoplasms in patients with polyps, adenomas or cancers in upper gastrointestinal tract comparing with controls. A search was conducted through PubMed, EMBASE, reference lists of potentially relevant papers, and practice guidelines up to 27 November 2013 without languages restriction. Odd ratios (ORs were pooled using random-effects models. RESULTS: The search yielded 3 prospective and 21 retrospective case-control studies (n = 37152 participants. The principal findings included: (1 OR for colorectal polyps was 1.15 (95% CI, 1.04-1.26 in the gastric polyps group comparing with control groups; (2 Patients with gastric polyps and neoplasms have higher risk (OR, 1.31 [95% CI, 1.06-1.62], and 1.72 [95% CI, 1.42-2.09], respectively of colorectal neoplasms comparing with their controls; and (3 Positive association was found between the presence of colorectal neoplasms and sporadic duodenal neoplasms (OR, 2.59; 95% CI, 1.64-4.11. CONCLUSIONS: Findings from present meta-analysis of 24 case-control studies suggest that the prevalence of colorectal polyps was higher in patients with gastric polyps than in those without gastric polyps, and the risk of colorectal neoplasms increases significantly in patients with gastric polyps, neoplasms, and duodenal neoplasms. Therefore, screening colonoscopy should be considered for patients with upper gastrointestinal polyps and neoplasms.

  11. Incomplete penetrance in mitochondrial optic neuropathies.

    Science.gov (United States)

    Caporali, Leonardo; Maresca, Alessandra; Capristo, Mariantonietta; Del Dotto, Valentina; Tagliavini, Francesca; Valentino, Maria Lucia; La Morgia, Chiara; Carelli, Valerio

    2017-07-14

    Incomplete penetrance characterizes the two most frequent inherited optic neuropathies, Leber's Hereditary Optic Neuropathy (LHON) and dominant optic atrophy (DOA), due to genetic errors in the mitochondrial DNA (mtDNA) and the nuclear DNA (nDNA), respectively. For LHON, compelling evidence has accumulated on the complex interplay of mtDNA haplogroups and environmental interacting factors, whereas the nDNA remains essentially non informative. However, a compensatory mechanism of activated mitochondrial biogenesis and increased mtDNA copy number, possibly driven by a permissive nDNA background, is documented in LHON; when successful it maintains unaffected the mutation carriers, but in some individuals it might be hampered by tobacco smoking or other environmental factors, resulting in disease onset. In females, mitochondrial biogenesis is promoted and maintained within the compensatory range by estrogens, partially explaining the gender bias in LHON. Concerning DOA, none of the above mechanisms has been fully explored, thus mtDNA haplogroups, environmental factors such as tobacco and alcohol, and further nDNA variants may all participate as protective factors or, on the contrary, favor disease expression and severity. Next generation sequencing, complemented by transcriptomics and proteomics, may provide some answers in the next future, even if the multifactorial model that seems to apply to incomplete penetrance in mitochondrial optic neuropathies remains problematic, and careful stratification of patients will play a key role for data interpretation. The deep understanding of which factors impinge on incomplete penetrance may shed light on the pathogenic mechanisms leading to optic nerve atrophy, on their possible compensation and, thus, on development of therapeutic strategies. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  12. Study of General Incomplete Star Interconnection Networks

    Institute of Scientific and Technical Information of China (English)

    史云涛; 侯紫峰; 宋建平

    2002-01-01

    The star networks, which were originally proposed by Akers and Harel, have suffered from a rigorous restriction on the number of nodes. The general incomplete star networks (GISN) are proposed in this paper to relieve this restriction. An efficient labeling scheme for GISN is given, and routing and broadcasting algorithms are also presented for GISN. The communication diameter of GISN is shown to be bounded by 4n - 7. The proposed single node broadcasting algorithm is optimal with respect to time complexity O(n log2 n).

  13. Entropy, heat, and G\\"odel incompleteness

    CERN Document Server

    Schlesinger, Karl-Georg

    2014-01-01

    Irreversible phenomena, such as the production of entropy and heat, arise from fundamental reversible dynamics because the forward dynamics is too complex, in the sense that it becomes impossible to provide the necessary information to keep track of the dynamics. On a heuristic level, this is well captured by coarse graining. We suggest that on a fundamental level the impossibility to provide the necessary information might be related to the incompleteness results of G\\"odel. This would hold interesting implications for both, mathematics and physics.

  14. Some results on resolvable incomplete block designs

    Institute of Scientific and Technical Information of China (English)

    LIU; Minqian; FANG; Kaitai

    2005-01-01

    This paper is concerned with the uniformity of a certain kind of resolvable incomplete block (RIB for simplicity) design which is called the PRIB design here. A sufficient and necessary condition is obtained, under which a PRIB design is the most uniform in the sense of a discrete discrepancy measure, and the uniform PRIB design is shown to be connected. A construction method for such designs via a kind of U-type designs is proposed, and an existence result of these designs is given. This method sets up an important bridge between PRIB designs and U-type designs.

  15. Godel's Incompleteness Theorems and Platonic Metaphysics

    CERN Document Server

    Mikovic, Aleksandar

    2015-01-01

    We argue by using Godel's incompletness theorems in logic that platonism is the best metaphysics for science. This is based on the fact that a natural law in a platonic metaphysics represents a timeless order in the motion of matter, while a natural law in a materialistic metaphysics can be only defined as a temporary order which appears at random in the chaotic motion of matter. Although a logical possibility, one can argue that this type of metaphysics is highly implausible. Given that mathematics fits naturally within platonism, we conclude that a platonic metaphysics is more preferable than a materialistic metaphysics.

  16. Inflationary spacetimes are incomplete in past directions.

    Science.gov (United States)

    Borde, Arvind; Guth, Alan H; Vilenkin, Alexander

    2003-04-18

    Many inflating spacetimes are likely to violate the weak energy condition, a key assumption of singularity theorems. Here we offer a simple kinematical argument, requiring no energy condition, that a cosmological model which is inflating--or just expanding sufficiently fast--must be incomplete in null and timelike past directions. Specifically, we obtain a bound on the integral of the Hubble parameter over a past-directed timelike or null geodesic. Thus inflationary models require physics other than inflation to describe the past boundary of the inflating region of spacetime.

  17. Use of automated irrigation pumps improves quality of bowel preparation for colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Sujan Ravi; Rana Sabbagh; Fadi Antaki

    2016-01-01

    AIM: To evaluate the effectiveness of automated irrigation pumps(AIPs) in improving the quality of the bowel preparation and the yield of colonoscopy.METHODS: A retrospective observational study was conducted at a single medical center. Outpatient colonoscopies performed during a 4-mo time period when AIPs were not in use, were compared to colonoscopies performed during control period. The main outcomes measured were quality of bowel preparation, procedures aborted due to poor preparation, recommendations to repeat at short interval due to suboptimal bowel preparation and adenoma detection rates.RESULTS: One thousand and thirty-seven colonoscopies were included. A higher proportion of cases did not achieve a satisfactory bowel preparation when AIPs were not used(24.4% vs 10.3%, P < 0.01). The number of procedures aborted due to inadequate preparation was not significantly different, however a repeat procedure at a short interval was recommended in a higher proportion of cases when AIPs were not used(21.3% vs 6.9%, P < 0.01). Good or excellent preparation was 2.91(95%CI: 2.04-4.15) times more likely when AIPs were used. Detection of polyps and adenomas was not significantly different.CONCLUSION: AIP use during colonoscopy results in a higher proportion of colonic preparation rated as satisfactory, although polyp detection rate is not significantly affected. Recommendations for repeat colonoscopy at shorter interval significantly decrease with the use of AIPs. This study supports the use of the irrigation pumps in endoscopy units to improve the quality of colonoscopy.

  18. Ascaris lumbricoides: To Expect the Unexpected during a Routine Colonoscopy.

    Science.gov (United States)

    Kanneganti, Kalyan; Makker, Jasbir S; Remy, Prospere

    2013-01-01

    Ascaris lumbricoides is a common nematode infecting humans worldwide with increased prevalence in tropical and subtropical areas of less developed countries. Recently, it has been estimated that over one billion individuals are infected with ascariasis worldwide with 7% in USA. Although most of these cases are due to increasing immigration and travel outside America it is worth recognizing that prevalence of ascariasis is high in southeastern parts of USA due to their temperate climate. Infections of A. lumbricoides are largely asymptomatic, and hence a large population of people carrying this worm remains undetected for years until they develop some symptoms. Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. Here, we present a case of an intestinal ascariasis found during routine colonoscopy in an African-American man from the Bronx with perianal itching. He denied any history of travel outside USA but reported frequent visits to South Carolina. This case illustrates the fact that ascariasis should be suspected even if immigration or travel outside USA is not involved. It should be suspected even in cases of travel within USA to the south east where endemic cases are reported.

  19. Ascaris lumbricoides: To Expect the Unexpected during a Routine Colonoscopy

    Directory of Open Access Journals (Sweden)

    Kalyan Kanneganti

    2013-01-01

    Full Text Available Ascaris lumbricoides is a common nematode infecting humans worldwide with increased prevalence in tropical and subtropical areas of less developed countries. Recently, it has been estimated that over one billion individuals are infected with ascariasis worldwide with 7% in USA. Although most of these cases are due to increasing immigration and travel outside America it is worth recognizing that prevalence of ascariasis is high in southeastern parts of USA due to their temperate climate. Infections of A. lumbricoides are largely asymptomatic, and hence a large population of people carrying this worm remains undetected for years until they develop some symptoms. Due to a large group of asymptomatic individuals with intestinal ascariasis, these worms are occasionally and unexpectedly identified during routine endoscopic procedures. Here, we present a case of an intestinal ascariasis found during routine colonoscopy in an African-American man from the Bronx with perianal itching. He denied any history of travel outside USA but reported frequent visits to South Carolina. This case illustrates the fact that ascariasis should be suspected even if immigration or travel outside USA is not involved. It should be suspected even in cases of travel within USA to the south east where endemic cases are reported.

  20. Medical image of the week: Boerhaave's syndrome during colonoscopy

    Directory of Open Access Journals (Sweden)

    Meenakshisundaram C

    2015-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A 76-year-old woman with no significant past medical history underwent outpatient screening colonoscopy. The procedure was difficult due to a tortuous colon and only multiple diverticula were visualized. She vomited once during the procedure. In the immediate postoperative period, she complained of neck swelling. Her vital signs were stable. On examination, right sided neck and facial swelling with palpable crepitations were noticed as well as coarse breath sounds heard on auscultation of both lung fields. Immediate chest X-ray (Figure 1 was obtained which showed bilateral subcutaneous emphysema extending from the supraclavicular area and above to the neck. Subsequent thoracic CT scan showed extensive subcutaneous air within the soft tissues of the neck bilaterally, extending into the mediastinum and along the anterior chest wall (Figure 2. An esophagram (Figure 3 revealed a focus of oral contrast actively extravasating approximately at 2.5 cm above the gastro-esophageal junction consistent with a small perforation ...

  1. Effective colonoscopy training techniques: strategies to improve patient outcomes.

    Science.gov (United States)

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.

  2. Information seeking and anxiety among colonoscopy-naïve adults: Direct-to-colonoscopy vs traditional consult-first pathways

    Science.gov (United States)

    Silvester, Jocelyn A; Kalkat, Harmandeep; Graff, Lesley A; Walker, John R; Singh, Harminder; Duerksen, Donald R

    2016-01-01

    AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-naïve patients. METHODS Colonoscopy-naïve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation. Survey items included clinical pathway (direct or consult), procedure indication (cancer screening or symptom investigation), telephone and written contact from the physician endoscopist office, information sources, and pre-procedure anxiety. Participants reported pre-procedure anxiety using a 10 point scale anchored by “very relaxed” (1) and “very nervous” (10). At least three months following the procedure, patient medical records were reviewed to determine sedative dose, procedure indications and any adverse events. The primary comparison was between the direct and consult pathways. Given the very different implications, a secondary analysis considering the patient-reported indication for the procedure (symptoms or screening). Effects of pathway (direct vs consult) were compared both within and between the screening and symptom subgroups. RESULTS Of 409 patients who completed the survey, 34% followed a direct pathway. Indications for colonoscopy were similar in each group. The majority of the participants were women (58%), married (61%), and internet users (81%). The most important information source was family physicians (Direct) and specialist physicians (Consult). Use of other information sources, including the internet (20% vs 18%) and Direct family and friends (64% vs 53%), was similar in the Direct and Consult groups, respectively. Only 31% of the 81% who were internet users accessed internet health information. Most sought fundamental information such as what a colonoscopy is or why it is done. Pre-procedure anxiety did not differ between care pathways. Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3, 95

  3. Extensive Generalization of Statistical Mechanics Based on Incomplete Information Theory

    Directory of Open Access Journals (Sweden)

    Qiuping A. Wang

    2003-06-01

    Full Text Available Statistical mechanics is generalized on the basis of an additive information theory for incomplete probability distributions. The incomplete normalization is used to obtain generalized entropy . The concomitant incomplete statistical mechanics is applied to some physical systems in order to show the effect of the incompleteness of information. It is shown that this extensive generalized statistics can be useful for the correlated electron systems in weak coupling regime.

  4. 49 CFR 529.4 - Requirements for incomplete automobile manufacturers.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 6 2010-10-01 2010-10-01 false Requirements for incomplete automobile... AUTOMOBILES § 529.4 Requirements for incomplete automobile manufacturers. (a) Except as provided in paragraph (c) of this section, §§ 529.5 and 529.6, each incomplete automobile manufacturer is considered,...

  5. A new version of an old modal incompleteness theorem

    NARCIS (Netherlands)

    Vosmaer, J.

    2010-01-01

    Thomason [5] showed that a certain modal logic L⊂ S4 is incomplete with respect to Kripke semantics. Later Gerson [3] showed that L is also incomplete with respect to neighborhood semantics. In this paper we show that L is in fact incomplete with respect to any class of complete Boolean algebras wit

  6. Measurement for Detection of Incomplete Partition Type II Anomalies on MR Imaging.

    Science.gov (United States)

    Reinshagen, K L; Curtin, H D; Quesnel, A M; Juliano, A F

    2017-08-03

    Incomplete partition type II of the cochlea, commonly coexisting with an enlarged vestibular aqueduct, can be a challenging diagnosis on MR imaging due to the presence of a dysplastic spiral lamina-basilar membrane neural complex, which can resemble the normal interscalar septum. The purpose of this study was to determine a reproducible, quantitative cochlear measurement to assess incomplete partition type II anomalies in patients with enlarged vestibular aqueducts using normal-hearing ears as a control population. Retrospective analysis of 27 patients with enlarged vestibular aqueducts (54 ears) and 28 patients (33 ears) with normal audiographic findings who underwent MR imaging was performed. Using reformatted images from a cisternographic 3D MR imaging produced in a plane parallel to the lateral semicircular canal, we measured the distance (distance X) between the osseous spiral lamina-basilar membrane complex of the upper basal turn and the first linear signal void anterior to the basilar membrane. The means of distance X in patients with normal hearing and prospectively diagnosed incomplete partition type II were, respectively, 0.93 ± 0.075 mm (range, 0.8-1.1 mm) and 1.55 ± 0.25 mm (range, 1-2.1 mm; P < .001). Using 3 SDs above the mean of patients with normal hearing (1.2 mm) as a cutoff for normal, we diagnosed 21/27 patients as having abnormal cochleas; 4/21 were diagnosed retrospectively. This finding indicated that almost 20% of patients were underdiagnosed. Interobserver agreement with 1.2 mm as a cutoff between normal and abnormal produced a κ score of 0.715 (good). Incomplete partition type II anomalies on MR imaging can be subtle. A reproducible distance X of ≥1.2 mm is considered abnormal and may help to prospectively diagnose incomplete partition type II anomalies. © 2017 American Society of Neuroradiology.

  7. The CIMP Phenotype in BRAF Mutant Serrated Polyps from a Prospective Colonoscopy Patient Cohort

    Directory of Open Access Journals (Sweden)

    Winnie C. Fernando

    2014-01-01

    Full Text Available Colorectal cancers arising via the serrated pathway are often associated with BRAF V600E mutation, CpG island methylator phenotype (CIMP, and microsatellite instability. Previous studies have shown a strong association between BRAF V600E mutation and serrated polyps. This study aims to evaluate CIMP status of all the serrated polyp subtypes and its association with functionally important genes such as MLH1, p16, and IGFBP7. CIMP status and methylation were evaluated using the real-time based MethyLight assay in 154 serrated polyps and 63 conventional adenomas. Results showed that CIMP-high serrated polyps were strongly associated with BRAF mutation and proximal colon. CIMP-high was uncommon in conventional adenomas (1.59%, occurred in 8.25% of hyperplastic polyps (HPs, and became common in sessile serrated adenomas (SSAs (51.43%. MLH1 methylation was mainly observed in the proximal colon and was significantly associated with BRAF mutation and CIMP-high. The number of samples methylated for p16 and IGFBP7 was the highest in SSAs. The methylation panel we used to detect CIMP is highly specific for CIMP-high cancers. With this panel, we demonstrate that CIMP-high is much more common in SSAs than HPs. This suggests that CIMP-high correlates with increased risk of malignant transformation which was also observed in methylation of functionally important genes.

  8. Barriers and facilitators associated with colonoscopy completion in individuals with multiple chronic conditions: a qualitative study

    Directory of Open Access Journals (Sweden)

    Sultan S

    2017-05-01

    Full Text Available Shahnaz Sultan,1–4 Melissa R Partin,1,2 Phalgoon Shah,5 Jennifer LeLaurin,4 Ivette Magaly Freytes,4 Chandylen L Nightingale,6 Susan F Fesperman,4 Barbara A Curbow,7 Rebecca J Beyth3,4,8 1Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, 2Department of Medicine, University of Minnesota, Minneapolis, MN, 3Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 4Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 5Department of Medicine, Tripler Army Medical Center, Honolulu, HI, 6Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem NC, 7Department of Community and Behavioral Health, University of Maryland, College Park, MD, 8Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA Background: A recommendation to undergo a colonoscopy, an invasive procedure that requires commitment and motivation, planning (scheduling and finding a driver and preparation (diet restriction and laxative consumption, may be uniquely challenging for individuals with multiple chronic conditions (MCCs. This qualitative study aimed to describe the barriers and facilitators to colonoscopy experienced by such patients.Materials and methods: Semistructured focus groups were conducted with male Veterans who were scheduled for outpatient colonoscopy and either failed to complete the procedure or completed the examination. Focus group recordings were transcribed and analyzed by an inductive grounded approach using constant comparative analysis.Results: Forty-four individuals aged 51–83 years participated in this study (23 adherent and 21 nonadherent. Participants had an average of 7.4 chronic conditions (range 2–14. The five most common chronic conditions were hypertension (75%, hyperlipidemia (75

  9. Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: A prospective study

    Institute of Scientific and Technical Information of China (English)

    Puglisi Carlo; Russo Francesco Paolo; Barbera Carmelo; Incarbone Salvatore; Aprile Giuseppe; Bonanno Giacomo; Russo Antonio

    2006-01-01

    AIM: To relate the endoscopic findings in patients with hematochezia with regard to age in "low and average risk" for colorectal cancer (CRC) and to localize significant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy.METHODS: This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hematochezia. The final study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma,patients reporting blood mixed with stools and/or progressive colonic symptoms, or patients who had undergone colon surgery for neoplastic lesions.RESULTS: Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones.Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly.Our findings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identified before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon.CONCLUSION: Young patients with scant hematochezia but without risk factors for neoplasia do not need a total colonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.

  10. Developing a tool to preserve eye contact with patients undergoing colonoscopy for pain monitoring

    Directory of Open Access Journals (Sweden)

    Niv Y

    2012-08-01

    Full Text Available Yaron Niv, Yossi TalDepartment of Gastroenterology, Rabin Medical Center, Tel Aviv University, IsraelAbstract: Colonoscopy has become the leading procedure for early detection and prevention of colorectal cancer. Patients’ experience of colonic endoscopic procedures is scarcely reported, even though it is considered a major factor in colorectal cancer screening participation. Pain due to air inflation or stretching the colon with an endoscope is not rare during examination and may be the main obstacle to cooperation and participation in a screening program. We propose a four-stage study for developing a tool dedicated to pain monitoring during colonoscopy, as follows: (1 comparison of patient, nurse, and endoscopist questionnaire responses about patient pain and technical details of the procedure using the PAINAD tool during colonoscopy; (2 observation of the correlation between patients’ facial expressions and other parameters (using the short PAINAD; (3 development of a device for continuous monitoring of the patient’s facial expression during the procedure; (4 assessment of the usability of such a tool and its contribution to the outcomes of colonoscopy procedures. Early intervention by the staff performing the procedure, in reaction to alerts encoded by this tool, may prevent adverse events during the procedure.Keywords: pain scoring, colonoscopy, pain monitoring, facial expression

  11. Quality Assessment of Colonoscopy Reporting: Results from a Statewide Cancer Screening Program

    Directory of Open Access Journals (Sweden)

    Jun Li

    2010-01-01

    Full Text Available This paper aimed to assess quality of colonoscopy reports and determine if physicians in practice were already documenting recommended quality indicators, prior to the publication of a standardized Colonoscopy Reporting and Data System (CO-RADS in 2007. We examined 110 colonoscopy reports from 2005-2006 through Maryland Colorectal Cancer Screening Program. We evaluated 25 key data elements recommended by CO-RADS, including procedure indications, risk/comorbidity assessments, procedure technical descriptions, colonoscopy findings, specimen retrieval/pathology. Among 110 reports, 73% documented the bowel preparation quality and 82% documented specific cecal landmarks. For the 177 individual polyps identified, information on size and morphology was documented for 87% and 53%, respectively. Colonoscopy reporting varied considerately in the pre-CO-RADS period. The absence of key data elements may impact the ability to make recommendations for recall intervals. This paper provides baseline data to assess if CO-RADS has an impact on reporting and how best to improve the quality of reporting.

  12. COLONOSCOPY COMPLICATIONS IN THE ELDERLY: the impact of age and multimorbidity

    Directory of Open Access Journals (Sweden)

    Francine de Cristo STEIN

    2013-12-01

    Full Text Available Context Age has been considered an independent risk factor for colonoscopy complications, especially when associated with multimorbidity. Objectives The primary objective was to verify the relationships between age, multimorbidity and colonoscopy complications in the elderly. Methods A retrospective cohort including patients of 60 years or older who had undergone a colonoscopy. Data relating to age, multimorbidities according to the cumulative illness scale for geriatrics and the Charlson index and complications related to bowel preparation and procedure (sedation and exam were collected. Results Of the 207 patients (mean age 70.47 ± 7.04 with appropriate indication for colonoscopy according to the American Society for Gastrointestinal Endoscopy, 43 (20.77% patients had some colonoscopy complications: 1 (0.48% with the sedation (apnea, 4 (1.93% with the procedure (abdominal pain and bacteremia and 38 (18.35% with the bowel preparation (acute renal failure, hypotension. Individuals ≥80 years had an RR = 3.4 (1.2-10.1, P = 0.025, and those with a Charlson index 3 had an RR = 5.2 (1.6-16.8, P = 0.006, for complications. The cumulative illness rating scale for geriatrics was not associated with complications (P = 0.45. Conclusion There was a significant risk of complications in ≥80 years and in the group with a Charlson index 3. The cumulative illness rating scale for geriatrics was not a good predictor of risk in this sample.

  13. CO_2 insufflation for potentially difficult colonoscopies:Efficacy when used by less experienced colonoscopists

    Institute of Scientific and Technical Information of China (English)

    Toshio Uraoka; Jun Kato; Motoaki Kuriyama; Keisuke Hori; Shin Ishikawa; Keita Harada; Koji Takemoto; Sakiko Hiraoka; Hideyuki Fujita; Joichiro Horii; Yutaka Saito; Kazuhide Yamamoto

    2009-01-01

    AIM: To clarify the effectiveness of CO_2 insufflation in potentially difficult colonoscopy cases, particularly in relation to the experience level of colonoscopists. METHODS: One hundred twenty potentially difficult cases were included in this study, which involved females with a low body mass index and patients with earlier abdominal and/or pelvic open surgery or previously diagnosed left-side colon diverticulosis. Patients receiving colonoscopy examinations without sedation using a pediatric variable-stiffness colonoscope were divided into two groups based on either CO_2 or standard air insufflation. Both insufflation procedures were also evaluated according to the experience level of the respective colonoscopists who were divided into an experienced colonoscopist (EC) group and a less experienced colonoscopist (LEC) group. Study measurements included a 100-mm visual analogue scale (VAS) for patient pain during and after colonoscopy examinations, in addition to insertion to the cecum and withdrawal times. RESULTS: Examination times did not differ, however, VAS scores in the CO_2 group were significantly better than in the air group (P < 0.001, two-way ANOVA) from immediately after the procedure and up to 2 h later. There were no significant differences between either insufflation method in the EC group (P = 0.29), however, VAS scores for CO_2 insufflation were significantly better than air insufflation in the LEC group (P = 0.023) immediately after colonoscopies and up to 4 h afterwards. CONCLUSION: CO_2 insufflation reduced patient pain after colonoscopy in potentially difficult cases when performed by LECs.

  14. Gastronet survey on the use of one- or two-person technique for colonoscopy insertion

    Directory of Open Access Journals (Sweden)

    Kjellevold Øystein

    2011-06-01

    Full Text Available Abstract Background Usually, colonoscopy insertion is performed by the colonoscopist (one-person technique. Quite common in the early days of endoscopy, the assisting nurse is now only rarely doing the insertion (two-person technique. Using the Norwegian national endoscopy quality assurance (QA programme, Gastronet, we wanted to explore the extent of two-person technique practice and look into possible differences in performance and QA output measures. Methods 100 colonoscopists in 18 colonoscopy centres having reported their colonoscopies to Gastronet between January and December 2009 were asked if they practiced one- or two-person technique during insertion of the colonoscope. They were categorized accordingly for comparative analyses of QA indicators. Results 75 endoscopists responded to the survey (representing 9368 colonoscopies - 62 of them (83% applied one-person technique and 13 (17% two-person technique. Patients age and sex distributions and indications for colonoscopy were also similar in the two groups. Caecal intubation was 96% in the two-person group compared to 92% in the one-person group (p Conclusion Two-person technique for colonoscope insertion was practiced by a considerable minority of endoscopists (17%. QA indicators were either similar to or better than one-person technique. This suggests that there may be some beneficial elements to this technique worth exploring and try to import into the much preferred one-person insertion technique.

  15. Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Min Sun Kim; Young Jin Park

    2007-01-01

    AIM: To evaluate the clinical significance of pre-and intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.METHODS: Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.RESULTS: Two hundred and eighty-two synchronous lesions were detected in 124 (39.2%) of 316 patients including all lesions regardless of their histologic type.True adenomatous polyps were found in 91 (28.8%)of 316 patients, and 17 (5.4% of all patients) patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 (14.0%) of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range.Further segmental resection or polypectomy through enterotomy was necessary in 19 patients. Nineteen (37.2%) of 51 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 (13.7%) of 51 intraoperative colonoscopy cases to remove the lesions.CONCLUSION: Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment.Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.

  16. Willingness-to-Pay to Avoid the Time Spent and Discomfort Associated with Screening Colonoscopy

    Science.gov (United States)

    Jonas, Daniel E.; Russell, Louise B.; Chou, Jon; Pignone, Michael

    2014-01-01

    Background The screening colonoscopy process requires a considerable amount of time and some discomfort for patients. Objective We sought to use willingness-to-pay (WTP) to value the time required and the discomfort associated with screening colonoscopy. In addition, we aimed to explore some of the differences between and potential uses of the WTP and the human capital methods. Methods Subjects completed a diary recording time and a questionnaire including WTP questions to value the time and discomfort associated with colonoscopy. We also valued the elapsed time reported in the diaries (but not the discomfort) using the human capital method. Results 110 subjects completed the study. Mean WTP to avoid the time and discomfort was $263. Human capital values for elapsed time were greater. Linear regressions showed that WTP was influenced most by the difficulty of the preparation, which added $147 to WTP (p=0.03). Conclusions WTP values to avoid the time and discomfort associated with the screening colonoscopy process were substantially lower than most of the human capital values for elapsed time alone. The human capital method may overestimate the value of time in situations that involve an irregular, episodic series of time intervals, such as preparation for or recovery after colonoscopy. PMID:19725018

  17. Polyp measurement based on CT colonography and colonoscopy: variability and systematic differences

    Energy Technology Data Exchange (ETDEWEB)

    Vries, Ayso H. de; Bipat, Shandra; Liedenbaum, Marjolein H.; Florie, Jasper; Vos, Frans M.; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Dekker, Evelien; Fockens, Paul; Mathus-Vliegen, Elizabeth M. [University of Amsterdam, Department of Gastroenterology, Academic Medical Centre, Amsterdam (Netherlands); Kraan, Roel van der; Truyen, Roel [Philips Healthcare, Department of Healthcare Informatics, Best (Netherlands); Reitsma, Johannes B.; Zwinderman, Aeilko H. [University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Amsterdam Medical Center, Amsterdam (Netherlands)

    2010-06-15

    To assess the variability and systematic differences in polyp measurements on optical colonoscopy and CT colonography. Gastroenterologists measured 51 polyps by visual estimation, forceps comparison and linear probe. CT colonography observers randomly assessed polyp size two-dimensionally (abdominal and intermediate window) and three-dimensionally (manually and semi-automatically). Linear mixed models were used to assess the variability and systematic differences between CT colonography and optical colonoscopy techniques. The variability of forceps and linear probe measurements was comparable and both showed less variability than measurement by visual assessment. Measurements by linear probe were 0.7 mm smaller than measurements by visual assessment or by forceps. The variability of all CT colonography techniques was lower than for measurements by forceps or visual assessment and sometimes lower (only 2D intermediate window and manual 3D) compared with measurements by linear probe. All CT colonography measurements judged polyps to be larger than optical colonoscopy, with differences ranging from 0.7 to 2.3 mm. A linear probe does not reduce the measurement variability of endoscopists compared with the forceps. Measurement differences between observers on CT colonography were usually smaller than at optical colonoscopy. Polyps appeared larger when using various CT colonography techniques than when measured during optical colonoscopy. (orig.)

  18. Dual energy virtual CT colonoscopy with dual source computed tomography. Initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Karcaaltincaba, M.; Karaosmanoglu, D.; Akata, D.; Sentuerk, S.; Oezmen, M. [Dept. of Radiology, Hacettepe Univ. School of Medicine (Turkey); Alibek, S. [Dept. of Radiology, Hacettepe Univ. School of Medicine (Turkey); Radiology Inst., Univ. of Erlangen (Germany)

    2009-09-15

    Purpose: To describe the technique of DE MDCT colonoscopy and to assess its feasibility. Materials and Methods: 8 patients were scanned with DSCT with a DE scan protocol and dose modulation software. Analysis was performed using dedicated DE software. Prone non-contrast images and DE supine images after contrast injection were obtained. Results: DE colonoscopic images were successfully obtained in 7 patients, but the FOV did not cover all colonic segments in 1 patient, thus resulting in a technical success rate was 87.5%. Streak artifacts were present in the pelvic region in 2 patients. Virtual unenhanced images and iodine map images were obtained for all patients. In 1 patient a polypoid non-enhancing structure was noted on the iodine map, and conventional colonoscopy revealed impacted stool. Enhancing rectal cancer in 1 patient was correctly shown on the iodine map. Iodine maps helped to differentiate stool fragments/retained fluid by the absence of enhancement when compared to prone CT images. The major advantage of DE colonoscopy was the lack of misregistration. Conclusion: DE MDCT colonoscopy is technically feasible and may obviate the need for unenhanced prone images. It may be possible to perform noncathartic DECT colonoscopy. The major limitation is the limited FOV of tube B. The dose should be optimized to reduce streak artifacts in the pelvic region. (orig.)

  19. Optimism and barriers to colonoscopy in low-income Latinos at average risk for colorectal cancer.

    Science.gov (United States)

    Efuni, Elizaveta; DuHamel, Katherine N; Winkel, Gary; Starr, Tatiana; Jandorf, Lina

    2015-09-01

    Colorectal cancer (CRC) screening continues to be underused, particularly by Latinos. CRC and colonoscopy fear, worry, and fatalism have been identified as screening barriers in Latinos. The study purpose was to examine the relationship of optimism, fatalism, worry, and fear in the context of Latinos referred for CRC screening. Our sample included 251 Latinos between the ages of 50 and 83 years who had no personal or immediate family history of CRC, no personal history of gastrointestinal disorder, no colonoscopy in the past 5 years, and received a referral for a colonoscopy. Face-to-face interviews were performed, and data were analyzed using regression models. Greater optimism (β = -1.72, p optimism (β = -0.09, p < 0.05), higher fatalism (β = 0.28, p < 0.01), and female gender (β = 0.9, p < 0.05) were associated with greater worry. Interventions that address fatalism and promote optimistic beliefs may reduce worry among Latinos referred for colonoscopy. Interventions that alleviate colonoscopy fear because of family history of cancer particularly among Latino women may help improve distress about CRC screening. Copyright © 2014 John Wiley & Sons, Ltd.

  20. Colonoscopy and computerised tomography scan are not sufficient to localise right sided colonic lesions accurately.

    LENUS (Irish Health Repository)

    Solon, Jacqueline Gemma

    2009-11-23

    : Aim: accurate pre-operative localisation of colonic lesions is critical especially in laparoscopic colectomy where tactile localisation is absent particularly in screen-detected tumours. The study aimed to evaluate the accuracy of colonoscopy and double-contrast computerised tomography (CT) to localise lesions treated by right hemicolectomy. Method: a retrospective chart review was performed of patients treated by right hemicolectomy under the colorectal service between July 2003 and October 2006. Pre-operative tumour location determined by CT scan and colonoscopy were compared with the intra-operative and histopathologic findings. Results: of 101 patients, 73 (73%) were for adenoma or cancer, with a final diagnosis of adenocarcinoma in 59 (59%). Pre-operative localisation was inaccurate in 29% of lesions using both CT and colonoscopy. In the transverse colon colonoscopy alone was only 37.5% accurate, increasing to 62.5% when information from the CT scan was added. Conclusion: pre-operative localisation of right-sided colon cancers using colonoscopy and CT scanning is unreliable in at least 29% of cases. Inaccurate localisation of transverse colon tumours risks inadequate lymphadenectomy with an adverse cancer outcome. Pre-operative abdominal CT scan improves accuracy but endoscopic tattoo localisation should be employed routinely especially in patients undergoing laparoscopic resection.

  1. Comorbid Illness, Bowel Preparation, and Logistical Constraints Are Key Reasons for Outpatient Colonoscopy Nonattendance

    Directory of Open Access Journals (Sweden)

    Deepti Chopra

    2016-01-01

    Full Text Available Background. Colonoscopy nonattendance is a challenge for outpatient clinics globally. Absenteeism results in a potential delay in disease diagnosis and loss of hospital resources. This study aims to determine reasons for colonoscopy nonattendance from a Canadian perspective. Design. Demographic data, reasons for nonattendance, and patient suggestions for improving compliance were elicited from 49 out of 144 eligible study participants via telephone questionnaire. The 49 nonattenders were compared to age and sex matched controls for several potential contributing factors. Results. Nonattendance rates were significantly higher in winter months; the OR of nonattendance was 5.2 (95% CI, 1.6 to 17.0, p<0.001 in winter versus other months. Being married was positively associated with attendance. There was no significant association between nonattendance and any of the other variables examined. The top 3 reasons for nonattendance were being too unwell to attend the procedure, being unable to complete bowel preparation, or experiencing logistical challenges. Conclusions. Colonoscopy attendance rates appear to vary significantly by season and it may be beneficial to book more colonoscopies in the summer or overbook in the winter. Targets for intervention include more tailored teaching sessions, reminders, taxi chits, and developing a hospital specific colonoscopy video regarding procedure and bowel preparation requirements.

  2. The Effect of Music on Pain, Anxiety and Vital Signs of Children during Colonoscopy

    Directory of Open Access Journals (Sweden)

    M Najafi

    2014-04-01

    Full Text Available Introduction: This study aimed to investigate the effect of music on pain, anxiety and vital signs in children undergoing colonoscopy.   Method and Materials: This randomized study was carried out on 101 children (7 to 14 years old requiring colonoscopy. Children were randomly allocated to a control or case group. The case group was played relaxing music (by Clayderman during the procedure. Spiegelberger and pain questionaires were administered immediately after the colonoscopy. Pulse rate, blood pressure and percent blood oxygen saturation were recorded for each subject. The control group was treated in an identical manner, but was not played music during the procedure. Data were analyzed using SPSS software.   Results: Satisfaction, anxiety, pain, and blood pressure were significantly different between the groups                (P0.05.   Conclusion: Music can reduce anxiety and pain during colonoscopy.   Key words: Anxiety, Music,Vital signs, Colonoscopy

  3. {sup 99} {sup m}Tc antigranulocyte monoclonal antibody imaging for the detection and assessment of inflammatory bowel disease newly diagnosed by colonoscopy in children

    Energy Technology Data Exchange (ETDEWEB)

    Charron, M.; Hickeson, M.P. [Hospital of the Univ. of Pennsylvania (HUP), Philadelphia (United States). Dept. of Radiology; Lorenzo, C. di; Kocoshis, S.A.; Orenstein, S.R.; Goyal, A.; Kahn, S.; Collins, L. [Dept. of Gastroenterology, Children' s Hospital of Pittsburgh, PA (United States)

    2001-11-01

    Objective: This prospective study evaluated a {sup 99m}Tc antigranulocyte monoclonal antibody Fab' imaging agent (Sulesomab) in children with inflammatory bowel disease (IBD) newly diagnosed by colonoscopy. Materials and methods: Ten children (4 boys, 6 girls; mean age 14 years) with newly diagnosed Crohn's disease (n = 6) or ulcerative colitis (n = 4) were studied. Colonoscopy was performed in all of these patients. Within 24 h after colonoscopy, they underwent scintigraphy with {sup 99} {sup m}Tc-Sulesomab. Abdominal/pelvic images were acquired at 30 min (planar) and 2-4 h (planar and SPECT) after injection of Sulesomab. Eighty bowel segments were evaluated semi-quantitatively by the investigators, using these three sets of images. The Pediatric Disease Activity (PDA) was correlated with the erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, albumin, Kirschner's score, the Sulesomab bowel segment with maximum uptake, and the sum of Sulesomab score in each segment. Results: The median PDA score was 26 (range 12.5-40). Three children had normal ESR and six normal WBC counts. All patients had at least one positive mucosal biopsy for IBD. While using the Kirschner's scale, the maximal severity of colonoscopy findings was graded as none (n = 2), mild (n = 4), moderate (n = 3), or severe (n = 1). Of the 59 segments evaluated with endoscopy, 35 were found to be endoscopically abnormal. The planar images identified 17 of these abnormal segments and the SPECT images 20. Nine of these ten children had abnormal bowel uptake by scintigraphy. Thus, the sensitivity of Sulesomab per patient was 90 % and per bowel segment 57 %. The correlation coefficient between the scintigraphic score for the segment with the Sulesomab maximum activity and the PDA was 0.3 (P = 0.41). Conclusion: In pediatric IBD assessment, planar imaging with Sulesomab did not prove very sensitive in detecting inflammation in each bowel segment. However, SPECT detected the

  4. Building Chaotic Model From Incomplete Time Series

    Science.gov (United States)

    Siek, Michael; Solomatine, Dimitri

    2010-05-01

    This paper presents a number of novel techniques for building a predictive chaotic model from incomplete time series. A predictive chaotic model is built by reconstructing the time-delayed phase space from observed time series and the prediction is made by a global model or adaptive local models based on the dynamical neighbors found in the reconstructed phase space. In general, the building of any data-driven models depends on the completeness and quality of the data itself. However, the completeness of the data availability can not always be guaranteed since the measurement or data transmission is intermittently not working properly due to some reasons. We propose two main solutions dealing with incomplete time series: using imputing and non-imputing methods. For imputing methods, we utilized the interpolation methods (weighted sum of linear interpolations, Bayesian principle component analysis and cubic spline interpolation) and predictive models (neural network, kernel machine, chaotic model) for estimating the missing values. After imputing the missing values, the phase space reconstruction and chaotic model prediction are executed as a standard procedure. For non-imputing methods, we reconstructed the time-delayed phase space from observed time series with missing values. This reconstruction results in non-continuous trajectories. However, the local model prediction can still be made from the other dynamical neighbors reconstructed from non-missing values. We implemented and tested these methods to construct a chaotic model for predicting storm surges at Hoek van Holland as the entrance of Rotterdam Port. The hourly surge time series is available for duration of 1990-1996. For measuring the performance of the proposed methods, a synthetic time series with missing values generated by a particular random variable to the original (complete) time series is utilized. There exist two main performance measures used in this work: (1) error measures between the actual

  5. The SAFE-T assessment tool: derivation and validation of a web-based application for point-of-care evaluation of gastroenterology fellow performance in colonoscopy.

    Science.gov (United States)

    Kumar, Navin L; Kugener, Guillaume; Perencevich, Molly L; Saltzman, John R

    2017-05-10

    Attending assessment is a critical part of endoscopic education for gastroenterology fellows. The aim of this study was to develop and validate a concise assessment tool to evaluate real-time fellow performance in colonoscopy administered via a web-based application. The Skill Assessment in Fellow Endoscopy Training (SAFE-T) tool was derived as a novel 5-question evaluation tool that captures both summative and formative feedback adapted into a web-based application. A prospective study of 15 gastroenterology fellows (5 fellows each from years 1 to 3 of training) was performed using the SAFE-T tool. An independent reviewer evaluated a subset of these procedures and completed the SAFE-T tool and Mayo Colonoscopy Skills Assessment Tool (MCSAT) for reliability testing. Twenty-six faculty completed 350 SAFE-T evaluations of the 15 fellows in the study. The mean SAFE-T overall score (year 1, 2.00; year 2, 3.84; year 3, 4.28) differentiated each sequential fellow year of training (P  0.90, P web-based means of assessing real-time gastroenterology fellow performance in colonoscopy. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  6. A Review of Current Issues Underlying Colon Cleansing before Colonoscopy

    Directory of Open Access Journals (Sweden)

    Lawrence C Hookey

    2007-01-01

    Full Text Available The present review examines four current issues related to the efficacy, patient tolerance and safety of the following bowel cleansing agents: oral sodium phosphate (NaP, polyethylene glycol (PEG and magnesium citrate (Pico-Salax, Ferring Pharmaceuticals Inc, Canada, an agent recently made available in Canada. MedLine and PubMed databases were systematically searched to identify studies related to the efficacy of altered PEG solutions combined with adjunct treatments; the efficacy, tolerability and safety of Pico-Salax; the association between nephrocalcinosis, and chronic renal failure and oral NaP use; and the role of diet. Although lower volume PEG solutions combined with adjuvant agents were generally associated with better patient tolerance, their efficacy was varied and interpretation of this end point is complicated by study design issues. There are very few reported studies of Pico-Salax, and as a result, there are insufficient data to draw conclusions about the efficacy of this agent. The available data suggest that Pico-Salax may be better tolerated by patients, than oral NaP and PEG solutions. There is a paucity of hemodynamic monitoring data pre- and postadministration, but the available data suggests that this small-volume osmotic agent could cause subclinical contraction of the intravascular space. Recent case reports suggest an association between nephrocalcinosis and oral NaP ingestion, but to date, these reports have been confined to a single centre. Preliminary studies suggest that this is not a widespread problem, but more studies are needed. There are only a few studies examining diet and patient tolerability, but they do suggest that diet may be liberalized with some cleansing regimens to enhance tolerability without decreasing efficacy. The present review highlights current controversies and advances in colon cleansing before colonoscopy, and also identifies areas for further study.

  7. Low-Rank Representation for Incomplete Data

    Directory of Open Access Journals (Sweden)

    Jiarong Shi

    2014-01-01

    Full Text Available Low-rank matrix recovery (LRMR has been becoming an increasingly popular technique for analyzing data with missing entries, gross corruptions, and outliers. As a significant component of LRMR, the model of low-rank representation (LRR seeks the lowest-rank representation among all samples and it is robust for recovering subspace structures. This paper attempts to solve the problem of LRR with partially observed entries. Firstly, we construct a nonconvex minimization by taking the low rankness, robustness, and incompletion into consideration. Then we employ the technique of augmented Lagrange multipliers to solve the proposed program. Finally, experimental results on synthetic and real-world datasets validate the feasibility and effectiveness of the proposed method.

  8. Inflaton dark matter from incomplete decay

    Science.gov (United States)

    Bastero-Gil, Mar; Cerezo, Rafael; Rosa, João G.

    2016-05-01

    We show that the decay of the inflaton field may be incomplete, while nevertheless successfully reheating the Universe and leaving a stable remnant that accounts for the present dark matter abundance. We note, in particular, that since the mass of the inflaton decay products is field dependent, one can construct models, endowed with an appropriate discrete symmetry, where inflaton decay is kinematically forbidden at late times and only occurs during the initial stages of field oscillations after inflation. We show that this is sufficient to ensure the transition to a radiation-dominated era and that inflaton particles typically thermalize in the process. They eventually decouple and freeze out, yielding a thermal dark matter relic. We discuss possible implementations of this generic mechanism within consistent cosmological and particle physics scenarios, for both single-field and hybrid inflation.

  9. Inflaton dark matter from incomplete decay

    CERN Document Server

    Bastero-Gil, Mar; Rosa, Joao G

    2015-01-01

    We show that the decay of the inflaton field may be incomplete, while nevertheless successfully reheating the universe and leaving a stable remnant that accounts for the present dark matter abundance. We note, in particular, that since the mass of the inflaton decay products is field-dependent, one can construct models, endowed with an appropriate discrete symmetry, where inflaton decay is kinematically forbidden at late times and only occurs during the initial stages of field oscillations after inflation. We show that this is sufficient to ensure the transition to a radiation-dominated era and that inflaton particles typically thermalize in the process. They eventually decouple and freeze out, yielding a thermal dark matter relic. We discuss possible implementations of this generic mechanism within consistent cosmological and particle physics scenarios, for both single-field and hybrid inflation.

  10. Scalable tensor factorizations for incomplete data

    DEFF Research Database (Denmark)

    Acar, Evrim; Dunlavy, Daniel M.; KOlda, Tamara G.

    2011-01-01

    The problem of incomplete data—i.e., data with missing or unknown values—in multi-way arrays is ubiquitous in biomedical signal processing, network traffic analysis, bibliometrics, social network analysis, chemometrics, computer vision, communication networks, etc. We consider the problem of how...... to factorize data sets with missing values with the goal of capturing the underlying latent structure of the data and possibly reconstructing missing values (i.e., tensor completion). We focus on one of the most well-known tensor factorizations that captures multi-linear structure, CANDECOMP/PARAFAC (CP......-WOPT on two real-world applications: a novel EEG (electroencephalogram) application where missing data is frequently encountered due to disconnections of electrodes and the problem of modeling computer network traffic where data may be absent due to the expense of the data collection process....

  11. Bereavement: an incomplete rite of passage.

    Science.gov (United States)

    Hunter, Jennifer

    A bereavement ritual observed during anthropological fieldwork in Peru gives basis to this article which asserts that bereavement has become an incomplete rite of passage. The article reviews the role of ritual and rites of passage, examines other anthropologic examples of death and bereavement rituals, and identifies the lack of post-funeral ritual for many bereaved individuals in the United States. While funerary rituals which end with the funeral and burial of the dead are helpful in providing immediate structure for the bereaved, they are not congruent with the long-term emotional needs and reconstruction of meaning within grief. The author acknowledges value of both private ritual and reunions of the community of mourners, and recommends that bereavement counselors and/or the funeral industry offer to help bereaved construct a "ritual of remembrance and new meaning" after time has allowed them to move along in meaning reconstruction processes of making sense, finding benefits, and identity change.

  12. Iatrogenic Perforations During Colonoscopy In a Portuguese Population: A Study Including In and Out-Of-Hospital Procedures

    Directory of Open Access Journals (Sweden)

    Sara Campos

    2016-07-01

    Conclusion: Perforations in colonoscopy are rare in our clinical practice. Endoscopic closure was effective, though limited to perforations found during the procedure. The mortality was relatively low and endoscopic management did not seem to worsen it. An additional effort is necessary in order to detect perforations during colonoscopy.

  13. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center.

    Science.gov (United States)

    Green, Alexander R; Peters-Lewis, Angelleen; Percac-Lima, Sanja; Betancourt, Joseph R; Richter, James M; Janairo, Maria-Pamela R; Gamba, Gloria B; Atlas, Steven J

    2008-06-01

    Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities. To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center. DESIGN, PARTICIPANTS, AND APPROACH: We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques. Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation, including "laziness" and "procrastination"; (4) Dissuasion by others influencing participants' decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions. Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.

  14. Regulatory perspective on incomplete control rod insertions

    Energy Technology Data Exchange (ETDEWEB)

    Chatterton, M.

    1997-01-01

    The incomplete control rod insertions experienced at South Texas Unit 1 and Wolf Creek are of safety concern to the NRC staff because they represent potential precursors to loss of shutdown margin. Even before it was determined if these events were caused by the control rods or by the fuel there was an apparent correlation of the problem with high burnup fuel. It was determined that there was also a correlation between high burnup and high drag forces as well as with rod drop time histories and lack of rod recoil. The NRC staff initial actions were aimed at getting a perspective on the magnitude of the problem as far as the number of plants and the amount of fuel that could be involved, as well as the safety significance in terms of shutdown margin. As tests have been performed and data has been analyzed the focus has shifted more toward understanding the problem and the ways to eliminate it. At this time the staff`s understanding of the phenomena is that it was a combination of factors including burnup, power history and temperature. The problem appears to be very sensitive to these factors, the interaction of which is not clearly understood. The model developed by Westinghouse provides a possible explanation but there is not sufficient data to establish confidence levels and sensitivity studies involving the key parameters have not been done. While several fixes to the problem have been discussed, no definitive fixes have been proposed. Without complete understanding of the phenomena, or fixes that clearly eliminate the problem the safety concern remains. The safety significance depends on the amount of shutdown margin lost due to incomplete insertion of the control rods. Were the control rods to stick high in the core, the reactor could not be shutdown by the control rods and other means such as emergency boration would be required.

  15. In praise of the incomplete leader.

    Science.gov (United States)

    Ancona, Deborah; Malone, Thomas W; Orlikowski, Wanda J; Senge, Peter M

    2007-02-01

    Today's top executives are expected to do everything right, from coming up with solutions to unfathomably complex problems to having the charisma and prescience to rally stakeholders around a perfect vision of the future. But no one leader can be all things to all people. It's time to end the myth of the complete leader, say the authors. Those at the top must come to understand their weaknesses as well as their strengths. Only by embracing the ways in which they are incomplete can leaders fill in the gaps in their knowledge with others' skills. The incomplete leader has the confidence and humility to recognize unique talents and perspectives throughout the organization--and to let those qualities shine. The authors' work studying leadership over the past six years has led them to develop a framework of distributed leadership. Within that model, leadership consists of four capabilities: sensemaking, relating, "visioning," and inventing. Sensemaking involves understanding and mapping the context in which a company and its people operate. A leader skilled in this area can quickly identify the complexities of a given situation and explain them to others. The second capability, relating, means being able to build trusting relationships with others through inquiring (listening with intention), advocating (explaining one's own point of view), and connecting (establishing a network of allies who can help a leader accomplish his or her goals). Visioning, the third capability, means coming up with a compelling image of the future. It is a collaborative process that articulates what the members of an organization want to create. Finally, inventing involves developing new ways to bring that vision to life. Rarely will a single person be skilled in all four areas. That's why it's critical that leaders find others who can offset their limitations and complement their strengths. Those who don't will not only bear the burden of leadership alone but will find themselves at the helm

  16. PillCam© Colon Capsule for the study of colonic pathology in clinical practice: Study of agreement with colonoscopy Capsula colónica PillCam© para el estudio de la patología del colon en la práctica clínica

    Directory of Open Access Journals (Sweden)

    J. M. Herrerías-Gutiérrez

    2011-02-01

    Full Text Available Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE compared with the colonoscopy in the study of the colonic pathology. Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents. The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed. Results: a total of 144 subjects (67 women and 77 men; (52.17±16.71 years with the following indications were included: screening of Colorectal cancer (88 patients, control after polipectomy (24, incomplete colonoscopy (7, rectal bleeding (10, anemia (8, diarrhea (7. The CCE exploration was complete in 134/144 cases (93%, with no case of retention. The preparation was good-very good in 88/134 (65,6%, fair in 26/134 (19,4% and poor in 20/134 (15% of the cases. The average colonic transit was of 140.76 min (9-603. Any adverse effect was notified. In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist. Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %. The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn's Disease in 9 and ulcerative colitis in other 8 cases. Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agree-ment with the colonoscopy, it could be useful in clinical practice. Further studies

  17. Enhanced education for bowel preparation before colonoscopy: a state-of-the-art review.

    Science.gov (United States)

    Liu, Zhu; Zhang, Ming Ming; Li, Yue Yue; Li, Li Xiang; Li, Yan Qing

    2017-01-09

    Colonoscopy remains the mainstay in the diagnosis and monitoring for colorectal cancer and other colorectal lesions. The diagnostic efficiency of colonoscopy highly depends on the quality of bowel preparation, which is closely associated with patient's compliance to preparation instructions. In addition, the procedural requirements of bowel preparation are often complex and difficult to be comprehended and memorized by patients, especially those with lower health literacy and motivation. Therefore, in recent years, many educational methods have been constantly developed, such as educational booklets, cartoon visual aids, educational videos, the short message service, the telephone, social media applications and smart phone applications. These educational methods have significantly improved the compliance with the instructions for bowel preparation and ultimately promoted the visualisation of colon in patients undergoing colonoscopy. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Colonoscopy surveillance for dysplasia and colorectal cancer in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Aalykke, Claus; Jensen, Michael Dam; Fallingborg, Jan;

    2015-01-01

    The risk of colorectal cancer (CRC) and dysplasia in patients with inflammatory bowel disease (IBD) has been highly debated as risk estimates from different studies vary greatly. The present national Danish guideline on colonoscopy surveillance for dysplasia and colorectal cancer in patients......, in some subgroups of patients the risk is increased. These subgroups of patients, who should be offered colonoscopy surveillance, include patients with ulcerative colitis having extensive disease and a long disease duration (10-13 years); early age at onset (less than 19 years of age) of ulcerative...... colitis; and patients with ulcerative colitis as well as Crohn´s disease with a concomitant diagnosis of primary sclerosing cholangitis. A colonoscopy surveillance program is recommended in these subgroups with intervals ranging from every 3-6 months to every 5 years, using chromoendoscopy with targeted...

  19. Trichuris trichiura infection diagnosed by colonoscopy: case reports and review of literature.

    Science.gov (United States)

    Ok, Kyung-Sun; Kim, You-Sun; Song, Jung-Hoon; Lee, Jin-Ho; Ryu, Soo-Hyung; Lee, Jung-Hwan; Moon, Jeong-Seop; Whang, Dong-Hee; Lee, Hye-Kyung

    2009-09-01

    Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm, humid climates. In Korea, trichuriasis was a highly prevalent soil-transmitted helminthiasis until the 1970s. However, the nationwide prevalence decreased to 0.02% in 2004 as a result of national control activities and improvement in the socioeconomic status of Koreans. Most infected individuals have no distinct symptoms, if lightly infected. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample; few reports have described detection of the parasite during colonoscopy. Recently, we managed 4 patients with trichuriasis who were diagnosed by detection of the parasite on colonoscopy, and we reviewed the literature on the colonoscopic diagnosis of T. trichiura in Korea. We suggest that colonoscopy might be a useful diagnostic tool, especially when infected by only a few male worms with no eggs in the stool.

  20. Evaluating screening colonoscopy quality in an uninsured urban population following patient navigation

    Directory of Open Access Journals (Sweden)

    Keith Naylor

    2017-03-01

    Full Text Available Patient navigation (PN increases screening colonoscopy completion in minority and uninsured populations. However, colonoscopy quality is under-reported in the setting of PN and quality indicators have often failed to meet benchmark standards. This study investigated screening colonoscopy quality indicators after year-one of a PN initiative targeting the medically uninsured. This was a retrospective analysis of 296 outpatient screening colonoscopies. Patients were 45 to 75 years of age with no history of bowel cancer, inflammatory bowel disease, or colorectal surgery. The screening colonoscopy quality indicators: adenoma detection rate (ADR, cecal intubation rate (CIR, and bowel preparation quality were compared in 89 uninsured Federally Qualified Health Center (FQHC patients who received PN and 207 University Hospital patients who received usual care. The FQHC PN and University Hospital cohorts were similar in female sex (69% vs. 70%; p = 0.861 and African American race (61% vs. 61%; p = 0.920. The FQHC PN cohort was younger (57 years vs. 60 years; p < 0.001. There was no difference in ADR (33% vs. 32%; p = 0.971 or CIR (96% vs. 95%; p = 0.900 comparing the FQHC PN and University Hospital cohorts. The FQHC PN patients had a greater likelihood of an optimal bowel preparation on multivariate logistic regression (odds ratio 4.17; 95% confidence interval 1.07 to 16.20. Uninsured FQHC patients who received PN were observed to have intra-procedure quality indicators that exceeded bench-mark standards for high-quality screening colonoscopy and were equivalent to those observed in an insured University Hospital patient population.

  1. Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Michelle Petro; Anil Minocha

    2005-01-01

    Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of the lumen due to various causes is believed to be the most common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microscopic documentation of the case is also presented.

  2. Follow-up of Pseudomembranous Colitis in Children Using Colonoscopy: A Case Report.

    Science.gov (United States)

    Zhao, Q; Yuan, H; Hu, H; Yan, M Q

    2015-09-01

    Pseudomembranous colitis (PMC) occurs mainly in adults and is believed to be caused almost exclusively by toxins produced by Clostridium difficile. Colonoscopy found that PMC occurs mainly in the colon, sigmoid colon and rectum in up to 80% ~ 100% of cases. Colonoscopy is simple and fast. It has the significance of making a definite diagnosis and can be used as the main examination method of diagnosis. Reports of children suffering from PMC are rare. Herein, we report a case of PMC in a child. This report has some clinical value for the study of the spectrum of PMC in patients.

  3. Patient acceptance of MR colonography with improved fecal tagging versus conventional colonoscopy

    DEFF Research Database (Denmark)

    Achiam, M P; Løgager, V; Chabanova, E;

    2010-01-01

    Conventional colonoscopy (CC) is the gold standard for colonic examinations. However, patient acceptance is not high. Patient acceptance is influenced by several factors, notably anticipation and experience. This has led to the assumption that patient acceptance would be higher in non-invasive ex......Conventional colonoscopy (CC) is the gold standard for colonic examinations. However, patient acceptance is not high. Patient acceptance is influenced by several factors, notably anticipation and experience. This has led to the assumption that patient acceptance would be higher in non...

  4. Change in renal function after sodium phosphate preparation for screening colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Dong; Choon; Seol; Sung; Noh; Hong; Jeong; Hwan; Kim; In; Kyung; Sung; Hyung; Seok; Park; Jung; Hyun; Lee; Chan; Sup; Shim

    2010-01-01

    AIM:To investigate the changes in renal function at 12-24 mo in patients following sodium phosphate(NaP) preparation for screening colonoscopy.METHODS:We carried out a retrospective study on the results from patients who received health check-up services as part of an employer-provided wellness program performed between August 2006 and May 2008 and who were followed up for 12-24 mo.Prior to screening colonoscopy,224 patients underwent bowel cleansing with NaP(NaP group) and 113 patients with polyethylene gl...

  5. Chronic methadone use, poor bowel visualization and failed colonoscopy: A preliminary study

    Institute of Scientific and Technical Information of China (English)

    Siddharth Verma; Joshua Fogel; David J Beyda; Brett Bernstein; Vincent Notar-Francesco; Smruti R Mohanty

    2012-01-01

    AIM:To examine effects of chronic methadone usage on bowel visualization,preparation,and repeat colonoscopy.METHODS:In-patient colonoscopy reports from October,2004 to May,2009 for methadone dependent (MD) patients were retrospectively evaluated and compared to matched opioid naive controls (C).Strict criteria were applied to exclude patients with risk factors known to cause constipation or gastric dysmotility.Colonoscopy reports of all eligible patients were analyzed for degree of bowel visualization,assessment of bowel preparation (good,fair,or poor),and whether a repeat colonoscopy was required.Bowel visualization was scored on a 4 point scale based on multiple prior studies:excellent =1,good =2,fair =3,or poor =4.Analysis of variance (ANOVA) and Pearson x2 test were used for data analyses.Subgroup analysis included correlation between methadone dose and colonoscopy outcomes.All variables significantly differing between MD and C groups were included in both univariate and multivariate logistic regression analyses.P values were two sided,and <0.05 were considered statistically significant.RESULTS:After applying exclusionary criteria,a total of 178 MD patients and 115 C patients underwent a colonoscopy during the designated study period.A total of 67 colonoscopy reports for MD patients and 72 for C were included for data analysis.Age and gender matched controls were randomly selected from this population to serve as controls in a numerically comparable group.The average age for MD patients was 52.2 ± 9.2 years (range:32-72 years) years compared to 54.6 ± 15.5 years (range:20-81 years) for C (P =0.27).Sixty nine percent of patients in MD and 65% in C group were males (P =0.67).When evaluating colonoscopy reports for bowel visualization,MD patients had significantly greater percentage of solid stool (i.e.,poor visualization) compared to C (40.3% vs 6.9%,P < 0.001).Poor bowel preparation (35.8% vs 9.7%,P < 0.001) and need for repeat colonoscopy (32

  6. Incomplete hemolytic-uremic syndrome in Argentinean children with bloody diarrhea.

    Science.gov (United States)

    López, E L; Contrini, M M; Devoto, S; de Rosa, M F; Graña, M G; Aversa, L; Gómez, H F; Genero, M H; Cleary, T G

    1995-09-01

    Argentina has an exceptionally high frequency of hemolytic-uremic syndrome (HUS). We sought to define prospectively the role of verocytotoxins (Shiga-like toxins [SLTs]) in 254 Argentinean children with grossly bloody diarrhea during spring and summer. Free fecal SLTs (I/II) and/or DNA probe-positive isolates were found in 99 (39%) of the children. During the follow-up period, HUS developed in 6 patients (4 with evidence of recent SLT infection based on stool studies); another 14 patients had some, but not all, of the abnormalities seen in typical HUS. The development of HUS or incomplete HUS in these children was significantly associated with recent SLT-Escherichia coli infection (p = 0.024). The high incidence of SLT-associated bloody diarrhea in Argentina explains, at least partially, the unusually high frequency of HUS. Our data indicate that incomplete forms of HUS may be common in patients with SLT-associated bloody diarrhea.

  7. Finding the solution for incomplete small bowel capsule endoscopy

    Institute of Scientific and Technical Information of China (English)

    José; Cotter; Francisca; Dias; de; Castro; Joana; Magalhes; Maria; Joo; Moreira; Bruno; Rosa

    2013-01-01

    AIM:To evaluate whether the use of real time viewer(RTV)and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations(IE)and improve the diagnostic yield of small bowel capsule endoscopy(SBCE).METHODS:Prospective single center interventional study,from June 2012 to February 2013.Capsule location was systematically checked one hour after ingestion using RTV.If it remained in the stomach,the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min.If the capsule remained in the stomach a second dose of10 mg of domperidone was administered orally.After another 30 min the position was rechecked and if the capsule remained in the stomach,it was passed into the duodenum by upper gastrointestinal(GI)endoscopy.The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department(control group,January 2009-May 2012).RESULTS:Both groups were similar regarding age,sex,indication,inpatient status and surgical history.The control group included 307 patients,with 48(15.6%)IE.The RTV group included 82 patients,with3(3.7%)IE,P=0.003.In the control group,average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel(77 min vs 26 min,P=0.003).In the RTV group,the capsule remained in the stomach one hour after ingestion in 14/82 patients(17.0%)vs 48/307(15.6%)in the control group,P=0.736.Domperidone did not significantly affect small bowel transit time(260min vs 297 min,P=0.229).The capsule detected positive findings in 39%of patients in the control group and 49%in the RTV group(P=0.081).CONCLUSION:The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations,with no effect on small bowel transit time or diagnostic yield.

  8. The Role of Incompleteness in Commodity Futures Markets

    Directory of Open Access Journals (Sweden)

    Takashi eKanamura

    2015-10-01

    Full Text Available This paper proposes a convenience yield-based pricing for commodity futures, which embeds incompleteness of commodity futures markets in convenience yields. By using the pricing method, we conduct empirical analyses of the prices of WTI crude oil, heating oil, and natural gas futures traded on the NYMEX in order to assess the incompleteness of energy futures markets. We show that the fluctuation from the incompleteness is partly driven by the fluctuation from convenience yields. In addition, it is shown that the incompleteness of natural gas futures market is more highlighted than the incompleteness of WTI crude oil and heating oil futures markets. We apply the implied market price of risk from the NYMEX data to pricing an Asian call option written on WTI crude oil futures. Finally, we try to apply the market incompleteness analysis to the post-crisis periods after 2009.

  9. Observation of incomplete fusion at low angular momenta

    Directory of Open Access Journals (Sweden)

    Singh Devendra P.

    2015-01-01

    Full Text Available Present work deals with experimental studies of incomplete fusion reaction dynamics using off-line γ-ray spectrometry at energies as low as ≈3-6 MeV/nucleon. Excitation functions for five reaction products populated via complete and/or incomplete fusion processes in 16O+130Te system have been measured and compared with the predictions of the statistical model code PACE4. A significant enhancement in the measured excitation functions compared to theoretical predictions for α-emitting channels has been observed and is attributed to incomplete fusion processes. The relative strength of incomplete fusion has been found to increase with projectile energy. Results show that incomplete fusion is associated even for angular momenta lesser than the critical angular momentum for complete fusion and also reveals importance of incomplete fusion even at energies as low as ≈3-6 MeV/nucleon.

  10. Scalable tensor factorizations with incomplete data.

    Energy Technology Data Exchange (ETDEWEB)

    Morup, Morten (Technical University of Denmark); Dunlavy, Daniel M. (Sandia National Laboratories, Albuquerque, NM); Acar, Evrim (Information Technologies Institute, Turkey); Kolda, Tamara Gibson

    2010-07-01

    The problem of incomplete data - i.e., data with missing or unknown values - in multi-way arrays is ubiquitous in biomedical signal processing, network traffic analysis, bibliometrics, social network analysis, chemometrics, computer vision, communication networks, etc. We consider the problem of how to factorize data sets with missing values with the goal of capturing the underlying latent structure of the data and possibly reconstructing missing values (i.e., tensor completion). We focus on one of the most well-known tensor factorizations that captures multi-linear structure, CANDECOMP/PARAFAC (CP). In the presence of missing data, CP can be formulated as a weighted least squares problem that models only the known entries. We develop an algorithm called CP-WOPT (CP Weighted OPTimization) that uses a first-order optimization approach to solve the weighted least squares problem. Based on extensive numerical experiments, our algorithm is shown to successfully factorize tensors with noise and up to 99% missing data. A unique aspect of our approach is that it scales to sparse large-scale data, e.g., 1000 x 1000 x 1000 with five million known entries (0.5% dense). We further demonstrate the usefulness of CP-WOPT on two real-world applications: a novel EEG (electroencephalogram) application where missing data is frequently encountered due to disconnections of electrodes and the problem of modeling computer network traffic where data may be absent due to the expense of the data collection process.

  11. Deep community detection in topologically incomplete networks

    Science.gov (United States)

    Xin, Xin; Wang, Chaokun; Ying, Xiang; Wang, Boyang

    2017-03-01

    In this paper, we consider the problem of detecting communities in topologically incomplete networks (TIN), which are usually observed from real-world networks and where some edges are missing. Existing approaches to community detection always consider the input network as connected. However, more or less, even nearly all, edges are missing in real-world applications, e.g. the protein-protein interaction networks. Clearly, it is a big challenge to effectively detect communities in these observed TIN. At first, we bring forward a simple but useful method to address the problem. Then, we design a structured deep convolutional neural network (CNN) model to better detect communities in TIN. By gradually removing edges of the real-world networks, we show the effectiveness and robustness of our structured deep model on a variety of real-world networks. Moreover, we find that the appropriate choice of hop counts can improve the performance of our deep model in some degree. Finally, experimental results conducted on synthetic data sets also show the good performance of our proposed deep CNN model.

  12. Goedel incompleteness theorems and the limits of their applicability. I

    Energy Technology Data Exchange (ETDEWEB)

    Beklemishev, Lev D [Steklov Mathematical Institute, Russian Academy of Sciences, Moscow (Russian Federation)

    2011-01-25

    This is a survey of results related to the Goedel incompleteness theorems and the limits of their applicability. The first part of the paper discusses Goedel's own formulations along with modern strengthenings of the first incompleteness theorem. Various forms and proofs of this theorem are compared. Incompleteness results related to algorithmic problems and mathematically natural examples of unprovable statements are discussed. Bibliography: 68 titles.

  13. Paired comparison of procedural sequence in same-day bidirectional endoscopy with moderate sedation and carbon dioxide insufflation: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Jui-Hsiang Tang

    2016-01-01

    Full Text Available Background/Aims: Same-day bidirectional endoscopy (BDE is a commonly performed procedure, but the optimal sequence of the procedure with carbon dioxide insufflation is not well established. In this study, we investigated the optimal sequence for same-day BDE without polypectomy under moderate sedation and carbon dioxide insufflation in terms of sedation doses and colonoscopy performance. Patients and Methods: We performed a prospective observational study of 63 asymptomatic patients who were admitted for physical check-ups. A colonoscopy-esophagogastroduodenoscopy (EGD examination was performed first and then an EGD-colonoscopy examination was performed within 1.5 years. Results: The total procedure time, procedure complexity, bowel preparation quality, cecal intubation time, colon polyp detection rate, and adverse events were similar between the two study groups. The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than that for the EGD-colonoscopy group (70.8 ± 9.6 μg vs. 56.6 ± 9.2 μg and 6.1 ± 1.3 mg vs. 4.6 ± 1.1 mg, P < 0.0001 and P < 0.0001, respectively. The recovery time to discharge was significantly longer for the colonoscopy-EGD group compared to the EGD-colonoscopy group (38.5 ± 3.9 min vs. 31.9 ± 3.2 min, P < 0.001, respectively. Conclusions: EGD-colonoscopy is the optimal sequence for same-day BDE. In this order, the procedures are better tolerated, the sedation doses are reduced, and the recovery time is shorter.

  14. Paired Comparison of Procedural Sequence in Same-day Bidirectional Endoscopy with Moderate Sedation and Carbon Dioxide Insufflation: A Prospective Observational Study

    Science.gov (United States)

    Tang, Jui-Hsiang; Cheng, Chi-Liang; Kuo, Yen-Lin; Tsui, Yi-Ning

    2016-01-01

    Background/Aims: Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence of the procedure with carbon dioxide insufflation is not well established. In this study, we investigated the optimal sequence for same-day BDE without polypectomy under moderate sedation and carbon dioxide insufflation in terms of sedation doses and colonoscopy performance. Patients and Methods: We performed a prospective observational study of 63 asymptomatic patients who were admitted for physical check-ups. A colonoscopy-esophagogastroduodenoscopy (EGD) examination was performed first and then an EGD-colonoscopy examination was performed within 1.5 years. Results: The total procedure time, procedure complexity, bowel preparation quality, cecal intubation time, colon polyp detection rate, and adverse events were similar between the two study groups. The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than that for the EGD-colonoscopy group (70.8 ± 9.6 μg vs. 56.6 ± 9.2 μg and 6.1 ± 1.3 mg vs. 4.6 ± 1.1 mg, P < 0.0001 and P < 0.0001, respectively). The recovery time to discharge was significantly longer for the colonoscopy-EGD group compared to the EGD-colonoscopy group (38.5 ± 3.9 min vs. 31.9 ± 3.2 min, P < 0.001, respectively). Conclusions: EGD-colonoscopy is the optimal sequence for same-day BDE. In this order, the procedures are better tolerated, the sedation doses are reduced, and the recovery time is shorter.

  15. Closed loop control of sedation for colonoscopy using the Bispectral Index

    NARCIS (Netherlands)

    Leslie, K.; Absalom, A.; Kenny, G. N. C.

    Sixteen patients undergoing colonoscopy were sedated with propofol using a closed-loop control system guided by the Bispectral Index (BIS). Propofol administration, via a target-controlled infusion, was controlled by a proportional-integral-differential control algorithm. The median (range) propofol

  16. Colovesical fistula as a complication of colonic diverticulosis: diagnosis with virtual colonoscopy.

    Science.gov (United States)

    Nadır, Işılay; Ozın, Yasemin; Kiliç, Zeki Mesut Yalın; Oğuz, Dilek; Ulker, Aysel; Arda, Kemal

    2011-02-01

    A 65-year-old female patient admitted to our clinic with complaints of abdominal pain and watery diarrhea. She was diagnosed with colovesical fistula based on virtual colonoscopy findings. Since endoscopic and other radiological diagnostic tools were not able to establish a definite diagnosis, we found this case suitable for presentation.

  17. Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)

    DEFF Research Database (Denmark)

    Burnand, B; JK, Harris; Wietlisbach, V

    2006-01-01

    was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. CONCLUSIONS: About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic...

  18. Seeing better--Evidence based recommendations on optimizing colonoscopy adenoma detection rate.

    Science.gov (United States)

    Aranda-Hernández, Javier; Hwang, Jason; Kandel, Gabor

    2016-02-07

    Colorectal cancer is one of the three most frequent causes of cancer deaths in men and women in Europe and North America. Diagnosis and resection of adenomas has convincingly demonstrated its utility in diminishing colorectal cancer incidence. Therefore, colonoscopy is now the gold standard for colorectal cancer screening. But it is also known that colonoscopy effectiveness varies among endoscopists. Among different quality indicators, the most used is the adenoma detection rate (ADR) which is the percentage of average-risk patients for colorectal cancer who are found to have at least one adenoma or adenocarcinoma during a screening colonoscopy. There is compelling evidence supporting an inverse correlation between ADR and interval colorectal cancer (cancer found after a screening colonoscopy). Many factors such as quality of precolonoscopy preparation, additional observers, manoeuvres with the endoscope (second view, retroflexion, water inflation rather than air), time spent during withdrawal, changes in patient position, fold-flattener devices, new imaging or endoscopic modalities and use of intravenous or through the scope sprayed drugs, have been studied and developed with the aim of increasing the ADR. This reviews discusses these factors, and the current evidence, to "see better" in the colon and optimize ADR.

  19. Development of a colonoscopy add-on device for improvement of the intubation process

    Directory of Open Access Journals (Sweden)

    Litten JD

    2011-12-01

    Full Text Available Jonathan D Litten1, JungHun Choi2, David Drozek31Department of Mechanical Engineering; 2Department of Mechanical Engineering and Biomedical Engineering Program; 3College of Osteopathic Medicine, Department of Specialty Medicine, Ohio University, Athens, OH, USAAbstract: A colonoscopy add-on device has been developed to reduce intubation time without modification of the current colonoscope and peripheral devices. One of the main purposes of the system is to minimize trauma caused by the distal tip of the colonoscope. The detachable sensory fixture at the end of the distal tip measures the distance between the distal tip and the colon wall in three directions, and the actuation system attached at the base of the colonoscope controls the distal tip by rotating two dial knobs. The device controls the distal tip to minimize contact between the distal tip and the colon wall, and the distal tip ideally points out the next possible lumen. A compatibility test of the infrared sensory system was carried out, and the design of the actuation system was accomplished. The system is integrated and controlled by a microprocessor. The device was tested in a silicon colon and porcine intestine. The results showed that a colonoscopist successfully reached the cecum with the aid of the colonoscopy add-on device without significant contact between the colon wall and the distal tip. The colonoscopy aid device was very helpful for the novice colonoscopist.Keywords: colonoscope, infrared sensors, intubation, trauma, colonoscopy training model

  20. Colonoscopy after CT Diagnosis of Diverticulitis to Exclude Colon Cancer: A Systematic Literature Review

    OpenAIRE

    Sai, Victor F.; Velayos, Fernando; Neuhaus, John; Westphalen, Antonio C.

    2012-01-01

    There are limited data about follow-up colonoscopy after a CT diagnosis of acute diverticulitis, and the pooled prevalence of colorectal cancer in a small number of patients is only slightly higher than the calculated prevalence of colorectal cancer in a population of comparable age.

  1. Colon Capsule Endoscopy: Detection of Colonic Polyps Compared with Conventional Colonoscopy and Visualization of Extracolonic Pathologies

    Directory of Open Access Journals (Sweden)

    Alexander F Hagel

    2014-01-01

    Full Text Available BACKGROUND: Conventional colonoscopy (CC is the gold standard for diagnostic examination of the colon. However, the overall acceptance of this procedure is low due to patient fears of complications or embarrassment. Colon capsule endoscopy (CCE represents a minimally invasive, patient-friendly procedure that offers complete visualization of the entire intestine.

  2. Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer

    DEFF Research Database (Denmark)

    Arditi, C; Peytremann-Bridevaux, I; Burnand, B;

    2009-01-01

    BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2...

  3. The effect of auricular acupuncture on pain during colonoscopy with midazolam and pethidine

    Science.gov (United States)

    Kusumastuti, R.; Srilestari, A.; Abdurrohim, K.; Abdullah, M.

    2017-08-01

    Colonoscopy is the standard procedure for colorectal cancer screening. One of its common complications is abdominal pain. Analgesia has not provided favorable outcomes so various complementary practices have been developed, including auricular acupuncture. In this study, a randomized controlled trial of 56 patients who underwent colonoscopy was conducted to determine the effect of acupuncture on the pain experienced during colonoscopy. Subjects were divided into two groups: The first received acupuncture combined with midazolam and pethidine, while the second were administered placebo puncture in addition to midazolam and pethidine. The median Critical Care Pain Observation Tool (CPOT) score was lower in the auricular acupuncture group than in the placebo puncture group(0.7 [0-4.83] vs. 1.9 [0-6.20] p = 0.010), while there were no significant differences to median Visual Analog Scale (VAS) scores (29 [0-100] vs. 44.5 [0-100] p = 0.147), heart rate changes (-2.58 [14.31] vs.-2.43 [12.28]; p = 0.970), or the mean time to the cecum (16 [8-51] vs. 22 [5-63] p = 0.206). Auricular acupuncture combined with midazolam and pethidine was found to be effective at reducing pain during colonoscopy.

  4. Colonoscopy results are not enhanced by use of magnet endoguide in specialist practice

    DEFF Research Database (Denmark)

    Bak-Christensen, Anders; Knudsen, Elisabeth; Hendel, Jakob;

    2013-01-01

    screening. UPD has been proposed as a tool for optimization of results and reduction of patient discomfort. In this study, we aimed to qualify the debate by examining the success rate and patient discomfort in an unselected colonoscopy population referred to specialist clinics with experienced investigators...

  5. Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy

    NARCIS (Netherlands)

    Koch, A.D.; Buzink, S.N.; Heemskerk, J.; Botden, S.M.B.I.; Veenendaal, R; Jakimowicz, J.J.; Schoon, E.J.

    2007-01-01

    Objectives The main objectives of this study were to establish expert validity (a convincing realistic representation of colonoscopy according to experts) and construct validity (the ability to discriminate between different levels of expertise) of the Simbionix GI Mentor II virtual reality (VR) si

  6. Colonoscopy surveillance for dysplasia and colorectal cancer in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Aalykke, Claus; Jensen, Michael Dam; Fallingborg, Jan

    2015-01-01

    colitis; and patients with ulcerative colitis as well as Crohn´s disease with a concomitant diagnosis of primary sclerosing cholangitis. A colonoscopy surveillance program is recommended in these subgroups with intervals ranging from every 3-6 months to every 5 years, using chromoendoscopy with targeted...

  7. Clinical predictors of colorectal polyps and carcinoma in a low prevalence region:Results of a colonoscopy based study

    Institute of Scientific and Technical Information of China (English)

    Yousef Bafandeh; Manoochehr Khoshbaten; Amir Taher Eftekhar Sadat; Sara Farhang

    2008-01-01

    AIM:To estimate the prevalence of colorectal cancer (CRC) in patients with long lasting colonic symptoms undergoing total colonoscopy;and to establish clinical features predicting its occurrence.METIHODS:This prospective study was carried out in Imam Hospital,Tabriz University of medical sciences,Iran.Continuous patients with long lasting lower gastrointestinal tract symptoms who had the criteria of a colonoscopy were included.The endoscopist visualized the caecum documented by a photo and/or a specimen from terminal ileum.RESULTS:Four hundred and eighty consecutive symptomatic patients [mean age (SD):42.73 (16.21)]were included.The prevalence of colorectal neoplasia was 15.3%(34 subjects) and 37.7% (181 subjects)had a completely normal colon.Adenomatous polyps were detected in 56 (11.7%) patients,in 12.3% of men and 10.9% of women.The mean age of the patients with a polyp was significantly higher than the others (49.53±14.16 vs 41.85±16.26,P=0.001).Most of the adenomatous polyps were left sided and tubular;only 22.5% of polyps were more than 10 mm.Cancer was detected in 16 (3.6%) of our study population,which was mostly right sided (57.2%).The mean age of patients with cancer was significantly higher than the others (60.25±8.26 vs 42.13±16.08,P<0.005) and higher than patients with polyps[60.25 (8.26) vs 49.53 (1.91) (P<0.0005)].None of the symptoms (diarrhea,abdominal pain,rectal bleeding,constipation,altering diarrhea and constipation,history of cancer,known irritable bowel disease,history of polyp and fissure or family history of cancer) were predictors for cancer or polyps,but the age of the patient and unexplained anemia independently predicted cancer.CONCLUSION:Less advanced patterns and smaller sizes of adenomas in Iran is compatible with other data from Asia and the Middle East,but in contrast to western countries.Prevalence of colonic neoplasia in our community seems to be lower than that in western population.Colonic symptoms are not predictors

  8. Reluctance to screening colonoscopy in Arab Americans: a community based observational study.

    Science.gov (United States)

    Talaat, Nizar; Harb, Walid

    2013-08-01

    To explore compliance of Arab-Americans to colorectal cancer (CRC) screening and identify the barriers for non-compliance. An observational community based study. Arab-American Friday prayer attendees' ≥50 years in three mosques in Dearborn, MI volunteered. Demographics, health insurance status, screening history, availability of a primary care physician (PCP) and the ability to communicate in Arabic were inquired. The responses were compared using a student t test between respondents who have had CRC screening with colonoscopy and those who have not had any screening tests. A p value of 0.05 or lower was considered statistically significant. Total number surveyed was 130. Average age is 64 years. Males were 76 % (99) and females 24 % (31). More than 50 % were Lebanese and 28 % were from Yemen. Majority had health insurance (89 %), and 86 % had a primary care physician of which 79 % of them spoke Arabic. Half of the participants had colonoscopy mostly for screening purposes. Fifty-eight (45 %) participants did not have CRC screening. Majority of the females (72.4 %) had colonoscopy compared to 46.8 % of the males (p value = 0.016). The mean length of stay in the U.S was 39.16 years in the colonoscopy group compared to 30.77 years in the non-screening group (p value = 0.006). Participants without a PCP did not have CRC screening (77.8 %) (p value = 0.005). Participants with a non-Arabic speaking PCP had more colonoscopy rates (77.3 %) compared to those with an Arabic speaking PCP (50 %) (p value = 0.027). More Lebanese had colonoscopy (71.9 %) compared to 25.7 % of the surveyed Yemenis (p value = 0.00). Discomfort, unawareness about CRC screening, and nonrecommendation by PCP were reported barriers. Arab-Americans have lower screening colonoscopy rates. Unfamiliarity of the importance of screening is a principal issue. Having a non-arabic speaking PCP is beneficial. Better education to this population about the benefits and ease of

  9. Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Corcillo, Antonella, E-mail: antonella.corcillo@chuv.ch [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Medecine Interne (Switzerland); Aellen, Steve, E-mail: steve.aellen@hopitalvs.ch; Zingg, Tobias [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Bize, Pierre [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland); Demartines, Nicolas [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Denys, Alban [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland)

    2013-10-15

    Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

  10. Managing passive incontinence and incomplete evacuation.

    Science.gov (United States)

    Collins, Brigitte; Norton, Christine

    Both passive faecal incontinence and evacuation difficulty are distressing and demoralising conditions, resulting in physical and psychological problems including social restrictions, loss of self-esteem, altered body image and loss of skin integrity. Conservative management and biofeedback therapy has been shown to help most patients with faecal incontinence and evacuation difficulty by creating a manageable situation that can significantly improve quality of life. However, some patients may not improve their symptoms and require alternative measures. This article reports an audit of the use of the Qufora mini irrigation system in 50 patients (48 female, 2 male) with passive faecal incontinence and/or evacuation difficulty who had failed to respond to conventional biofeedback. Seventy percent found the irrigation comfortable and 74% rated the system as good or acceptable. Two-thirds believed symptoms were improved and would wish to continue using the system. Prospective studies are needed to confirm which patients are most suitable and respond well to the irrigation.

  11. Incomplete resistance to coffee leaf rust (Hemileia vastatrix)

    NARCIS (Netherlands)

    Eskes, T.K.A.B.

    1983-01-01

    Incomplete resistance to coffee leaf rust ( Hemileia vastatrix ) may be of value in obtaining durable resistance, which is of great importance for the perennial coffee crop. Methods were developed to assess incomplete resistance to coffee leaf rust by using illustrated scales ranging from 0 t

  12. Incomplete resistance to coffee leaf rust (Hemileia vastatrix)

    NARCIS (Netherlands)

    Eskes, A.B.

    1983-01-01

    Incomplete resistance to coffee leaf rust ( Hemileia vastatrix ) may be of value in obtaining durable resistance, which is of great importance for the perennial coffee crop. Methods were developed to assess incomplete resistance to coffee leaf rust by using illustrated scales

  13. Risk factors for incomplete small-bowel capsule endoscopy

    NARCIS (Netherlands)

    Westerhof, Jessie; Weersma, Rinse K.; Koornstra, Jan J.

    2009-01-01

    Background: In 20% to 30% of capsule endoscopy (CE) procedures, the capsule does not reach the cecum within recording time, with incomplete imaging of the small bowel, which limits the value of CE. Objective: To identify possible risk factors for incomplete small-bowel CE examinations. Design: Data

  14. Stepwise Relationship Between Components of Metabolic Syndrome and Risk of Colorectal Adenoma in a Taiwanese Population Receiving Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Nien-Chih Hu

    2011-02-01

    Conclusion: Subjects with metabolic syndrome have increased risk of developing colorectal adenoma. Screening colonoscopy for prevention of colorectal adenoma might be warranted when abdominal obesity or more than three components of MS are present.

  15. Comparison of indium-111 scintigraphy and colonoscopy with histologic study in children for evaluation of colonic chronic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Tolia, V.; Kuhns, L.R.; Chang, C.H.; Slovis, T.L. (Department of Pediatric Gastroenterology, Children' s Hospital of Michigan, Detroit (USA))

    1991-04-01

    Indium-111 leukocyte scanning and colonoscopy were performed in 19 children and adolescents with chronic inflammatory bowel disease to study the correlation of evaluation between these two diagnostic modalities in comparison to histologic study for colonic disease. Seven patients had ulcerative colitis, 10 had Crohn's disease, and two patients had no specific diagnosis after evaluation. The sensitivity of indium-111 scan was 18%, specificity was 62.5%, and accuracy for diagnosing colonic disease was only 37%. In comparison, sensitivity and specificity for colonoscopy were 100 and 57%, respectively. Furthermore, accuracy with colonoscopy was 84%. The authors data suggest that the usefulness of scans is limited to patients in whom standard diagnostic procedures are contraindicated. In addition, it is essential to confirm the visual diagnostic impression on colonoscopy with histologic study.

  16. Consequences of Increasing Time to Colonoscopy Examination After Positive Result From Fecal Colorectal Cancer Screening Test.

    Science.gov (United States)

    Meester, Reinier G S; Zauber, Ann G; Doubeni, Chyke A; Jensen, Christopher D; Quinn, Virginia P; Helfand, Mark; Dominitz, Jason A; Levin, Theodore R; Corley, Douglas A; Lansdorp-Vogelaar, Iris

    2016-10-01

    Delays in diagnostic testing after a positive result from a screening test can undermine the benefits of colorectal cancer (CRC) screening, but there are few empirical data on the effects of such delays. We used microsimulation modeling to estimate the consequences of time to colonoscopy after a positive result from a fecal immunochemical test (FIT). We used an established microsimulation model to simulate an average-risk United States population cohort that underwent annual FIT screening (from ages 50 to 75 years), with follow-up colonoscopy examinations for individuals with positive results (cutoff, 20 μg/g) at different time points in the following 12 months. Main evaluated outcomes were CRC incidence and mortality; additional outcomes were total life-years lost and net costs of screening. For individuals who underwent diagnostic colonoscopy within 2 weeks of a positive result from an FIT, the estimated lifetime risk of CRC incidence was 35.5/1000 persons, and mortality was 7.8/1000 persons. Every month added until colonoscopy was associated with a 0.1/1000 person increase in cancer incidence risk (an increase of 0.3%/month, compared with individuals who received colonoscopies within 2 weeks) and mortality risk (increase of 1.4%/month). Among individuals who received colonoscopy examinations 12 months after a positive result from an FIT, the incidence of CRC was 27.0/1000 persons (increase of 4%, compared with 2 weeks), and mortality was 9.1/1000 persons (increase of 16%). Total years of life gained for the entire screening cohort decreased from an estimated 93.7/1000 persons with an almost immediate follow-up colonoscopy (cost savings of $208 per patient, compared with no colonoscopy) to 84.8/1000 persons with follow-up colonoscopies at 12 months (decrease of 9%; cost savings of $100/patient, compared with no colonoscopy). By using a microsimulation model of an average-risk United States screening cohort, we estimated that delays of up to 12 months after a

  17. Yield of colonoscopy with special reference to lower gastrointestinal bleeding in a tertiary referral center in Eastern India

    Directory of Open Access Journals (Sweden)

    Gautam Ray

    2015-01-01

    Full Text Available Background: Little data exist on the yield of colonoscopy in its different indications, especially gastrointestinal (GI bleeding. Furthermore, there are no formal guidelines regarding the timing of its performance in the work up for lower GI bleeding. Methods: In a retrospective study, spanning from January 2007 to December 2013, the clinical data of all the patients undergoing colonoscopy were retrieved from the hospital records including the predominant symptom which mandated colonoscopy and results of the other tests done before colonoscopy including upper GI endoscopy (esophagogastroduodenoscopy [EGD]. The type of GI bleed (overt or occult along with the presence or absence of iron deficiency anemia (IDA was noted. The yield of EGD in the corresponding years in those having a presentation with lower GI bleed and/or IDA was also noted for comparison. Results: Overall yield of colonoscopy was low (25.7% like for all its indications except lower GI bleed where its yield was highest (45.2%. 81.2% of the cases with a diagnosis presented with lower GI bleed, highest for colon cancer (90%, and polyps (86.1%. Cases of occult bleed more often had a positive diagnosis than overt bleed (P = 0.02. EGD yielded positive findings in more cases (43.2%, P = 0.00 than colonoscopy (except piles. Colonic cancers and polyps were presented with hematochezia when compared to gastric cancer which presented more often with occult bleed and other clinical symptoms. Conclusion: EGD should be done first in lower GI bleeding to exclude upper GI source and select subsequent colonoscopy. For hematochezia and occult bleed, colonoscopy is important whether IDA is present or not.

  18. Factors associated with incomplete small bowel capsule endoscopy studies

    Institute of Scientific and Technical Information of China (English)

    Mitchell; M; Lee; Andrew; Jacques; Eric; Lam; Ricky; Kwok; Pardis; Lakzadeh; Ajit; Sandhar; Brandon; Segal; Sigrid; Svarta; Joanna; Law; Robert; Enns

    2010-01-01

    AIM:To identify patient risk factors associated with incomplete small bowel capsule endoscopy(CE) studies.METHODS:Data from all CE procedures performed at St.Paul's Hospital in Vancouver,British Columbia,Canada,between December 2001 and June 2008 were collected and analyzed on a retrospective basis.Data collection for complete and incomplete CE study groups included patient demographics as well as a number of potential risk factors for incomplete CE including indication for the procedure,hospitalization,dia...

  19. Incomplete fusion reactions in 16O+165Ho

    Indian Academy of Sciences (India)

    Anil Sharma; B Bindu Kumar; S Mukherjee; S Chakrabarty; B S Tomar; A Goswami; G K Gubbi; S B Manohar; A K Sinha; S K Datta

    2000-03-01

    Excitation functions for evaporation residues of the system 16O+165Ho have been measured up to 100 MeV. Recoil range distribution of long lived reaction products were measured at 16O beam energy of 100 MeV. Detailed Monte Carlo simulation of recoil range distributions of products were performed with the help of PACE2 code, in order to extract the contributions of incomplete fusion in the individual channels. The results clearly show the incomplete fusion contributions in the tantalum and thulium products. This is confirmed by the predictions of breakup fusion model of the incomplete fusion.

  20. Increased Detection of Colorectal Polyps in Screening Colonoscopy Using High Definition i-SCAN Compared with Standard White Light

    Science.gov (United States)

    Kim, Woo Jung; Park, Sang Young; Park, Iksoo; Lee, Wook Jin; Park, Jaechan; Chon, Nuri; Oh, Tak Geun; Kim, Kwang Hyun

    2016-01-01

    Background/Aims: The aim of this study was to evaluate the efficacy of high definition (HD) i-SCAN for colorectal polyp detection in screening colonoscopy. Methods: We retrospectively analyzed the records of 501 patients who had undergone screening colonoscopy performed by three endoscopists with either HD i-SCAN (n=149) or standard white light (n=352) from January 2, 2014 through June 30, 2014. Patient information and inter-endoscopist variation as well as polyp number, endoscopic findings, and pathologic characteristics were reviewed. Results: The detection rates of colorectal and neoplastic polyps were significantly higher using HD i-SCAN than standard white light colonoscopy (52% vs. 38.1%, p=0.004 for colorectal polyps; and 37.2% vs. 27.9%, p=0.041 for neoplastic polyps). Analysis of endoscopic findings revealed no difference in detected polyp size between HD i-SCAN and standard white light colonoscopy (4.59±2.35 mm vs. 4.82±2.81 mm, p=0.739), but non-protruding polyps were more commonly detected by i-SCAN than by standard white light colonoscopy (24.6% vs. 13.5%, p=0.007). Conclusions: Colonoscopy using HD i-SCAN had a significantly higher detection rate of colorectal polyps, including neoplastic polyps, because of improved sensitivity for detecting non-protruding lesions. PMID:26855927

  1. Current state of micro-robots/devices as substitutes for screening colonoscopy: assessment based on technology readiness levels.

    Science.gov (United States)

    Tapia-Siles, Silvia C; Coleman, Stuart; Cuschieri, Alfred

    2016-02-01

    Previous reports have described several candidates, which have the potential to replace colonoscopy, but to date, there is still no device capable of fully replacing flexible colonoscopy in the management of colonic disorders and for mass adult population screening for asymptomatic colorectal cancer. NASA developed the TRL methodology to describe and define the stages of development before use and marketing of any device. The definitions of the TRLS used in the present review are those formulated by "The US Department of Defense Technology Readiness Assessment Guidance" but adapted to micro-robots for colonoscopy. All the devices included are reported in scientific literature. They were identified by a systematic search in Web of Science, PubMed and IEEE Xplore amongst other sources. Devices that clearly lack the potential for full replacement of flexible colonoscopy were excluded. The technological salient features of all the devices included for assessment are described briefly, with particular focus on device propulsion. The devices are classified according to the TRL criteria based on the reported information. An analysis is next undertaken of the characteristics and salient features of the devices included in the review: wireless/tethered devices, data storage-transmission and navigation, additional functionality, residual technology challenges and clinical and socio-economical needs. Few devices currently possess the required functionality and performance to replace the conventional colonoscopy. The requirements, including functionalities which favour the development of a micro-robot platform to replace colonoscopy, are highlighted.

  2. [The radicality of surgical resection in rectal cancer. Analysis of factors associated with incomplete mesorectal excision].

    Science.gov (United States)

    Ferko, A; Orhalmi, J; Nikolov, D H; Hovorková, E; Chobola, M; Vošmik, M; Cermáková, E

    2013-06-01

    Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision. Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery. 168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmanns procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) - 11 out of 27 (41%), and Hartmanns operation - 6 out of 10 (60%). Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors

  3. High resolution colonoscopy in a bowel cancer screening program improves polyp detection

    Institute of Scientific and Technical Information of China (English)

    Matthew R Banks; Kalpesh Basherdas; Manuel Rodriguez-Justo; Laurence B Lovat; Rehan Haidry; M Adil Butt; Lisa Whitley; Judith Stein; Louise Langmead; Stuart L Bloom; Austin O'Bichere; Sara McCartney

    2011-01-01

    AIM:To compare high resolution colonoscopy (Olympus Lucera) with a megapixel high resolution system (Pentax HiLine) as an in-service evaluation.METHODS:Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures.Five colonoscopists conducted the study over a three month period,as part of the United Kingdom bowel cancer screening program.ration (X2 P = 0.98),caecal intubation rates (X2 P = 0.67),or depth of sedation (X2 P = 0.64).Mild discomfort was more common in the Pentax group (X2 P = 0.036).Adenoma detection rate was significantly higher in the Pentax group (X2 test for trend P = 0.01).Most of the extra polyps detected were flat or sessile adenomas.CONCLUSION:Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance.Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.

  4. Impact of Health Literacy-directed Colonoscopy Bowel Preparation Instruction Sheet.

    Science.gov (United States)

    Davis, Terry C; Hancock, Jill; Morris, James; Branim, Perry; Seth, Abhishek; Rademaker, Alfred; Arnold, Connie L

    2017-05-01

    To improve patient colonoscopy bowel preparation with a newly developed simplified instruction sheet in a safety-net hospital system. Bowel preparation quality was compared in a retrospective chart review of 543 patients, 287 of whom received standard instructions (9th grade reading level) between November 2015 and February 2016, and 256 of whom received simplified instructions (6th grade level) between March and May 2016. Instructions were mailed to all patients. The primary outcome was bowel preparation quality recorded by the endoscopist as optimal or suboptimal preparation. 543 medical records were reviewed and results indicated a significant association between the instructions used and preparation quality with patients receiving simplified instructions being significantly more prepared (69.1% vs 65.5%) and having a lower cancellation rate (4.7% vs 10.5%), p = .042. A no-cost simplified colonoscopy instruction sheet improved bowel preparation among patients in an academic safety-net health system.

  5. Is surveillance colonoscopy necessary for patients with sporadic gastric hyperplastic polyps?

    Directory of Open Access Journals (Sweden)

    Hailong Cao

    Full Text Available Gastric polyps, such as adenomas and hyperplastic polyps, can be found in various colonic polyposis syndromes. Unlike in sporadic gastric adenomas, in which the increased risk of colorectal neoplasia has been well characterized, information in sporadic gastric hyperplastic polyps was limited.To evaluate the association of sporadic gastric hyperplastic polyps with synchronous colorectal neoplasia in a large cohort.Patients with sporadic gastric hyperplastic polyps who underwent colonoscopy simultaneously or within six months were consecutively enrolled. Each patient was compared with two randomly selected age and sex matched controls without gastric polyps who also underwent colonoscopy in the same period. Data of patients' demographics and characteristics of the gastrointestinal polyps were documented.A total of 261 cases in 118,576 patients who underwent esophagogastroduodenoscopy were diagnosed as sporadic gastric hyperplastic polyps, and 192 of 261 (73.6% patients underwent colonoscopy. Colorectal neoplasias were identified in 46 (24.0% of 192 cases and in 40 (10.4% of 384 controls (P<0.001. The mean size and distribution of colorectal neoplasias were not significantly different between the two groups. There was a significantly higher rate of colorectal adenoma (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.9-5.3 in the gastric hyperplastic polyps group than in the control group, while the prevalence of colorectal cancer was similar in the two groups. Logistic regression analysis also suggested that the presence of gastric hyperplastic polyps (OR 2.5, 95% CI 1.5-4.0 was an independent risk factor for colorectal neoplasias.The risk of colorectal adenoma increases in patients with sporadic gastric hyperplastic polyps, and surveillance colonoscopy for these patients should be considered.

  6. Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea

    Science.gov (United States)

    Harvin, Glenn; Ali, Eslam; Raina, Amit; Leland, William; Abid, Sabeen; Vahora, Zahid; Movahed, Hossein; Kachru, Sumyra; Tee, Rick

    2016-01-01

    AIM To discover the prevalence and the feasibility of screening for obstructive sleep apnea (OSA) in patients presenting for routine colonoscopy. METHODS Adult patients having a colonoscopy for routine indications at our outpatient endoscopy center were eligible if they did not carry a diagnosis of OSA or had not had a prior sleep study. All patients were administered the Berlin questionnaire prior to the procedure. Mallampati, neck circumference, height, weight, and BMI were obtained for each patient. Patients were observed for any drops in oxygen saturation 10 s. Patients were determined to be high-risk if they met at least 2 of the 3 symptom categories for the Berlin questionnaire. RESULTS A total of 60 patients were enrolled and completed the study; mean age was 56 years (range 23-72 year). Twenty-six patients had a positive Berlin questionnaire (43.3%), 31 patients had a negative Berlin questionnaire (51.6%) and 3 patients had an equivocal result (5.0%). Patients with a positive Berlin questionnaire were more likely to be of increased weight (mean 210.5 lbs vs mean 169.8 lbs, P = 0.003), increased BMI (33.0 kg/m2 vs 26.8 kg/m2, P = 0.0016), and have an increased neck circumference (38.4 cm vs 35.5 cm, P = 0.012). Patients with a positive Berlin questionnaire were more likely to have a drop in oxygen saturation < 92% (76.9% vs 36.4%, P = 0.01). Patients with snoring were more likely to have a positive Berlin questionnaire (8/9 patients vs 1/31 patients with negative Berlin questionnaire; P = 0.0045). CONCLUSION Risk for OSA is extremely common in a population presenting for a routine colonoscopy, and screening at the time of a colonoscopy offers an excellent opportunity to identify these patients. PMID:27909549

  7. Surveillance colonoscopy practice in Lynch syndrome in the Netherlands: A nationwide survey

    Institute of Scientific and Technical Information of China (English)

    Jan J Koornstra; Hans FA Vasen

    2007-01-01

    Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence of colorectal cancer, this strategy is recommended worldwide. Recently, several advances in colonoscopic techniques have improved detection rates of neoplasia in Lynch syndrome. In this nationwide survey, we evaluated current surveillance colonoscopy practices for Lynch syndrome in the Netherlands and the extent to which advanced techniques have been adopted in routine clinical practice.

  8. BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen DEHGHANI

    2015-12-01

    Full Text Available Background - Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. Objectives - The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. Methods - This study included children with the range of ages (2-21 who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA were used for data analysis. Results - In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%, 36 (94.73%, and 14 (82.35% of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05. For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. Conclusion - There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.

  9. Impact of a simulation training curriculum on technical and nontechnical skills in colonoscopy: a randomized trial.

    Science.gov (United States)

    Grover, Samir C; Garg, Ankit; Scaffidi, Michael A; Yu, Jeffrey J; Plener, Ian S; Yong, Elaine; Cino, Maria; Grantcharov, Teodor P; Walsh, Catharine M

    2015-12-01

    GI endoscopy simulation-based training augments early clinical performance; however, the optimal manner by which to deliver training is unknown. We aimed to validate a simulation-based structured comprehensive curriculum (SCC) designed to teach technical, cognitive, and integrative competencies in colonoscopy. Single-blinded, randomized, controlled trial. Endoscopic simulation course at an academic hospital. Thirty-three novice endoscopists were allocated to an SCC group or self-regulated learning (SRL) group. The SCC group received a curriculum consisting of 6 hours of didactic lectures and 8 hours of virtual reality simulation-based training with expert feedback. The SRL group was provided a list of desired objectives and was instructed to practice on the simulator for an equivalent time (8 hours). Clinical transfer was assessed during 2 patient colonoscopies using the Joint Advisory Group Direct Observation of Procedural Skills (JAG DOPS) scale. Secondary outcome measures included differences in procedural knowledge, immediate post-training simulation performance, and delayed post-training (4-6 weeks) performance during an integrated scenario test on the JAG DOPS communication and integrated scenario global rating scales. There was no significant difference in baseline or post-training performance on the simulator task. The SCC group performed superiorly during their first and second clinical colonoscopies. Additionally, the SCC group demonstrated significantly better knowledge and colonoscopy-specific performance, communication, and global performance during the integrated scenario. We were unable to measure SRL participants' effort outside of mandatory training. In addition, feedback metrics and number of available simulation cases are limited. These results support integration of endoscopy simulation into a structured curriculum incorporating instructional feedback and complementary didactic knowledge as a means to augment technical, cognitive, and

  10. Role of computed tomographic colonoscopy of postoperative surveillance in patient with gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Dae Won Jun; Dong Hoo Lee; Oh Young Lee; Hyun Chul Lim; Sung Joon Kwon; Hang Lak Lee; Byung Chul Yoon; Ho Soon Choi; Joon Soo Hahm; Min Ho Lee

    2007-01-01

    AIM: To examine the diagnostic yield of colorectal neoplasia at computed tomographic colonoscopy (CTC) as well as the feasibility of contrast enhanced CTC in patients with gastric cancer.METHODS: To examine the incidence of colon polyp we selected postoperative 188 gastric cancer patients, which we refer to as the 'colon polyp survey group'. To examine the feasibility of CTC for early detection of colon cancer or advanced colon adenoma, we selected 47 gastric cancer patients (M:F 29:18, mean age 53.8 years), which we call the 'CT colonoscopy group'. All the 47 patients underwent successive CTC and colonoscopy on the same day.RESULTS: Totally 109 colon polyps were observed from 59 out of 188 gastric cancer patients, the incidence rate of colon polyps in gastric cancer patients being 31.4%. The sensitivity of CTC in detecting individuals with at least 1 lesion of any size was 57.1%, the specificity was 72.7%, the positive predictive value was 47.1%, and the negative predictive value was 71.9%. When the cutoff size was decreased to 6 mm, the sensitivity and specificity were 80.0% and 92.9%, respectively, with positive and negative predictive values of 57.1% and 97.5%, respectively. Only one patient was classified as false negative by virtual colonoscopy.CONCLUSION: The diagnostic yield of colorectal polyp was 31.4% in patients with gastric cancer, and contrast enhanced CTC is an acceptable tool for the detection of synchronous colorectal advanced adenoma and postoperative surveillance of gastric cancer patients.

  11. Gödel’s Incompleteness Theorems and Physics

    Directory of Open Access Journals (Sweden)

    Newton C. A. da Costa

    2011-12-01

    Full Text Available This paper is a summary of a lecture in which I presented some remarks on Gödel’s incompleteness theorems and their meaning for the foundations of physics. The entire lecture will appear elsewhere.

  12. Systematics for low energy incomplete fusion: Still a puzzle?

    Directory of Open Access Journals (Sweden)

    Yadav Abhishek

    2016-01-01

    Full Text Available In order to have a better and clear picture of incomplete fusion reactions at energies ≈4-7MeV/nucleon, the excitation function measurements have been performed for 18O+159Tb system. The experimental data have been analyzed within the framework of compound nucleus decay. The cross-section for xn/pxn-channels are found to be well reproduced by PACE4 predictions, which suggest their production via complete fusion process. However, a significant enhancement in the excitation functions of α-emitting channels has been observed over the theoretical ones, which has been attributed due to the incomplete fusion processes. The incomplete fusion fractions have been deduced at each studied energy and compared with other nearby systems for better insight into the underlying dynamics. The incomplete fusion fraction has been found to be sensitive to the projectile’s energy and α-Q-value.

  13. Genetic etiology and clinical consequences of complete and incomplete achromatopsia

    NARCIS (Netherlands)

    Thiadens, A.A.H.J.; Slingerland, N.W.; Roosing, S.; Schooneveld, M.J. van; Lith-Verhoeven, J.J. van; Moll-Ramirez, N.G. van; Born, L.I. van den; Hoyng, C.B.; Cremers, F.P.M.; Klaver, C.C.

    2009-01-01

    OBJECTIVE: To investigate the genetic causes of complete and incomplete achromatopsia (ACHM) and assess the association between disease-causing mutations, phenotype at diagnosis, and visual prognosis. DESIGN: Clinic-based, longitudinal, multicenter study. PARTICIPANTS: Probands with complete ACHM (n

  14. Pilot Clinical Trial of Indocyanine Green Fluorescence-Augmented Colonoscopy in High Risk Patients

    Directory of Open Access Journals (Sweden)

    Rahul A. Sheth

    2016-01-01

    Full Text Available White light colonoscopy is the current gold standard for early detection and treatment of colorectal cancer, but emerging data suggest that this approach is inherently limited. Even the most experienced colonoscopists, under optimal conditions, miss at least 15–25% of adenomas. There is an unmet clinical need for an adjunctive modality to white light colonoscopy with improved lesion detection and characterization. Optical molecular imaging with exogenously administered organic fluorochromes is a burgeoning imaging modality poised to advance the capabilities of colonoscopy. In this proof-of-principle clinical trial, we investigated the ability of a custom-designed fluorescent colonoscope and indocyanine green, a clinically approved fluorescent blood pool imaging agent, to visualize polyps in high risk patients with polyposis syndromes or known distal colonic masses. We demonstrate (1 the successful performance of real-time, wide-field fluorescence endoscopy using off-the-shelf equipment, (2 the ability of this system to identify polyps as small as 1 mm, and (3 the potential for fluorescence imaging signal intensity to differentiate between neoplastic and benign polyps.

  15. Virtual colonoscopy with multi-slice computed tomography; Virtuelle Koloskopie mit der Mehrschichtcomputertomographie. Vorlaeufige Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Rust, G.-F.; Eisele, O.; Reiser, M. [Institut fuer Klinische Radiologie, Klinikum Grosshadern, Muenchen Univ. (Germany); Hoffmann, J.N.; Kopp, R.; Fuerst, H. [Chirurgische Klinik und Poliklinik, Klinikum der Univ. Muenchen (Germany)

    2000-03-01

    Subject: Using multi-slice computed tomography (MSCT) large body areas can scanned with high spatial resolution. In this study, MSCT was employed for virtual colonoscopy in various pathologies of the colon. Results: Nine polyps and four of five colon carcinomas were detected using MSCT virtual colonoscopy. In three patients with ulcerative colitis virtual coloscopy revealed morphological alterations compatible with this disease. In two of four patients with multiple diverticula of the colon the true extent of the disorder could be assessed in virtual colonoscopy. (orig.) [German] Fragestellung: Die Mehrschichtcomputertomographie (MSCT) vermag, grosse Organbereiche mit hoher raeumlicher Aufloesung zu untersuchen. Daher koennen auch fuer die virtuelle Koloskopie eine bisher nicht erreichbare Ortsaufloesung und Detailtreue erwartet werden. Die ersten Ergebnisse mit der MSCT-Koloskopie bei unterschiedlichen pathologischen Veraenderungen des Kolons werden vorgestellt. Ergebnisse: 4 von 5 Kolonkarzinomen konnten mit der virtuellen Koloskopie dargestellt werden. Bei 3 Patienten wurden mit der virtuellen Koloskopie typische Veraenderungen der Colitis ulcerosa dargestellt, wovon ein Patient die konventionelle Koloskopie nicht tolerierte. Bei 9 Patienten mit Kolonpolypen stimmten die virtuelle und konventionelle Koloksopie vollstaendig ueberein. Bei 4 Patienten mit Divertikulose war mit der virtuellen Koloskopie nur in 2 Faellen der Befund vollstaendig zu sichern. (orig.)

  16. The role of autofluorescence colonoscopy in diagnosis and management of solitary rectal ulcer syndrome

    Science.gov (United States)

    Latos, W.; Kawczyk-Krupka, A.; Ledwon, A.; Kosciarz-Grzesiok, A.; Misiak, A.; Sieron-Stoltny, K.; Sieron, A.

    2008-02-01

    Solitary rectal ulcer syndrome (SRUS) is a chronic disease of the rectum. Although SRUS is a benign condition there are studies which suggest that chronic ischaemia which occurs in the SRUS may lead to "transitional mucosa" that is similar to that adjacent to colorectal carcinomas and adenomas and may lead to colorectal dysplasia and carcinoma development. The exclusion of primary or metastatic malignancy is the most important aim in the differential diagnosis of SRUS. In our study we assess the possibilities of autofluorescence colonoscopy (AFC) in diagnosis and management of SRUS. We performed white light colonoscopy first. The tissue samples were taken for pathological examination. When SRUS was histopathologically confirmed AFC was performed by means of Xillix OncoLIFE. During AFC numerical colour value (NCV) of autofluorescence of SRUS lesions was noted. During 1946 colonoscopies eight persons were diagnosed as having solitary rectal ulcer syndrome. We did not observe autofluorescence increase in case of polipoid and flat ulcer lesions (NCV 0,39-0,67; mean 0,525) and little increase of autofluorescence in case of erythema lesion (NCV- 0,94). SRUS is a rare disorder of the rectum but it causes differential diagnosis problems. The most common reason for incorrect diagnosis are inadequate tissue specimens. AFC allows to reveal subtle areas within the lesions of more intense autofluorescence and localizes the potential cancer-transformating dysplasia. In this way the most representative area with highest risk of pre- or cancerous changes, for biopsy specimen is indicated.

  17. Transparent-cap-fitted colonoscopy shows higher performance with cecal intubation time in difficult cases

    Institute of Scientific and Technical Information of China (English)

    Hyung Hun Kim; Seun Ja Park; Moo In Park; Won Moor; Sung Eun Kim

    2012-01-01

    AIM:To investigate the efficacy of cap-fitted colonoscopy (CFC) with regard to cecal intubation time.METHODS:Two hundred and ninety-five patients undergoing screening colonoscopy at Gospel Hospital,Kosin University College of Medicine were enrolled in this randomized controlled trial between January and December 2010.Colonoscopies were conducted by a single endoscopist.Patient characteristics including age,sex,body mass index,history of abdominal surgery,quality of preparation,and the presence of diverticulosis were recorded.RESULTS:One hundred and fifty patients were allocated into a CFC group and 145 into a non-CFC (NCF)group.Cecal intubations were achieved in all patients.Cecal intubation time in the CFC group was significantly shorter than in the NCF group for specific conditions:age ≥ 60 years,prior abdominal surgery,and poor bowel preparation.The number of detected adenomas was higher in the CFC group than in the NCF group (P =0.040).CONCLUSION:CFC facilitated shortening of the cecal intubation time in difficult cases,and was more sensitive for detecting adenomas than was NCF.

  18. Effect of music on level of anxiety in patients undergoing colonoscopy without sedation.

    Science.gov (United States)

    Ko, Chia-Hui; Chen, Yi-Yu; Wu, Kuan-Ta; Wang, Shu-Chi; Yang, Jeng-Fu; Lin, Yu-Yin; Lin, Chia-I; Kuo, Hsiang-Ju; Dai, Chia-Yen; Hsieh, Meng-Hsuan

    2017-03-01

    Listening to music can be a noninvasive method for reducing the anxiety level without any adverse effects. The aim of this study was to explore whether music can reduce anxiety and to compare two different styles of music, informal classical music and light music, to ascertain the more effective style of music in reducing anxiety in patients undergoing colonoscopy without sedation. This study enrolled 138 patients who underwent colonoscopy without sedation during a general health examination from February 2009 to January 2015. The patients were randomly assigned to a group that did not listen to music, a group that listened to music by David Tolley, or a group that listened to music by Kevin Kern. The State-Trait Anxiety Inventory was used to evaluate the status of anxiety. A trend test for mild anxiety was performed on the patients in the three groups, and a significant trend was noted (p=0.017 for all patients; p=0.014 for analysis by sex). Multivariate analysis for mild anxiety on the patients in each group was also performed in this study, and music by Kevin Kern was found to have the lowest odds ratio (Odds ratio=0.34, p=0.045). Listening to music, especially music by Kevin Kern, reduced the level of anxiety in patients undergoing colonoscopy examination without sedation. Copyright © 2016. Published by Elsevier Taiwan LLC.

  19. Propofol Versus Midazolam/Fentanyl Sedation for Colonoscopy in the Elderly Patient Population.

    Science.gov (United States)

    Lovett, Pamela; Gómez, Victoria; Hodge, David O; Ladlie, Beth

    2017-06-01

    Despite current literature, data on the most effective sedation and best patient outcomes are insufficient for providing recovery time recommendations for elderly patients undergoing colonoscopy with sedation. We sought to identify the best sedation practice for shorter recovery times. Therefore, a study was conducted to examine recovery times among patients older than 65 years undergoing elective colonoscopy with intravenous sedation with either propofol or the combination of midazolam/fentanyl. A retrospective descriptive, exploratory design was used. We retrospectively reviewed data from patients older than 65 years undergoing outpatient elective colonoscopy at our institution between January and December 2013. Recovery times were evaluated for those administered intravenous propofol or a combination of midazolam/fentanyl. Patient demographics and sedation medications were obtained from patient records. A modified Aldrete score greater than 8 was required for discharge. Recovery time was defined as the time from procedure completion to a modified Aldrete score greater than 8. Propofol sedation was associated with longer recovery times compared with sedation with a combination of midazolam and fentanyl (mean: 50 minutes versus 31 minutes, P < .001). Propofol sedation was not associated with shorter recovery times. Further studies are needed to validate these findings. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  20. Two methods of Haustral fold detection from computed tomographic virtual colonoscopy images

    Science.gov (United States)

    Chowdhury, Ananda S.; Tan, Sovira; Yao, Jianhua; Linguraru, Marius G.; Summers, Ronald M.

    2009-02-01

    Virtual colonoscopy (VC) has gained popularity as a new colon diagnostic method over the last decade. VC is a new, less invasive alternative to the usually practiced optical colonoscopy for colorectal polyp and cancer screening, the second major cause of cancer related deaths in industrial nations. Haustral (colonic) folds serve as important landmarks for virtual endoscopic navigation in the existing computer-aided-diagnosis (CAD) system. In this paper, we propose and compare two different methods of haustral fold detection from volumetric computed tomographic virtual colonoscopy images. The colon lumen is segmented from the input using modified region growing and fuzzy connectedness. The first method for fold detection uses a level set that evolves on a mesh representation of the colon surface. The colon surface is obtained from the segmented colon lumen using the Marching Cubes algorithm. The second method for fold detection, based on a combination of heat diffusion and fuzzy c-means algorithm, is employed on the segmented colon volume. Folds obtained on the colon volume using this method are then transferred to the corresponding colon surface. After experimentation with different datasets, results are found to be promising. The results also demonstrate that the first method has a tendency of slight under-segmentation while the second method tends to slightly over-segment the folds.

  1. Arthemis: annotation software in an integrated capturing and analysis system for colonoscopy.

    Science.gov (United States)

    Liu, Danyu; Cao, Yu; Kim, Ki-Hwan; Stanek, Sean; Doungratanaex-Chai, Bancha; Lin, Kungen; Tavanapong, Wallapak; Wong, Johnny; Oh, JungHwan; de Groen, Piet C

    2007-11-01

    Colonoscopy is an endoscopic technique that allows physicians to inspect the inside of the human colon. During a colonoscopic procedure, a tiny video camera at the tip of the endoscope generates a video signal of the internal mucosa of the colon. In current practice, the entire colonoscopic procedure is not routinely captured. Software tools providing easy access to important contents of videos that are digitally captured during colonoscopy are not available. Hence, it is very time consuming to review an entire video, locate important contents, annotate them, and extract the annotated contents for research, teaching, and training purposes. Arthemis, a software application, was developed to facilitate this process. For convenient data sharing, Arthemis allows annotation according to the European Gastrointestinal Society for Endoscopy (ESGE) Minimal Standard Terminology (MST), an internationally accepted standard for digestive endoscopy. Arthemis is part of our integrated capturing and content analysis system for colonoscopy called Endoscopic Multimedia Information System (EMIS). This paper presents Arthemis as a component of EMIS, the design and implementation of Arthemis, and key lessons learned from the development process.

  2. Efficient Algorithms for Bayesian Network Parameter Learning from Incomplete Data

    Science.gov (United States)

    2015-07-01

    Efficient Algorithms for Bayesian Network Parameter Learning from Incomplete Data Guy Van den Broeck∗ and Karthika Mohan∗ and Arthur Choi and Adnan...We propose a family of efficient algorithms for learning the parameters of a Bayesian network from incomplete data. Our approach is based on recent...algorithms like EM (which require inference). 1 INTRODUCTION When learning the parameters of a Bayesian network from data with missing values, the

  3. The Index of Dirac Operators on Incomplete Edge Spaces

    Science.gov (United States)

    Albin, Pierre; Gell-Redman, Jesse

    2016-09-01

    We derive a formula for the index of a Dirac operator on a compact, even-dimensional incomplete edge space satisfying a ''geometric Witt condition''. We accomplish this by cutting off to a smooth manifold with boundary, applying the Atiyah-Patodi-Singer index theorem, and taking a limit. We deduce corollaries related to the existence of positive scalar curvature metrics on incomplete edge spaces.

  4. On the Pricing of Options in Incomplete Markets

    OpenAIRE

    Melenberg, B.; Werker, B.J.M.

    1996-01-01

    In this paper we reconsider the pricing of options in incomplete continuous time markets.We first discuss option pricing with idiosyncratic stochastic volatility.This leads, of course, to an averaged Black-Scholes price formula.Our proof of this result uses a new formalization of idiosyncraticy which encapsulates other definitions in the literature.Our method of proof is subsequently generalized to other forms of incompleteness and systematic (i.e. non-idiosyncratic) information.Generally thi...

  5. Filtering, control and fault detection with randomly occurring incomplete information

    CERN Document Server

    Dong, Hongli; Gao, Huijun

    2013-01-01

    This book investigates the filtering, control and fault detection problems for several classes of nonlinear systems with randomly occurring incomplete information. It proposes new concepts, including RVNs, ROMDs, ROMTCDs, and ROQEs. The incomplete information under consideration primarily includes missing measurements, time-delays, sensor and actuator saturations, quantization effects and time-varying nonlinearities. The first part of this book focuses on the filtering, control and fault detection problems for several classes of nonlinear stochastic discrete-time systems and

  6. Incomplete Financial Markets and Jumps in Asset Prices

    DEFF Research Database (Denmark)

    Crès, Hervé; Markeprand, Tobias Ejnar; Tvede, Mich

    A dynamic pure-exchange general equilibrium model with uncertainty is studied. Fundamentals are supposed to depend continuously on states of nature. It is shown that: 1. if financial markets are complete, then asset prices vary continuously with states of nature, and; 2. if financial markets...... are incomplete, jumps in asset prices may be unavoidable. Consequently incomplete financial markets may increase volatility in asset prices significantly....

  7. Unexpected show up of incomplete fusion at low projectile energies

    Directory of Open Access Journals (Sweden)

    Singh B.P.

    2011-10-01

    Full Text Available In this paper, some of the important findings of recent measurements performed to study incomplete fusion at low bombarding energies (i.e., Elab ≈ 4-7 MeV/nucleon in 12C, 16O+169Tm systems are briefly summarized. The spin-distributions of xn, pxn, αxn/2αxn- channels have been measured to probe entirely different γ-emission patterns (and feeding intensity profiles during the de-excitation of complete and incomplete fusion objects. Incomplete fusion strength function has been deduced (from the analysis of experimental excitation functions in context of equilibrated compound nucleus decay to achieve information of onset and strength of incomplete fusion in terms of various entrance channel parameters. Presence of incomplete fusion at slightly above barrier energies has been confirmed by the measurement of linear momentum distribution of heavy recoils. Present results conclusively demonstrate, the existence of incomplete fusion at low bombarding energies, its strong dependence on entrance channel parameters, and the possibility to populate high spin states.

  8. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Kosonen, Petteri; Vikman, Saila; Jensen, Lisette Okkels;

    2013-01-01

    This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST...... is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial....

  9. Back-to-Back Comparison of Auto-Fluorescence Imaging (AFI Versus High Resolution White Light Colonoscopy for Adenoma Detection

    Directory of Open Access Journals (Sweden)

    Moriichi Kentaro

    2012-06-01

    Full Text Available Abstract Background Some patients under close colonoscopic surveillance still develop colorectal cancer, thus suggesting the overlook of colorectal adenoma by endoscopists. AFI detects colorectal adenoma as a clear magenta, therefore the efficacy of AFI is expected to improve the detection ability of colorectal adenoma. The aim of this study is to determine the efficacy of AFI in detecting colorectal adenoma. Methods This study enrolled 88 patients who underwent colonoscopy at Asahikawa Medical University and Kushiro Medical Association Hospital. A randomly selected colonoscopist first observed the sigmoid colon and rectum with conventional high resolution endosopy (HRE. Then the colonoscopist changed the mode to AFI and handed to the scope to another colonoscopist who knew no information about the HRE. Then the second colonoscopist observed the sigmoid colon and rectum. Each colonoscopist separately recorded the findings. The detection rate, miss rate and procedural time were assessed in prospective manner. Results The detection rate of flat and depressed adenoma, but not elevated adenoma, by AFI is significantly higher than that by HRE. In less-experienced endoscopists, AFI dramatically increased the detection rate (30.3% and reduced miss rate (0% of colorectal adenoma in comparison to those of HRE (7.7%, 50.0%, but not for experienced endoscopists. The procedural time of HRE was significantly shorter than that of AFI. Conclusions AFI increased the detection rate and reduced the miss rate of flat and depressed adenomas. These advantages of AFI were limited to less-experienced endoscopists because experienced endoscopists exhibited a substantially high detection rate for colorectal adenoma with HRE.

  10. Colonoscopy Preparation: Polyethylene Glycol with Gatorade is as Safe and Efficacious as 4 Liters of Polyethylene Glycol with Balanced Electrolytes

    Science.gov (United States)

    McKenna, Thomas; Macgill, Alice; Porat, Gail; Friedenberg, Frank K.

    2013-01-01

    Background Four liters of polyethylene glycol 3350 with balanced electrolytes for colonoscopy preparation has had poor acceptance. Another approach is the use of electrolyte-free PEG combined with 1.9L of Gatorade. Despite its widespread use, there are no data on metabolic safety and minimal data on efficacy. Our aim was to assess the efficacy and electrolyte safety of these two PEG-based preparations. Methods This was a prospective, randomized, single-blind, non-inferiority trial. Patients were randomized to 238g PEG + 1.9L Gatorade or 4L of PEG-ELS containing 236g PEG. Split dosing was not performed. On procedure day blood was drawn for basic chemistries. The primary outcome was preparation quality from procedure photos using the Boston Bowel Preparation Scale. Results We randomized 136 patients (66 PEG + Gatorade, 70 PEG-ELS). There were no differences in preparation scores between the two agents in the ITT analysis (7.2 ± 1.9 for PEG-ELS and 7.0 ± 2.1 for PEG + Gatorade; p = 0.45). BBPS scores were identical for those who completed the preparation and dietary instructions as directed (7.4 ± 1.7 for PEG-ELS, and 7.4 ± 1.8 for PEG + Gatorade; p = 0.98). There were no statistical differences in serum electrolytes between the two preparations. Patients who received PEG + Gatorade gave higher overall satisfaction scores for the preparation experience (p = 0.001), and had fewer adverse effects. Conclusions Use of 238g PEG + 1.9L Gatorade appears to be safe, better tolerated, and non-inferior to 4L PEG-ELS. This preparation may be especially useful for patients who previously tolerated PEG-ELS poorly. PMID:22711499

  11. Colonoscopy preparation: polyethylene glycol with Gatorade is as safe and efficacious as four liters of polyethylene glycol with balanced electrolytes.

    Science.gov (United States)

    McKenna, Thomas; Macgill, Alice; Porat, Gail; Friedenberg, Frank K

    2012-12-01

    Four liters of polyethylene glycol 3350 (PEG) with balanced electrolytes for colonoscopy preparation has had poor acceptance. Another approach is the use of electrolyte-free PEG combined with 1.9 L of Gatorade. Despite its widespread use, there are no data on metabolic safety and minimal data on efficacy. Our aim was to assess the efficacy and electrolyte safety of these two PEG-based preparations. This was a prospective, randomized, single-blind, non-inferiority trial. Patients were randomized to 238 g PEG + 1.9 L Gatorade or 4 L of PEG-ELS containing 236 g PEG. Split dosing was not performed. On procedure day blood was drawn for basic chemistries. The primary outcome was preparation quality from procedure photos using the Boston Bowel Preparation Scale. We randomized 136 patients (66 PEG + Gatorade, 70 PEG-ELS). There were no differences in preparation scores between the two agents in the ITT analysis (7.2 ± 1.9 for PEG-ELS and 7.0 ± 2.1 for PEG + Gatorade; p = 0.45). BBPS scores were identical for those who completed the preparation and dietary instructions as directed (7.4 ± 1.7 for PEG-ELS, and 7.4 ± 1.8 for PEG + Gatorade; p = 0.98). There were no statistical differences in serum electrolytes between the two preparations. Patients who received PEG + Gatorade gave higher overall satisfaction scores for the preparation experience (p = 0.001), and had fewer adverse effects. Use of 238 g PEG + 1.9 L Gatorade appears to be safe, better tolerated, and non-inferior to 4 L PEG-ELS. This preparation may be especially useful for patients who previously tolerated PEG-ELS poorly.

  12. Impact of bowel preparation type on the quality of colonoscopy: a multicenter community-based study

    Directory of Open Access Journals (Sweden)

    Daniel Martin

    2016-04-01

    Full Text Available Background: High-quality bowel preparation is crucial for achieving the goals of colonoscopy. However, choosing a bowel preparation in clinical practice can be challenging because of the many formulations. This study aims to assess the impact the type of bowel preparation on the quality of colonoscopy in a community hospital setting. Methods: A retrospective, observational study was conducted utilizing a colonoscopy screening/surveillance database in central Illinois during the period of January 1, 2010, to March 31, 2014. Patients without bowel preparation assessment were excluded from this study. Controlling for the confounders, generalized linear models were used to estimate the adjusted impact [odds ratio (OR] of bowel preparation type on the quality of preparation (excellent, good, fair, and poor, and on the detection of advanced adenoma. The association between the time of withdrawal after insertion and the quality of preparation was also examined using a linear model. Results: A total of 28,368 colonoscopies; half the patients were male, and the average age was 61±9 years. Polyethylene glycol (PEG was used in the majority (70.2% of bowel preparations, followed by sodium sulfate (21.4%, sodium phosphate (2.5%, magnesium sulfate (0.4%, and others. Compared with PEG, magnesium sulfate had a poorer quality of bowel preparations (OR=0.6, 95% CI 0.4–0.9; p<0.05, whereas the quality of bowel preparation was significantly improved by using sodium sulfate (OR=5.7, 95% CI 5.4–6.1; p<0.001 and sodium phosphate (OR=2.1, 95% CI 1.8–2.5; p<0.001. For those who had adequate bowel preparation, the better quality of preparation significantly increased the detection rate of advanced adenoma (5.0, 3.6, and 2.9% for excellent, good, and fair, respectively. Conclusion: When possible, sodium sulfate–based preparations should be recommended in the community setting for colonoscopy because of their high quality of bowel preparation.

  13. Gender preference and implications for screening colonoscopy: Impact of endoscopy nurses

    Institute of Scientific and Technical Information of China (English)

    Vui Heng Chong

    2012-01-01

    AIM:To assess the gender preferences,specifically the gender of the nursing staff (endoscopy assistants) and the impact on acceptance for screening colonoscopy (SC).METHODS:Patients or relatives attending the clinics or health care workers working in a tertiarycenter were invited to participate in this questionnaire study.The questionnaire enquired on the general demographics (1) age,gender,ethnicity,education level,and employment status,previous history of colonoscopy,family or personal history of colonic pathologies,personal and family history of any cancers; (2) subjects were asked if they would go for an SC if they had appropriate indications (age over 50 years,family history of colorectal cancer (CRC),fecal occult blood positive,anemia especially iron deficiency anemia,bleeding per rectum with or without loss of appetite,weight loss and abdominal pain) with and without symptoms attributable to CRC;and (3) preferences for the gender of the endoscopists and assistants and whether they would still undergo SC even if their preferences were not met.RESULTS:Eighty-four point seven percent (470/550)completed questionnaire were analysed.More female subjects expressed gender preferences for the endoscopists [overall 70%; female (67.7%) and male (2.3%)]compared to male subjects [overall 62.8%; male (56%)and female (6.8%),P =0.102].Similarly,more female subjects expressed gender preferences for the assistants [overall 74.5%; female (73.4%) and male (1.1%)]compared to male subjects [overall 58%,male (49.3%)and female (8.7%),P < 0.001].Overall,a third would decline an SC,despite having appropriate indications,if their preferences were not met.On univariate analysis,male gender,non-Malay ethnicity (Chinese and others)and previous colonoscopy experience were more likely to undergo an SC,even if their preferences were not met (all P < 0.05).Gender and previous experience [odds ratio (OR) 1.68,95% confidence interval (CI) 1.00-2.82,P < 0

  14. Simultaneous follow-up of mouse colon lesions by colonoscopy and endoluminal ultrasound biomicroscopy

    Science.gov (United States)

    Soletti, Rossana C; Alves, Kelly Z; de Britto, Marcelo AP; de Matos, Dyanna G; Soldan, Mônica; Borges, Helena L; Machado, João C

    2013-01-01

    AIM: To evaluate the potential use of colonoscopy and endoluminal ultrasonic biomicroscopy (eUBM) to track the progression of mouse colonic lesions. METHODS: Ten mice were treated with a single azoxymethane intraperitoneal injection (week 1) followed by seven days of a dextran sulfate sodium treatment in their drinking water (week 2) to induce inflammation-associated colon tumors. eUBM was performed simultaneously with colonoscopy at weeks 13, 17-20 and 21. A 3.6-F diameter 40 MHz mini-probe catheter was used for eUBM imaging. The ultrasound mini-probe catheter was inserted into the accessory channel of a pediatric flexible bronchofiberscope, allowing simultaneous acquisition of colonoscopic and eUBM images. During image acquisition, the mice were anesthetized with isoflurane and kept in a supine position over a stainless steel heated surgical waterbed at 37 °C. Both eUBM and colonoscopic images were captured and stored when a lesion was detected by colonoscopy or when the eUBM image revealed a modified colon wall anatomy. During the procedure, the colon was irrigated with water that was injected through a flush port on the mini-probe catheter and that acted as the ultrasound coupling medium between the transducer and the colon wall. Once the acquisition of the last eUBM/colonoscopy section for each animal was completed, the colons were fixed, paraffin-embedded, and stained with hematoxylin and eosin. Colon images acquired at the first time-point for each mouse were compared with subsequent eUBM/colonoscopic images of the same sites obtained in the following acquisitions to evaluate lesion progression. RESULTS: All 10 mice had eUBM and colonoscopic images acquired at week 13 (the first time-point). Two animals died immediately after the first imaging acquisition and, consequently, only 8 mice were subjected to the second eUBM/colonoscopy imaging acquisition (at the second time-point). Due to the advanced stage of colonic tumorigenesis, 5 animals died after the

  15. High-definition colonoscopy with i-Scan: Better diagnosis for small polyps and flat adenomas

    Institute of Scientific and Technical Information of China (English)

    Pier Alberto Testoni; Chiara Notaristefano; Cristian Vailati; Milena Di Leo; Edi Viale

    2012-01-01

    AIM:To investigate if high-definition (HD) colonoscope with i-Scan gave a higher detection rate of mucosal lesions vs standard white-light instruments.METHODS:Data were collected from the computerized database of the endoscopy unit of our tertiary referral center.We retrospectively analyzed 1101 consecutive colonoscopies that were performed over 1 year with standard white-light (n =849) or HD+ with i-Scan (n =252) instruments by four endoscopists,in an outpatient setting.Colonoscopy records included patients' main details and family history for colorectal cancer,indication for colonoscopy (screening,diagnostic or surveillance),type of instrument used (standard white-light or HD+ plus i-Scan),name of endoscopist and bowel preparation.Records for each procedure included whether the cecum was reached or not and the reason for failure,complications during or immediately after the procedure,and number,size,location and characteristics of the lesions.Polyps or protruding lesions were defined as sessile or pedunculated,and nonprotruding lesions were defined according to Paris classification.For each lesion,histological diagnosis was recorded.RESULTS:Eight hundred and forty-nine colonoscopies were carried with the standard white-light video colonoscope and 252 with the HD+ plus i-Scan video colonoscope.The four endoscopists did 264,300,276 and 261 procedures,respectively; 21.6%,24.0%,21.7% and 24.1% of them with the HD+ plus i-Scan technique.There were no significant differences between the four endoscopists in either the number of procedures done or the proportions of each imaging technique used.Both techniques detected one or more mucosal lesions in 522/1101 procedures (47.4%).The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left.A significantly higher number of colonoscopies recognized lesions in the HD+ plus i-Scan mode (171/252 =67.9%) than with the standard white-light technique (408/849 =48.1%) (P < 0.0001).HD

  16. Complicações da sedação e realização da colonoscopia Complications of sedation and colonoscopy performance

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2010-09-01

    sedation/analgesic, hypertension, hypotension, hypoxia, tachycardia, bradycardia. Method: Observational, prospective and descriptive study, being accompanied by it colonoscopy of 90 patients in private clinic. One used midazolan and meperidina for the sedation. It was surveyed arterial pressure, saturation of oxygen and cardiac frequency during and immediately before and after the examination. Results: Of the examined patients, 53.3% (n=48 were men. The age average was 48,4 years. For sedation they had on average used 2,95mg of midazolan and 29,5mg of meperidina. Of the initially hypertensive ones, 11 (40.7% had remained hypertensive to the end of the examination. Saturation of lesser oxygen was observed that 90% in 16 (17.8% patient ones; bradycardia in 19 (21.1% and tachycardia in 13 (14.4%. Nauseas, vomits and abdominal pain had been alterations gifts in 11 (12.2% patient ones and had had to the preparation of the large bowel for the colonoscopy. No important complication was verified.

  17. The role of physical examinations and education in prospective medicine

    Science.gov (United States)

    Jones, W. L.; Mockbee, J.; Snow, C. K.; Compton, J. R.

    1978-01-01

    NASA's prospective medicine program, with the principal elements of physical examinations and an educational program for health awareness is described. Participation in the voluntary physical examination program is increasing. In 1976 13,621 employees were given partial or complete examination in NASA Health Units. From the 941 examinations performed at NASA Headquarters in 1976, 522 principal findings were detected. Equipment and techniques in exercise EKG, tonometry, and colonoscopy were partially responsible for this high rate. The health awareness program includes consultations with physicians, training devices and courses, health bulletins, and special screening programs. Epidemiological studies, now underway, will be used to evaluate the health awareness programs.

  18. Prediction of incomplete screening mammograms based on age and race.

    Science.gov (United States)

    Justice, Tiffany D; Stiff, Jennifer H; Myers, John A; Milam, Michael R

    2012-01-01

    This study examined the age-associated rate of incomplete mammograms requiring additional testing based on Breast Imaging-Reporting and Data System (BIRADS) score. A retrospective, observational study design from a tertiary medical center was used to evaluate which explanatory variables significantly predicted whether a woman had an incomplete mammogram. An incomplete mammogram was defined as a BIRADS score of 0 (requiring further imaging), whereas a benign process was defined as a BIRADS score of 1 or 2. Explanatory variables included traditional clinical factors (age, race, and menopausal state). During the study period, 20,269 subjects were evaluated. The majority of the patients were white (n = 12,955; 64.6%) and had a BIRADS score consistent with a benign finding (n = 17,571; 86.6%). Premenopausal state (odds ratio [OR], 1.38; 95% CI, 1.27-1.50), white race (OR, 1.18; 95% CI, 1.08-1.29), and younger age (OR, 1.38; 95% CI, 1.27-1.50) significantly increased the odds a woman had an incomplete study. In this cross-sectional, single-institution analysis, premenopausal state and white race are associated with an increased rate for incomplete mammograms. Patients should be counseled appropriately before the initiation of screening.

  19. Neighborhood Hypergraph Based Classification Algorithm for Incomplete Information System

    Directory of Open Access Journals (Sweden)

    Feng Hu

    2015-01-01

    Full Text Available The problem of classification in incomplete information system is a hot issue in intelligent information processing. Hypergraph is a new intelligent method for machine learning. However, it is hard to process the incomplete information system by the traditional hypergraph, which is due to two reasons: (1 the hyperedges are generated randomly in traditional hypergraph model; (2 the existing methods are unsuitable to deal with incomplete information system, for the sake of missing values in incomplete information system. In this paper, we propose a novel classification algorithm for incomplete information system based on hypergraph model and rough set theory. Firstly, we initialize the hypergraph. Second, we classify the training set by neighborhood hypergraph. Third, under the guidance of rough set, we replace the poor hyperedges. After that, we can obtain a good classifier. The proposed approach is tested on 15 data sets from UCI machine learning repository. Furthermore, it is compared with some existing methods, such as C4.5, SVM, NavieBayes, and KNN. The experimental results show that the proposed algorithm has better performance via Precision, Recall, AUC, and F-measure.

  20. Handling incomplete smoking history data in survival analysis.

    Science.gov (United States)

    Furukawa, Kyoji; Preston, Dale L; Misumi, Munechika; Cullings, Harry M

    2014-10-26

    While data are unavoidably missing or incomplete in most observational studies, consequences of mishandling such incompleteness in analysis are often overlooked. When time-varying information is collected irregularly and infrequently over a long period, even precisely obtained data may implicitly involve substantial incompleteness. Motivated by an analysis to quantitatively evaluate the effects of smoking and radiation on lung cancer risks among Japanese atomic-bomb survivors, we provide a unique application of multiple imputation to incompletely observed smoking histories under the assumption of missing at random. Predicting missing values for the age of smoking initiation and, given initiation, smoking intensity and cessation age, analyses can be based on complete, though partially imputed, smoking histories. A simulation study shows that multiple imputation appropriately conditioned on the outcome and other relevant variables can produce consistent estimates when data are missing at random. Our approach is particularly appealing in large cohort studies where a considerable amount of time-varying information is incomplete under a mechanism depending in a complex manner on other variables. In application to the motivating example, this approach is expected to reduce estimation bias that might be unavoidable in naive analyses, while keeping efficiency by retaining known information.

  1. Observation of incomplete fusion reactions at l < l {sub crit}

    Energy Technology Data Exchange (ETDEWEB)

    Yadav, Abhishek, E-mail: abhishekyadav117@gmail.com; Sharma, Vijay R., E-mail: abhishekyadav117@gmail.com; Singh, Devendra P., E-mail: abhishekyadav117@gmail.com; Unnati,; Singh, B. P.; Prasad, R. [Department of Physics, Aligarh Muslim University, Aligarh (UP) - 202 002 (India); Singh, Pushpendra P. [GSI-Helmholtz Centre for Heavy Ion Research GmbH, D-64291 Darmstadt (Germany); Bala, Indu; Kumar, R.; Muralithar, S.; Singh, R. P. [NP-Group: Inter-University Accelerator Center, Aruna Asaf Ali Marg, New Delhi - 110 067 (India); Sharma, M. K. [Department of Physics, S. V. College, Aligarh- 202 001 (India)

    2014-08-14

    In order to understand the presence of incomplete fusion at low energies i.e. 4-7MeV/nucleon and also to study its dependence on various entrance-channel parameters, the two type of measurements (i) excitation function for {sup 12}C+{sup 159}Tb, and (ii) forward recoil ranges for {sup 12}C+{sup 159}Tb systems have been performed. The experimentally measured excitation functions have been analyzed within the framework of compound nucleus decay using statistical model code PACE4. Analysis of data suggests the production of xn/px)n-channels via complete fusion, as these are found to be well reproduced by PACE4 predictions, while, a significant enhancement in the excitation functions of α-emitting channels has been observed over the theoretical ones, which has been attributed due to the incomplete fusion processes. Further, the incomplete fusion events observed in case of forward recoil range measurements have been explained on the basis of the breakup fusion model, where these events may be attributed to the fusion of {sup 8}Be and/or {sup 4}He from {sup 12}C projectile to the target nucleus. In the present work, the SUMRULE model calculations are found to highly underestimate the observed incomplete fusion cross-sections which indicate that the l-values lower than l {sub crit} (limit of complete fusion) significantly contribute to the incomplete fusion reactions.

  2. Magnetic resonance colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy: Patient burden and preferences

    Energy Technology Data Exchange (ETDEWEB)

    Paardt, M.P. van der, E-mail: m.p.vanderpaardt@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Boellaard, T.N., E-mail: t.n.boellaard@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Zijta, F.M., E-mail: fmzijta@yahoo.com [Department of Radiology, Medisch Centrum Haaglanden, Den Haag (Netherlands); Baak, L.C., E-mail: l.c.baak@olvg.nl [Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Depla, A.C.T.M., E-mail: actm.depla@slz.nl [Department of Gastroenterology and Hepatology, Slotervaartziekenhuis, Amsterdam (Netherlands); Dekker, E., E-mail: e.dekker@amc.uva.nl [Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Nederveen, A.J., E-mail: a.j.nederveen@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Bipat, S., E-mail: s.bipat@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands); Stoker, J., E-mail: j.stoker@amc.uva.nl [Department of Radiology, Academic Medical Center Amsterdam, Amsterdam (Netherlands)

    2015-01-15

    Highlights: • MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. • When discarding the bowel preparation, the examinations were rated equally burdensome. • The majority of patients preferred MR colonography over colonoscopy for their future examination of the bowel. - Abstract: Objectives: To evaluate patient burden and preferences for MR colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy. Methods: Symptomatic patients were consecutively recruited to undergo MR colonography with automated carbon dioxide insufflation and a limited bowel preparation followed within four weeks by colonoscopy with a standard bowel cleansing preparation. Four questionnaires regarding burden (on a five-point scale) and preferences (on a seven-point scale) were addressed after MR colonography and colonoscopy and five weeks after colonoscopy. Results: Ninety-nine patients (47 men, 52 women; mean age 62.3, SD 8.7) were included. None of the patients experienced severe or extreme burden from the MR colonography bowel preparation compared to 31.5% of the patients for the colonoscopy bowel preparation. Colonoscopy was rated more burdensome (25.6% severe or extreme burden) compared to MR colonography (5.2% severe or extreme burden) (P < 0.0001). When discarding the bowel preparations, the examinations were rated equally burdensome (P = 0.35). The majority of patients (61.4%) preferred MR colonography compared to colonoscopy (29.5%) immediately after the examinations and five weeks later (57.0% versus 39.5%). Conclusion: MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. The majority of patients preferred MR colonography over colonoscopy.

  3. Application of Oral Lactulose in Combination With Polyethylene Glycol Electrolyte Powder for Colonoscopy Bowel Preparation in Patients With Constipation.

    Science.gov (United States)

    Lu, Juan; Cao, Qin; Wang, Xiaochun; Pu, Jianbin; Peng, Xuelian

    2016-01-01

    The aim of the study was to investigate the efficacy of combined application of lactulose oral solution and polyethylene glycol electrolyte powder compared with conventional method in preparing for colonoscopy bowel cleanliness in patients with constipation. Ninety patients, who had constipation and needed to have colonoscopy, were divided into study group and control group with 45 cases in each group, respectively. One day before the colonoscopy, patients in the experimental group were given lactulose oral solution and polyethylene glycol electrolyte powder, whereas the patients in the control group were given oral polyethylene glycol electrolyte powder only. The following parameters were then obtained: time of the first defecation (duration of the time from taking the drugs to the first bowel movement), defecation frequency, completion of bowel cleaning (duration from the first bowel movement to the stool becoming clear), and adverse reaction. Cleansing effect in the study group bowel preparation was significantly better than that in the control group (P 0.05). Combined application of lactulose oral solution and polyethylene glycol electrolyte powder is superior to the conventional method of polyethylene glycol electrolyte powder alone for colonoscopy bowel preparation in patients with constipation. Therefore, combined clinical application of the 2 compounds is strongly recommended for colonoscopy bowel preparation in patients with constipation.

  4. Patient factors associated with non-attendance at colonoscopy after a positive screening faecal occult blood test.

    Science.gov (United States)

    Plumb, Andrew A; Ghanouni, Alex; Rainbow, Sandra; Djedovic, Natasha; Marshall, Sarah; Stein, Judith; Taylor, Stuart A; Halligan, Steve; Lyratzopoulos, Georgios; von Wagner, Christian

    2017-03-01

    Background Screening participants with abnormal faecal occult blood test results who do not attend further testing are at high risk of colorectal cancer, yet little is known about their reasons for non-attendance. Methods We conducted a medical record review of 170 patients from two English Bowel Cancer Screening Programme centres who had abnormal guaiac faecal occult blood test screening tests between November 2011 and April 2013 but did not undergo colonoscopy. Using information from patient records, we coded and categorized reasons for non-attendance. Results Of the 170 patients, 82 were eligible for review, of whom 66 had at least one recorded reason for lack of colonoscopy follow-up. Reasons fell into seven main categories: (i) other commitments, (ii) unwillingness to have the test, (iii) a feeling that the faecal occult blood test result was a false positive, (iv) another health issue taking priority, (v) failing to complete bowel preparation, (vi) practical barriers (e.g. lack of transport), and (vii) having had or planning colonoscopy elsewhere. The most common single reasons were unwillingness to have a colonoscopy and being away. Conclusions We identify a range of apparent reasons for colonoscopy non-attendance after a positive faecal occult blood test screening. Education regarding the interpretation of guaiac faecal occult blood test findings, offer of alternative confirmatory test options, and flexibility in the timing or location of subsequent testing might decrease non-attendance of diagnostic testing following positive faecal occult blood test.

  5. THE THEORIES OF INCOMPLETE CONTRACTS IN ANALYZING THE COMPANY

    Directory of Open Access Journals (Sweden)

    Pacala Anca

    2012-07-01

    Full Text Available Incomplete contracts theories have developed significantly in recent decades, although insistence for rigorous models left little room for empirical research. By formalizing and extending some results from other theories such as transaction costs, incomplete contracts theory tries to analyze the prudence displayed by the parties before the possible opportunistic behavior that would follow completing a contract, especially in the case of specific investments and how the insufficient contractual protection measures can lead to inefficient levels of investment. Even the name - incomplete contracts theory- suggests that the main concern is to consider the limits of contracts, that the contracts fail to specify not only the investment ex ante, but also many other unforeseen items that may appear ex post, and that would be desirable to be introduced in such an arrangement. Explanations can be either the bounded rationality or excessive cost that would involve writing of such contracts.\\r\

  6. Fast assignment reduction in inconsistent incomplete decision systems

    Institute of Scientific and Technical Information of China (English)

    Min Li; Shaobo Deng; Shengzhong Feng; Jianping Fan

    2014-01-01

    This paper focuses on fast algorithm for computing the assignment reduct in inconsistent incomplete decision systems. It is quite inconvenient to judge the assignment reduct directly ac-cording to its definition. We propose the judgment theorem for the assignment reduct in the inconsistent incomplete decision system, which greatly simplifies judging this type reduct. On such basis, we derive a novel attribute significance measure and construct the fast assignment reduction algorithm (F-ARA), intended for com-puting the assignment reduct in inconsistent incomplete decision systems. Final y, we make a comparison between F-ARA and the discernibility matrix-based method by experiments on 13 Univer-sity of California at Irvine (UCI) datasets, and the experimental results prove that F-ARA is efficient and feasible.

  7. Incomplete fuzzy data processing systems using artificial neural network

    Science.gov (United States)

    Patyra, Marek J.

    1992-01-01

    In this paper, the implementation of a fuzzy data processing system using an artificial neural network (ANN) is discussed. The binary representation of fuzzy data is assumed, where the universe of discourse is decartelized into n equal intervals. The value of a membership function is represented by a binary number. It is proposed that incomplete fuzzy data processing be performed in two stages. The first stage performs the 'retrieval' of incomplete fuzzy data, and the second stage performs the desired operation on the retrieval data. The method of incomplete fuzzy data retrieval is proposed based on the linear approximation of missing values of the membership function. The ANN implementation of the proposed system is presented. The system was computationally verified and showed a relatively small total error.

  8. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy La capnografía es superior a la pulsioximetría en la detección de depresión respiratoria durante las colonoscopias

    Directory of Open Access Journals (Sweden)

    G. Cacho

    2010-02-01

    Full Text Available Background: pulse oximetry is a widely accepted procedure for ventilatory monitoring during gastrointestinal endoscopy, but this method provides an indirect measurement of the respiratory function. In addition, detection of abnormal ventilatory activity can be delayed, especially if supplemental oxygen is provided. Capnography offers continuous real-time measurement of expiratory carbon dioxide. Objective: we aimed at prospectively examining the advantages of capnography over the standard pulse oximetry monitoring during sedated colonoscopies. Patients and methods:fifty patients undergoing colonoscopy were simultaneously monitored with pulse oximetry and capnography by using two different devices in each patient. Several sedation regimens were administered. Episodes of apnea or hypoventilation detected by capnography were compared with the occurrence of hypoxemia. Results: twenty-nine episodes of disordered respiration occurred in 16 patients (mean duration 54.4 seconds. Only 38% of apnea or hypoventilation episodes were detected by pulse oximetry. A mean delay of 38.6 seconds was observed in the events detected by pulse oximetry (two episodes of disturbed ventilation were simultaneously detected by capnography and pulse oximetry. Conclusions: apnea or hypoventilation commonly occurs during colonoscopy with sedation. Capnography is more reliable than pulse oximetry in early detection of respiratory depression in this setting.

  9. Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

    Institute of Scientific and Technical Information of China (English)

    Peter D Siersema; Amit Rastogi; Anke M Leufkens; Paul A Akerman; Kassem Azzouzi; Richard I Rothstein; Frank P Vleggaar

    2012-01-01

    AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial data.METHODS:The Third Eye(R) Retroscope(R) Randomized Clinical Evaluation (TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward view.We performed a post-hoc analysis of the TER-RACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the device.Subjects were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy (SC)and Third Eye colonoscopy (TEC),randomized to SC followed by TEC or vice versa.RESULTS:Indication for colonoscopy was screening in 176/345 subjects (51.0%),surveillance after previous polypectomy in 87 (25.2%) and diagnostic workup in 82 (23.8%).In 4 subjects no indication was specified.Previously reported overall results had shown a net additional adenoma detection rate (ADR) with TEC of 23.2% compared to SC.Relative risk (RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92 (P =0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic combined.The RR of missing adenomas with SC vs TEC was 1.11 (P =0.815) for screening,3.15 (P =0.014) for surveillance,8.64 (P =0.039) for diagnostic and 3.34(P =0.003) for surveillance and diagnostic combined.Although a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was

  10. Colonoscopy and Colorectal Cancer Screening in Adults with Intellectual and Developmental Disabilities: Review of a Series of Cases and Recommendations for Examination

    Science.gov (United States)

    Fischer, Leonard S.; Becker, Andrew; Paraguya, Maria; Chukwu, Cecilia

    2012-01-01

    Adults with intellectual and developmental disabilities (IDD) frequently have comorbidities that might interfere with colonoscopy preparation and examination. In this article, the authors review their experience with colonoscopies performed from 2002 through 2010 on adults with IDD at a state institution to evaluate quality and safety of…

  11. Colonoscopy and Colorectal Cancer Screening in Adults with Intellectual and Developmental Disabilities: Review of a Series of Cases and Recommendations for Examination

    Science.gov (United States)

    Fischer, Leonard S.; Becker, Andrew; Paraguya, Maria; Chukwu, Cecilia

    2012-01-01

    Adults with intellectual and developmental disabilities (IDD) frequently have comorbidities that might interfere with colonoscopy preparation and examination. In this article, the authors review their experience with colonoscopies performed from 2002 through 2010 on adults with IDD at a state institution to evaluate quality and safety of…

  12. Miss rate of colorectal neoplastic polyps and risk factors for missed polyps in consecutive colonoscopies.

    Science.gov (United States)

    Kim, Nam Hee; Jung, Yoon Suk; Jeong, Woo Shin; Yang, Hyo-Joon; Park, Soo-Kyung; Choi, Kyuyong; Park, Dong Il

    2017-07-01

    Colonoscopic polypectomy is the best diagnostic and therapeutic tool to detect and prevent colorectal neoplasms. However, previous studies have reported that 17% to 28% of colorectal polyps are missed during colonoscopy. We investigated the miss rate of neoplastic polyps and the factors associated with missed polyps from quality-adjusted consecutive colonoscopies. We reviewed the medical records of patients who were found to have colorectal polyps at a medical examination center of the Kangbuk Samsung Hospital between March 2012 and February 2013. Patients who were referred to a single tertiary academic medical center and underwent colonoscopic polypectomy on the same day were enrolled in our study. The odds ratios (ORs) associated with polyp-related and patient-related factors were evaluated using logistic regression analyses. A total of 463 patients and 1,294 neoplastic polyps were analyzed. The miss rates for adenomas, advanced adenomas, and carcinomas were 24.1% (312/1,294), 1.2% (15/1,294), and 0% (0/1,294), respectively. Flat/sessile-shaped adenomas (adjusted OR, 3.62; 95% confidence interval [CI], 2.40-5.46) and smaller adenomas (adjusted OR, 5.63; 95% CI, 2.84- 11.15 for ≤5 mm; adjusted OR, 3.18; 95% CI, 1.60-6.30 for 6-9 mm, respectively) were more frequently missed than pedunculated/sub-pedunculated adenomas and larger adenomas. In patients with 2 or more polyps compared with only one detected (adjusted OR, 2.37; 95% CI, 1.55-3.61 for 2-4 polyps; adjusted OR, 11.52; 95% CI, 4.61-28.79 for ≥5 polyps, respectively) during the first endoscopy, the risk of missing an additional polyp was significantly higher. One-quarter of neoplastic polyps was missed during colonoscopy. We encourage endoscopists to detect smaller and flat or sessile polyps by using the optimal withdrawal technique.

  13. Predictors of suboptimal bowel preparation in asymptomatic patients undergoing average-risk screening colonoscopy.

    Science.gov (United States)

    Govani, Shail M; Elliott, Eric E; Menees, Stacy B; Judd, Stephanie L; Saini, Sameer D; Anastassiades, Constantinos P; Urganus, Annette L; Boyce, Suzanna J; Schoenfeld, Philip S

    2016-09-16

    To identify risk factors for a suboptimal preparation among a population undergoing screening or surveillance colonoscopy. Retrospective review of the University of Michigan and Veteran's Administration (VA) Hospital records from 2009 to identify patients age 50 and older who underwent screening or surveillance procedure and had resection of polyps less than 1 cm in size and no more than 2 polyps. Patients with inflammatory bowel disease or a family history of colorectal cancer were excluded. Suboptimal procedures were defined as procedure preparations categorized as fair, poor or inadequate by the endoscopist. Multivariable logistic regression was used to identify predictors of suboptimal preparation. Of 4427 colonoscopies reviewed, 2401 met our inclusion criteria and were analyzed. Of our population, 16% had a suboptimal preparation. African Americans were 70% more likely to have a suboptimal preparation (95%CI: 1.2-2.4). Univariable analysis revealed that narcotic and tricyclic antidepressants (TCA) use, diabetes, prep type, site (VA vs non-VA), and presence of a gastroenterology (GI) fellow were associated with suboptimal prep quality. In a multivariable model controlling for gender, age, ethnicity, procedure site and presence of a GI fellow, diabetes [odds ratio (OR) = 2.3; 95%CI: 1.6-3.2], TCA use (OR = 2.5; 95%CI: 1.3-4.9), narcotic use (OR = 1.7; 95%CI: 1.2-2.5) and Miralax-Gatorade prep vs 4L polyethylene glycol 3350 (OR = 0.6; 95%CI: 0.4-0.9) were associated with a suboptimal prep quality. Diabetes, narcotics use and TCA use were identified as predictors of poor preparation in screening colonoscopies while Miralax-Gatorade preps were associated with better bowel preparation.

  14. Relationship between chronic diarrhea with normal colonoscopy findings and terminal ileum lesions

    Institute of Scientific and Technical Information of China (English)

    LI Hongling; WANG Changcheng; LIU Shuqing; XU Dongsheng; ZHANG Ju; CHEN hongmei

    2014-01-01

    Background The causes and mechanisms of chronic diarrhea are complex.This study aimed to explore the relationship between chronic diarrhea with normal colonoscopy findings and terminal ileum lesions.Methods All cases were collected from January 2009 to June 2010.The 40 patients in the patient group had chronic diarrhea with normal colonoscopy findings.Those who had hyperthyroidism,diabetes,chronic pancreatitis,cirrhosis,atrophic gastritis,short bowel syndrome and connective tissue diseases had been excluded.The control group contained 40 healthy individuals without diarrhea.Endoscopy of the terminal ileum was applied in both groups,with the endoscope inserted into terminal ileum for more than 20 cm.The patients diagnosed of chronic diarrhea with terminal ileum lesions were treated with metronidazole and probiotics for 10-14 days.Results Before treatment there were significant differences in endoscopy findings of the terminal ileum between the two groups (P <0.05).In the patient group,endoscopy showed congestion,edema,erosion and ulcers in 29 cases,hyperplasia and enlargement of lymphoid follicles in 10 cases with a maximal diameter of 7-8 mm,and 1 case showed normal endoscopy results.After treatment,35 patients recovered from diarrhea,and terminal ileum lesions disappeared in 30 cases as determined by endoscopy.In the control group,endoscopy showed scattered hyperplasia of lymphoid follicles in 5 cases,and the follicles were small with the maximal diameter being 3 mm.There was no hyperemia,edema,erosion or ulcers.Conclusions Chronic diarrhea patients with normal colonoscopy findings may have lesions in the terminal ileum that can be detected by endoscopy; including hyperemia,erosion,ulcers and lymphoid follicle hyperplasia.Therapeutic effect is good with metronidazole and probiotics.

  15. Colonoscopy Surveillance After Colorectal Cancer Resection: Recommendations of the US Multi-Society Task Force on Colorectal Cancer.

    Science.gov (United States)

    Kahi, Charles J; Boland, C Richard; Dominitz, Jason A; Giardiello, Francis M; Johnson, David A; Kaltenbach, Tonya; Lieberman, David; Levin, Theodore R; Robertson, Douglas J; Rex, Douglas K

    2016-03-01

    The US Multi-Society Task Force has developed updated recommendations to guide health care providers with the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This document is based on a critical review of the literature regarding the role of colonoscopy, flexible sigmoidoscopy, endoscopic ultrasound, fecal testing and CT colonography in this setting. The document addresses the effect of surveillance, with focus on colonoscopy, on patient survival after CRC resection, the appropriate use and timing of colonoscopy for perioperative clearing and for postoperative prevention of metachronous CRC, specific considerations for the detection of local recurrence in the case of rectal cancer, as well as the place of CT colonography and fecal tests in post-CRC surveillance.

  16. Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)

    DEFF Research Database (Denmark)

    Burnand, B; JK, Harris; Wietlisbach, V

    2006-01-01

    was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative. CONCLUSIONS: About 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic......, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications. LIMITATIONS: Although data completeness...

  17. Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

    Directory of Open Access Journals (Sweden)

    Ignacio Couto-Worner

    2013-09-01

    Full Text Available Diverticular disease is the most frequent cause of lower gastrointestinal bleeding. Most of the times, bleeding stops without any intervention but in 10-20 % of the cases it is necessary to treat the hemorrhage. Several modalities of endoscopic treatment have been described after purging the colon. We present five cases of severe diverticular bleeding treated with injection of epinephrine and hemoclips. All the colonoscopies were performed without purging of the colon in an emergency setting, with correct visualization of the point of bleeding. Patients recovered well avoiding other aggressive procedures such as angiography or surgery.

  18. Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review

    Institute of Scientific and Technical Information of China (English)

    Imran; Ashraf; Sohail; Ashraf; Sameer; Siddique; Douglas; L; Nguyen; Abhishek; Choudhary; Matthew; L; Bechtold

    2014-01-01

    AIM: To assess the role of hyoscine for polyp detectionduring colonoscopy.METHODS: Studies(randomized controlled trials orRCTs) that compared the use of hyoscine vs no hyo-scine or placebo for polyp detection during colonoscopywere included in our analysis. A search on multiple da-tabases was performed in September 2013 with searchterms being "hyoscine and colonoscopy", "hyoscineand polyp", "hyoscine and adenoma", "antispasmoticand colonoscopy", "antispasmotic and adenoma", and"antispasmotic and polyp". Jadad scoring was used toassess the quality of studies. The efficacy of hyoscinewas analyzed using Mantel-Haenszel model for polypand adenoma detection with odds ratio(OR). The I2measure of inconsistency was used to assess hetero-geneity(P < 0.05 or I2 > 50%). Statistical analysis was performed by RevMan 5.1. Funnel plots was used to assess publication bias.RESULTS: The search of the electronic databases identified 283 articles. Of these articles, eight published RCTs performed at various locations in Europe, Asia, and Australia were included in our meta-analysis, seven published as manuscripts and one published as an ab-stract(n = 2307). All the studies included patients with a hyoscine and a no hyoscine/placebo group and were of adequate quality(Jadad score ≥ 2). Eight RCTs as-sessed the polyp detection rate(PDR)(n = 2307). The use of hyoscine demonstrated no statistically significant difference as compared to no hyoscine or placebo for PDR(OR = 1.06; 95%CI: 0.89-1.25; P = 0.51). Five RCTs assessed the adenoma detection rate(ADR)(n = 2015). The use of hyoscine demonstrated no statisti-cally significant difference as compared to no hyoscine or placebo for ADR(OR = 1.12; 95%CI: 0.92-1.37; P = 0.25). Furthermore, the timing of hyoscine admin-istration(given at cecal intubation or pre-procedure) demonstrated no differences in PDR compared to no hyoscine or placebo. Publication bias or heterogeneity was not observed for any of the outcomes.CONCLUSION: Hyoscine use in

  19. Risk of developing proximal versus distal colorectal cancer after a negative colonoscopy: a population-based study.

    Science.gov (United States)

    Lakoff, Josh; Paszat, Lawrence F; Saskin, Refik; Rabeneck, Linda

    2008-10-01

    The incidence of colorectal cancer (CRC) overall is reduced for up to 10 years after a negative colonoscopy. The objective of this research was to determine the incidence of proximal and distal CRC after a negative complete colonoscopy. A cohort of Ontario residents aged 50 to 80 years who had a negative complete colonoscopy between January 1, 1992, and December 31, 1997, was identified by using linked administrative databases. Cohort members had no prior history of CRC, inflammatory bowel disease, or recent colonic resection. Each individual was followed up through December 31, 2005, and the relative rate (RR) of overall CRC, distal CRC, and proximal CRC was compared with the remaining Ontario population. A cohort of 110,402 individuals with a negative complete colonoscopy was identified. The RR of CRC overall and the RR of distal CRC remained significantly lower than the Ontario population. For example, at year 14 the RR of distal CRC was 0.21 (95% confidence interval, 0.05-0.36). The RR of proximal CRC was significantly lower than the Ontario population in half of the follow-up years, mainly after 7 years of follow-up. Over a 14-year follow-up period, negative complete colonoscopy was associated with a subsequent reduced incidence of CRC overall, and of incident CRC in the distal colon. However, the reduction in incidence of proximal CRC differed in magnitude and timing, and occurred in half the follow-up years, mainly after 7 years of follow-up. These results highlight an important limitation of colonoscopy in usual clinical practice.

  20. Quantos exames são necessários para adquirir aptidão em colonoscopia? How many procedures are necessary to achieve competency in colonoscopy?

    Directory of Open Access Journals (Sweden)

    Fernanda Prata Borges Martins Thuler

    2004-12-01

    o número de exames realizados. Dependendo, porém, de aptidões individuais, talvez mais de 100 exames sejam necessários no treinamento.BACKGROUND: Competency for colonoscopy implies technical and cognitive skills. The American Society for Gastrointestinal Endoscopy has suggested 100 supervised procedures might be necessary. There are no specific recommendations in Brazil. AIM: To evaluate technical progress of trainees during a regular colonoscopy training program. MATERIALS AND METHOD: Two gastrointestinal fellows at Federal University of São Paulo, SP, Brazil, were prospectively evaluated during first year training. The frequency and time of reaching the cecum, total procedure duration, ability to identify lesions and patient discomfort were recorded. RESULTS: Two hundred and seventy one colonoscopies were preformed by both fellows (fellow A: 186 and B: 85. Twenty-seven cases were excluded of obstructive lesions or previous surgery, leading 171 and 72 exams, respectively. The mean success rate of reaching the cecum was 82.5% and 56.9%, respectively. For the first 72 exams it was 72.2% and 56.9%. Fellow A reached the cecum in 76% of first 100 colonoscopies, improving to 91.5% after the 101st. Mean time for trainees to complete the procedure was 17.7 and 23.5 minutes to fellows A and B. Trainee A took 19.8 and 14.7 minutes before and after the 100th colonoscopy. DISCUSSION: Success rate and time taken to reach the cecum progressively improved over the number of procedures with statistical significance. However, because of individual differences, 100 colonoscopies may be insufficient to acquisition of technical skills. CONCLUSION: Although analyzing the learning curve of two fellows only, we could notice a statistically significant improve in reaching the cecum with experience over time. However, depending on individual skills more than 100 procedures may be necessary during training.

  1. Evaluation of the Danish national strategy for selective use of colonoscopy in symptomatic outpatients without known risk factors for colorectal cancer

    DEFF Research Database (Denmark)

    Bjerregaard, Niels Chr.; Tøttrup, Anders; Sørensen, Henrik Toft;

    2007-01-01

    OBJECTIVE: A diagnostic strategy implemented in Denmark in 2002 recommends selective use of colonoscopy in outpatients without known colorectal cancer (CRC) risk factors who are referred with symptoms consistent with possible CRC. Selection of patients for colonoscopy was based on the presenting...... recorded. Missed CRCs were identified by follow-up in hospital discharge registries. RESULTS: CRC was diagnosed in 126 (5.3%; 95% CI: 4.5-6.3%) of the 2361 patients included during the diagnostic work-up. Two additional cancers identified at follow-up were both missed during colonoscopy (1.5%; 95% CI: 0.......2-5.4%). The adherence to the strategy was 75.7%, and 125 of the 126 patients with a CRC were examined in conformity with the recommended strategy. Almost 60% of the patients underwent colonoscopy and almost 50% underwent both flexible sigmoidoscopy and colonoscopy. CONCLUSIONS: The diagnostic strategy is an acceptable...

  2. Incomplete Continuous-time Securities Markets with Stochastic Income Volatility

    DEFF Research Database (Denmark)

    Christensen, Peter Ove; Larsen, Kasper

    2014-01-01

    We derive closed-form solutions for the equilibrium interest rate and market price of risk processes in an incomplete continuous-time market with uncertainty generated by Brownian motions. The economy has a finite number of heterogeneous exponential utility investors, who receive partially...... equilibrium displays both lower interest rates and higher risk premia compared to the equilibrium in an otherwise identical complete market....

  3. 19 CFR 122.74 - Incomplete (pro forma) manifest.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Incomplete (pro forma) manifest. 122.74 Section 122.74 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT...; Electronic Manifest Requirements for Passengers, Crew Members, and Non-Crew Members Onboard...

  4. Pricing the Option to Surrender in Incomplete Markets

    DEFF Research Database (Denmark)

    Consiglio, Andrea; De Giovanni, Domenico

    that encompasses the most known sources of incompleteness. We show that the surrender option, joined with a wide range of claims embedded in insurance contracts, can be priced through our tool, and deliver hedging portfolios to mitigate the risk arising from their positions. We provide extensive empirical analysis...

  5. Entrance channel effect in the incomplete fusion reactions

    Directory of Open Access Journals (Sweden)

    Singh B.P.

    2011-10-01

    Full Text Available In the present work the effect of various entrance channel parameters on incomplete fusion strength and the reaction dynamics in 12C+159Tb system at energies ≈ 4-7MeV/A have been investigated by measuring the excitation functions of individual reaction channels. Experimental excitation functions have been analyzed in the framework of compound nucleus decay using statistical model code PACE4. Analysis of data suggests the production of xn/pxn-channels via complete fusion of 12C with 159Tb, as these are found to be well reproduced by PACE4 predictions, while, a significant enhancement in the excitation functions of α-emitting channels has been observed over the theoretical ones. This enhancement has been attributed due to incomplete fusion. For better insight into the underlying dynamics, fraction of incomplete fusion to the total fusion has been deduced and compared with 16O+159Tb and other nearby systems as a function of various entrance channel parameters. The fraction of incomplete fusion has been found to be sensitive to the projectile type, energy and entrance-channel mass-asymmetry.

  6. Minimal Martingale Measures for Discrete-time Incomplete Financial Markets

    Institute of Scientific and Technical Information of China (English)

    Ping Li; Jian-ming Xia

    2002-01-01

    In this note, we give a characterization of the minimal martingale measure for a general discretetime incomplete financial market. Then we concretely work out the minimal martingale measure for a specific discrete-time market model in which the assets' returns in different times are independent.

  7. Pareto Improving Price Regulation when the Asset Market is Incomplete

    NARCIS (Netherlands)

    Herings, P.J.J.; Polemarchakis, H.M.

    1999-01-01

    When the asset market is incomplete, competitive equilibria are constrained suboptimal, which provides a scope for pareto improving interventions. Price regulation can be such a pareto improving policy, even when the welfare effects of rationing are taken into account. An appealing aspect of price r

  8. Plural Form in Franchising: An Incomplete Contracting Approach

    NARCIS (Netherlands)

    G.W.J. Hendrikse (George); T. Jiang (Tao)

    2005-01-01

    textabstractPlural form franchising is modeled from an incomplete contracting perspective. Complete franchising is the unique, efficient governance structure only when the plural form externality is limited and the costs of investment are low for both franchisees. Governance structure choice is irre

  9. On the Pricing of Options in Incomplete Markets

    NARCIS (Netherlands)

    Melenberg, B.; Werker, B.J.M.

    1996-01-01

    In this paper we reconsider the pricing of options in incomplete continuous time markets.We first discuss option pricing with idiosyncratic stochastic volatility.This leads, of course, to an averaged Black-Scholes price formula.Our proof of this result uses a new formalization of idiosyncraticy whic

  10. Local model uncertainty and incomplete-data bias

    NARCIS (Netherlands)

    Copas, John; Eguchi, Shinto; Ferguson, Claire; Henderson, Neil; Onabid, Mathias; Parker, Helen; Pritchard, Gareth; Sharif, Maarya; Zhu, Ximin; Wit, Ernst; McGrory, Clare; Barry, Sarah; Fearnside, Alastair; Nguyen, The Mahn; Conte, Rossella Lo; Weir, James; Miller, James; Recchia, Angela; Wit, Ernst; Purutçuoğlu, Vilda; Wit, Ernst

    2005-01-01

    Problems of the analysis of data with incomplete observations are all too familiar in statistics. They are doubly difficult if we are also uncertain about the choice of model. We propose a general formulation for the discussion of such problems and develop approximations to the resulting bias of

  11. Consumption-Portfolio Optimization with Recursive Utility in Incomplete Markets

    DEFF Research Database (Denmark)

    Kraft, Holger; Seifried, Frank Thomas; Steffensen, Mogens

    2013-01-01

    In an incomplete market, we study the optimal consumption-portfolio decision of an investor with recursive preferences of Epstein–Zin type. Applying a classical dynamic programming approach, we formulate the associated Hamilton–Jacobi–Bellman equation and provide a suitable verification theorem...

  12. A qualitative model for temporal reasoning with incomplete information

    Energy Technology Data Exchange (ETDEWEB)

    Geffner, H. [Universidad Simon Bolivar, Caracas (Venezuela)

    1996-12-31

    We develop a qualitative framework for temporal reasoning with incomplete information that features a modeling language based on rules and a semantics based on infinitesimal probabilities. The framework relates logical and probabilistical models, and accommodates in a natural way features that have been found problematic in other models like non-determinism, action qualifications, parallel actions, and abduction to actions and fluents.

  13. The AI&M procedure for learning from incomplete data

    DEFF Research Database (Denmark)

    Jaeger, Manfred

    2006-01-01

    We investigate methods for parameter learning from incomplete data that is not missing at random. Likelihood-based methods then require the optimization of a profile likelihood that takes all possible missingness mechanisms into account. Optimizing this profile likelihood poses two main difficult...

  14. Calculating balanced incomplete block design for educational assessment

    NARCIS (Netherlands)

    van der Linden, Willem J.; Carlson, James E.

    1999-01-01

    A popular design in large scale' educational assessments is the balanced incomplete block design. The design assumes that the item pool is split into a set of blocks of items that are assigned to assessment booklets. This paper shows how the technique of 0-1 linear programming can be used to calcula

  15. Incomplete molar pregnancy with live coexisting fetus: a case report

    Directory of Open Access Journals (Sweden)

    Leila Pourali

    2014-03-01

    Conclusion: The rate of pregnancy complications such as hypertension, hyperthyroidism, and obstetrics hemorrhage and also the risk of Gestational Trophoblastic Neoplasm (GTN are increasing in incomplete molar pregnancy. Therefore, early diagnosis and timely treatment of molar pregnancy is very important to reduce maternal morbidity and mortality.

  16. Asset pricing puzzles explained by incomplete Brownian equilibria

    DEFF Research Database (Denmark)

    Christensen, Peter Ove; Larsen, Kasper

    We examine a class of Brownian based models which produce tractable incomplete equilibria. The models are based on finitely many investors with heterogeneous exponential utilities over intermediate consumption who receive partially unspanned income. The investors can trade continuously on a finit...... markets. Consequently, our model can simultaneously help explaining the risk-free rate and equity premium puzzles....

  17. Local model uncertainty and incomplete-data bias

    NARCIS (Netherlands)

    Copas, John; Eguchi, Shinto; Ferguson, Claire; Henderson, Neil; Onabid, Mathias; Parker, Helen; Pritchard, Gareth; Sharif, Maarya; Zhu, Ximin; Wit, Ernst; McGrory, Clare; Barry, Sarah; Fearnside, Alastair; Nguyen, The Mahn; Conte, Rossella Lo; Weir, James; Miller, James; Recchia, Angela; Wit, Ernst; Purutçuoğlu, Vilda; Wit, Ernst

    2005-01-01

    Problems of the analysis of data with incomplete observations are all too familiar in statistics. They are doubly difficult if we are also uncertain about the choice of model. We propose a general formulation for the discussion of such problems and develop approximations to the resulting bias of max

  18. CT brainscan in incomplete Lesch-Nyhan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Holdeigel, M.

    1987-03-01

    The CT brain scan of a 17-year-old patient with primary hyperuricaemia and mental retardation is presented. The examination demonstrates subcortical and cortical atrophy of the brain. The HGPRTase level was below normal. Clinical evidence of selfmutilation or tophi was not found. This patient's condition was interpreted as an incomplete Lesch-Nyhan syndrome.

  19. Parameter learning in MTE networks using incomplete data

    DEFF Research Database (Denmark)

    Fernández, Antonio; Langseth, Helge; Nielsen, Thomas Dyhre

    a considerable computational burden as well as the inability to handle missing values in the training data. In this paper we describe an EM-based algorithm for learning the maximum likelihood parameters of an MTE network when confronted with incomplete data. In order to overcome the computational difficulties we...

  20. 49 CFR 568.4 - Requirements for incomplete vehicle manufacturers.

    Science.gov (United States)

    2010-10-01

    ... document applies. The identification shall be by vehicle identification number (VIN) or groups of VINs to... same tire size designation may, at the option of the incomplete vehicle manufacturer, be stated as a... statement that conformity with the standard cannot be determined based upon the components supplied on the...

  1. Incomplete inversion of the hippocampus - a common developmental anomaly

    Energy Technology Data Exchange (ETDEWEB)

    Bajic, Dragan; Wang, Chen; Raininko, Raili [Uppsala University Hospital, Department of Radiology, Uppsala (Sweden); Kumlien, Eva; Mattsson, Peter [Uppsala University Hospital, Department of Neurology, Uppsala (Sweden); Lundberg, Staffan; Eeg-Olofsson, Orvar [Uppsala University Hospital, Department of Child Neurology, Uppsala (Sweden)

    2008-01-15

    Incomplete inversion of the hippocampus, an imperfect fetal development, has been described in patients with epilepsy or severe midline malformations. We studied this condition in a nonepileptic population without obvious developmental anomalies. We analyzed the coronal MR images of 50 women and 50 men who did not have epilepsy. Twenty of them were healthy volunteers and 80 were patients without obvious intracranial developmental anomalies, intracranial masses, hydrocephalus or any condition affecting the temporal lobes. If the entire hippocampus (the head could not be evaluated) were affected, the incomplete inversion was classified as total, otherwise as partial. Incomplete inversion of the hippocampus was found in 19/100 subjects (9 women, 10 men). It was unilateral, always on the left side, in 13 subjects (4 women, 9 men): 9 were of the total type, 4 were partial. It was bilateral in six subjects (five women, one man): four subjects had total types bilaterally, two had a combination of total and partial types. The collateral sulcus was vertically oriented in all subjects with a deviating hippocampal shape. We conclude that incomplete inversion of the hippocampus is not an unusual morphologic variety in a nonepileptic population without other obvious intracranial developmental anomalies. (orig.)

  2. Root cause of incomplete control rod insertions at Westinghouse reactors

    Energy Technology Data Exchange (ETDEWEB)

    Ray, S. [Westinghouse, Monroeville, PA (United States)

    1997-01-01

    Within the past year, incomplete RCCA insertions have been observed on high burnup fuel assemblies at two Westinghouse PWRs. Initial tests at the Wolf Creek site indicated that the direct cause of the incomplete insertions observed at Wolf Creek was excessive fuel assembly thimble tube distortion. Westinghouse committed to the NRC to perform a root cause analysis by the end of August, 1996. The root cause analysis process used by Westinghouse included testing at ten sites to obtain drag, growth and other characteristics of high burnup fuel assemblies. It also included testing at the Westinghouse hot cell of two of the Wolf Creek incomplete insertion assemblies. A mechanical model was developed to calculate the response of fuel assemblies when subjected to compressive loads. Detailed manufacturing reviews were conducted to determine if this was a manufacturing related issue. In addition, a review of available worldwide experience was performed. Based on the above, it was concluded that the thimble tube distortion observed on the Wolf Creek incomplete insertion assemblies was caused by unusual fuel assembly growth over and above what would typically be expected as a result of irradiation exposure. It was determined that the unusual growth component is a combination of growth due to oxide accumulation and accelerated growth, and would only be expected in high temperature plants on fuel assemblies that see long residence times and high power duties.

  3. How incomplete contracts foster innovation in inter-organizational relationships

    NARCIS (Netherlands)

    Sumo, R.; van der Valk, Wendy; van Weele, A.J.; Duijsters, Geert

    2016-01-01

    Relative to relational governance, research into the use and effects of formal governance is scarce. Recent contributions suggest that a specific type of contract that has intentionally been left incomplete, the performance-based contract (PBC), fosters innovation. However, it is unknown how this

  4. Percutaneous vascular plug for incomplete surgical left atrial appendage closure.

    Science.gov (United States)

    Levisay, Justin P; Sangodkar, Sandeep; Salinger, Michael H; Lampert, Mark; Feldman, Ted

    2014-04-01

    Surgical left atrial appendage (LAA) exclusion has a failure rate as high as 60% due to persistent residual flow in the LAA or large LAA remnants. We describe a novel technique for treatment of incomplete surgical LAA ligation, and define the mechanism that led to persistence of the remnant LAA without any thrombus formation.

  5. Improvement of wheat in Zambia using incomplete resistance against rusts

    NARCIS (Netherlands)

    Milliano, de W.A.J.

    1983-01-01

    The programme of wheat improvement developed in Zambia used local facilities (finance, personnel, infrastructure), low budget, and few personnel. Incomplete resistance against rusts was used to obtain durable resistance.
    The abiotic conditions, socio-economic status of the farmers,

  6. Processen with 'incomplete' sensitivity lists and their synthesis aspects

    NARCIS (Netherlands)

    Molenkamp, Egbert; Mekenkamp, G.E.

    1997-01-01

    Synthesis tools only support a subset of VHDL. In this paper, we focus on the synthesis aspects of processes with an incomplete sensitivity list. In general, processes with a sensitivity list are used to describe combinational logic and clocked logic. The sensitivity list is called `complete' when a

  7. Can we make the second incompleteness theorem coordinate free?

    NARCIS (Netherlands)

    Visser, A.

    2008-01-01

    Is it possible to give a coordinate free formulation of the Second Incompleteness Theorem? We pursue one possible approach to this question. We show that (i) cutfree consistency for finitely axiomatized theories can be uniquely characterized modulo EA-provable equivalence, (ii) consistency for finit

  8. Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program

    Science.gov (United States)

    Chiu, Sherry Yueh-Hsia; Chuang, Shu-Ling; Chen, Sam Li-Sheng; Yen, Amy Ming-Fang; Fann, Jean Ching-Yuan; Chang, Dun-Cheng; Lee, Yi-Chia; Wu, Ming-Shiang; Chou, Chu-Kuang; Hsu, Wen-Feng; Chiou, Shu-Ti; Chiu, Han-Mo

    2017-01-01

    Objectives Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. Design From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. Results One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (μg Hb/g faeces) (100–149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. Conclusions Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC. PMID:26515543

  9. Prevalence of synchronous colorectal neoplasms in surgically treated gastric cancer patients and significance of screening colonoscopy.

    Science.gov (United States)

    Suzuki, Akira; Koide, Naohiko; Takeuchi, Daisuke; Okumura, Motohiro; Ishizone, Satoshi; Suga, Tomoaki; Miyagawa, Shinichi

    2014-05-01

    The existence of other primary tumors during the treatment and management of gastric cancer (GC) is an important issue. The present study investigated the prevalence and management of synchronous colorectal neoplasms (CRN) in surgically treated GC patients. Of 381 surgically treated GC patients, 332 (87.1%) underwent colonoscopy to detect CRN before surgery or within a year after surgery. CRN were synchronously observed in 140 patients (42.2%). Adenoma was observed in 131 patients (39.4%). Endoscopic resection was done in 18 patients with adenoma. Colorectal cancer (CRC) was observed in 16 patients (4.8%), superficial CRC in 13 and advanced CRC in three patients. Endoscopic resection of superficial CRC was carried out in seven patients, whereas simultaneous surgical resection of CRC was done in nine patients. CRN were more frequently observed in men. CRC was more frequently observed in GC patients with distant metastasis, albeit without significance. The overall survival of GC patients with CRN or CRC was poorer than that of patients without CRN or CRC. Synchronous CRN were commonly associated with GC and screening colonoscopy should be offered to patients with GC. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  10. The Quality of Colonoscopy Reporting in Usual Practice: Are Endoscopists Reporting Key Data Elements?

    Directory of Open Access Journals (Sweden)

    S. D. Hadlock

    2016-01-01

    Full Text Available Background. High quality reporting of endoscopic procedures is critical to the implementation of colonoscopy quality assurance programs. Objective. The aim of our research was to (1 determine the quality of colonoscopy (CS reporting in “usual practice,” (2 identify factors associated with good quality reporting, and (3 compare CS reporting in open-access and non-open-access procedures. Methods. 557 CS reports were randomly selected and assigned a score based on the number of mandatory data elements included in the report. Reports documenting greater than 70% of the mandatory data elements were considered to be of good quality. Physician and procedure factors associated with good quality CS reporting were identified. Results. Variables that were consistently well documented included date of the procedure (99.6%, procedure indication (88.9%, a description of the most proximal anatomical segment reached (98.6%, and documentation of polyp location (97.8%. Approximately 79.4% of the reports were considered to be of good quality. Gastroenterology specialty, lower annual CS volume, and fewer years in practice were associated with good quality reporting. Discussion. CS reporting in usual practice in Ontario lacks quality in several areas. Almost 1 in 5 reports was of poor quality in our study. Conclusions. Targeted interventions and/or use of mandatory fields in synoptic reports should be considered to improve CS reporting.

  11. Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Hyuk Lee; Jeong Hwan Kim

    2009-01-01

    AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A ( n = 40) received a split dose of midazolam in combination with meperidine. Group B ( n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia ( P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B ( P = 0.043). Group B recovered from sedation slightly sooner than group A ( P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination ( P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B ( P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

  12. A case of severe pseudomembranous colitis diagnosed by colonoscopy after Helicobacter pylori eradication.

    Science.gov (United States)

    Sato, Satoshi; Chinda, Daisuke; Yamai, Kiyonori; Satake, Ryu; Soma, Yasushi; Shimoyama, Tadashi; Fukuda, Shinsaku

    2014-06-01

    A 65-year-old male was admitted for hemorrhagic gastric ulcer. Since anti-Helicobacter pylori-immunoglobulin G antibody tested positive, eradication therapy was administered using rabeprazole, amoxicillin, and clarithromycin. During hospitalization, colonoscopy showed normal colonic mucosa except for a polyp of the sigmoid colon. He was discharged 4 days after finishing eradication therapy, but fever up and diarrhea appeared on the following day. After re-admission, colonoscopy revealed multiple yellowish-white, small circular membranous elevations, and a diagnosis of pseudomembranous colitis was made. He was successfully treated by oral administration of vancomycin. Concomitant use of antibiotics and a proton pump inhibitor for a hospitalized patient is a risk for pseudomembranous colitis. However, H. pylori eradication therapy should be started at re-introduction of oral feeding in cases of bleeding ulcers because rebleeding can be mortal in patients in 'poor general condition'. Physicians should consider pseudomembranous colitis as a diagnosis for the patients with diarrhea and high fever following H. pylori eradication therapy.

  13. Effect of music on procedure time and sedation during colonoscopy: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Wilson WS Tam; Eliza LY Wong; Sheila F Twinn

    2008-01-01

    AIM:To integrate results from different studies in examining the effectiveness of music in reducing the procedure time and the amount of sedation used during colonoscopic procedure.METHODS:An electronic search in various databases was performed to identify related articles.Study quality was evaluated by the Jadad's scale.The random effect model was used to pool the effect from individual trials and the Cohen Q-statistic was used to determine heterogeneity.Egger's regression was used to detect publication bias.RESULTS:Eight studies with 722 subjects were included in this meta-analysis.The combined mean difference for the time taken for the colonoscopy procedure between the music and control groups was-2.84 with 95% CI (-5.61 to-0.08),implying a short time for the music group.The combined mean difference for the use of sedation was-0.46 with 95%CI (-0.91 to-0.01),showing a significant reduction in the use of sedation in the music group.Heterogeneity was observed in both analyses but no publication bias was detected.CONCLUSION:Listening to music is effective in reducing procedure time and amount of sedation during colonoscopy and should be promoted.

  14. [Splenic injury after colonoscopy: a retrospective study and review of the literature].

    Science.gov (United States)

    Benter, T; Kurz, C; Schuler, M; Vinis, E; Gottschalk, U; Koop, H

    2009-09-01

    The increasing number of preventive screening investigations in the course of obtaining early diagnosis of colon cancer, has been leading to an increase in the number of colonoscopies in Germany. Splenic injury is one of the complications to be aware of, if postinterventional abdominal symptoms occur. This retrospective study was based on the answers to questionnaires sent to 220 members of the Working Party of Leading Hospital-Based Gastroenterologists. The response rate was 40%. Thirteen of the gastroenterologists reported a total of 16 splenic injuries, a rate of about one injury per 87,000 (about 0.001 %) this compares to a worldwide published splenic injury rate of 0.004 %. But the actual numbers are probably higher in Germany as well. In order to obtain a more exact complication rate in the future, splenic injuries should be reported centrally. This is possible by sending a report of the complication by e-mail to splenicinjury_colonoscopy@web.de. Georg Thieme Verlag KG Stuttgart, New York.

  15. Analysis of YouTube~TM videos related to bowel preparation for colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Corey; Hannah; Basch; Grace; Clarke; Hillyer; Rachel; Reeves; Charles; E; Basch

    2014-01-01

    AIM: To examine YouTubeTM videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTubeTM videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis(n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often(> 19400, 59.4% vs 40.8%,P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments(> 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube? videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.

  16. Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?

    LENUS (Irish Health Repository)

    Leyden, J E

    2011-11-01

    Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups.

  17. Can the localization of primary colonic tumors be improved by staging CT without specific bowel preparation compared to optical colonoscopy?

    Energy Technology Data Exchange (ETDEWEB)

    Feuerlein, Sebastian; Grimm, Lars J.; Davenport, Matthew S.; Haystead, Clare M.; Miller, Chad M.; Neville, Amy M. [Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710 (United States); Jaffe, Tracy A., E-mail: tracy.jaffe@duke.edu [Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710 (United States)

    2012-10-15

    Objectives: To investigate the ability of staging computed tomography (CT) without bowel preparation to accurately localize colonic tumors compared to optical colonoscopy. Methods: The local institutional review board approved this retrospective and HIPAA-compliant study. Forty-six patients with colonic adenocarcinoma, preoperative colonoscopy, and staging CT within 60 days of resection were included. Patients underwent contrast enhanced CT imaging without bowel preparation or oral contrast. The colon was divided into four segments with the operative reports used as the standard. Rectal and cecal cancers were excluded. CT scans were reviewed by 5 readers in a segmental binary fashion using a 5-point confidence scale in two sessions blinded and unblinded to the colonoscopy report. Results: At surgery 49 tumors were found in 46 patients. Readers detected 86.1%, 74.3%, and 66.9% of lesions with 92.0%, 94.1%, and 95.4% accuracy for confidence scores of ≥3, ≥4, and 5. CT interobserver agreement was good (κ = 0.82) for the unblinded and moderate (κ = 0.60) for the blinded read. Colonoscopic localization was only 78.7% accurate with 2 tumors undiscovered. Colonoscopic accuracy was low in the descending colon (57.1%) and the transverse colon (55.6%). Conclusions: Preoperative staging CT is more accurate than colonoscopy in the localization of colonic tumors.

  18. Face-to-face vs telephone pre-colonoscopy consultation in colorectal cancer screening; A randomised trial

    NARCIS (Netherlands)

    E. Stoop (Esther); T.R. de Wijkerslooth (Thomas); P.M.M. Bossuyt (Patrick); J. Stoker (Jacob); P. Fockens (Paul); E.J. Kuipers (Ernst); E. Dekker (Evelien); M.E. van Leerdam (Monique)

    2012-01-01

    textabstractBackground: A pre-colonoscopy consultation in colorectal cancer (CRC) screening is necessary to assess a screenees general health status and to explain benefits and risks of screening. The first option allows for personal attention, whereas a telephone consultation does not require trave

  19. Patterns of Use of Flexible Sigmidoscopy, Colonoscopy and Gastroscopy: A Population-Based Study in a Canadian Province

    Directory of Open Access Journals (Sweden)

    Robert J Hilsden

    2004-01-01

    Full Text Available BACKGROUND & AIMS: Flexible sigmoidoscopy, colonoscopy and gastroscopy are important in the diagnosis and treatment of gastrointestinal (GI diseases. Pressure on endoscopy resources is expected due to increased screening for GI cancers. The present study examined patterns of use of GI endoscopy in a Canadian province, Alberta, with universal health care insurance.

  20. The Impact of Patient Education with a Smartphone Application on the Quality of Bowel Preparation for Screening Colonoscopy.

    Science.gov (United States)

    Cho, JeongHyeon; Lee, SeungHee; Shin, Jung A; Kim, Jeong Ho; Lee, Hong Sub

    2017-07-03

    Few studies have evaluated the use of a smartphone application (app) for educating people undergoing colonoscopy and optimizing bowel preparation. Therefore, this study was designed to develop a smartphone app for people to use as a preparation guide and to evaluate the efficacy of this app when used prior to colonoscopy. In total, 142 patients (male:female=84:58, mean age=43.5±9.3 years), who were scheduled to undergo a colonoscopy at Myongji Hospital, were enrolled in this study. Seventy-one patients were asked to use a smartphone app that we had recently developed to prepare for the colonoscopy, while the 71 patients of the sex and age-matched control group were educated via written and verbal instructions. The quality of bowel cleansing, evaluated using the Boston Bowel Preparation Scale (BBPS), was significantly higher in the smartphone app group than in the control group (7.70±1.1 vs. 7.24±0.8, respectively, p=0.007 by t-test). No significant differences were found between the two groups regarding work-up time and the number of patients with polyps. In this study, targeting young adults (≤50 years), the bowel preparation achieved by patients using the smartphone app showed significantly better quality than that of the control group.

  1. Reactions to a Targeted Intervention to Increase Fecal Occult Blood Testing among Average-Risk Adults Waiting for Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    S Elizabeth McGregor

    2011-01-01

    Full Text Available BACKGROUND: Increasing demand combined with limited capacity has resulted in long wait times for average-risk adults referred for screening colonoscopy for colorectal cancer. Management of patients on these growing wait lists is an emerging clinical issue.

  2. Classifying the Indication for Colonoscopy Procedures: A Comparison of NLP Approaches in a Diverse National Healthcare System.

    Science.gov (United States)

    Patterson, Olga V; Forbush, Tyler B; Saini, Sameer D; Moser, Stephanie E; DuVall, Scott L

    2015-01-01

    In order to measure the level of utilization of colonoscopy procedures, identifying the primary indication for the procedure is required. Colonoscopies may be utilized not only for screening, but also for diagnostic or therapeutic purposes. To determine whether a colonoscopy was performed for screening, we created a natural language processing system to identify colonoscopy reports in the electronic medical record system and extract indications for the procedure. A rule-based model and three machine-learning models were created using 2,000 manually annotated clinical notes of patients cared for in the Department of Veterans Affairs. Performance of the models was measured and compared. Analysis of the models on a test set of 1,000 documents indicates that the rule-based system performance stays fairly constant as evaluated on training and testing sets. However, the machine learning model without feature selection showed significant decrease in performance. Therefore, rule-based classification system appears to be more robust than a machine-learning system in cases when no feature selection is performed.

  3. Topological effects of data incompleteness of gene regulatory networks

    CERN Document Server

    Sanz, J; Borge-Holthoefer, J; Moreno, Y

    2012-01-01

    The topological analysis of biological networks has been a prolific topic in network science during the last decade. A persistent problem with this approach is the inherent uncertainty and noisy nature of the data. One of the cases in which this situation is more marked is that of transcriptional regulatory networks (TRNs) in bacteria. The datasets are incomplete because regulatory pathways associated to a relevant fraction of bacterial genes remain unknown. Furthermore, direction, strengths and signs of the links are sometimes unknown or simply overlooked. Finally, the experimental approaches to infer the regulations are highly heterogeneous, in a way that induces the appearance of systematic experimental-topological correlations. And yet, the quality of the available data increases constantly. In this work we capitalize on these advances to point out the influence of data (in)completeness and quality on some classical results on topological analysis of TRNs, specially regarding modularity at different level...

  4. Incomplete nonextensive statistics and the zeroth law of thermodynamics

    Institute of Scientific and Technical Information of China (English)

    Huang Zhi-Fu; Ou Cong-Jie; Chen Jin-Can

    2013-01-01

    On the basis of the entropy of incomplete statistics (IS) and the joint probability factorization condition,two controversial problems existing in IS are investigated:one is what expression of the intemal energy is reasonable for a composite system and the other is whether the traditional zeroth law of thermodynamics is suitable for IS.Some new equivalent expressions of the internal energy of a composite system are derived through accurate mathematical calculation.Moreover,a self-consistent calculation is used to expound that the zeroth law of thermodynamics is also suitable for IS,but it cannot be proven theoretically.Finally,it is pointed out that the generalized zeroth law of thermodynamics for incomplete nonextensive statistics is unnecessary and the nonextensive assumptions for the composite internal energy will lead to mathematical contradiction.

  5. Double-level Incomplete Spinal Cord Injuries: A case report

    Directory of Open Access Journals (Sweden)

    Saeed Bin Ayaz

    2014-04-01

    Full Text Available Brown-Séquard Syndrome is a type of Incomplete Spinal Cord Injury characterized by a relatively greater ipsilateral loss of proprioception and motor function, with contralateral loss of pain and temperature sensations. The residual deficits in balance produced by such injury may render a person liable to fall that may result in vertebral fracture and another injury to the spinal cord. We present here a case who initially had Brown-Séquard Syndrome due to penetrating knife injury to the neck and later on developed Cauda Equina Syndrome (another Incomplete Spinal Cord Injury due to fractured LV1 following a fall. The fracture was fixed through Pedicle Screws and the patient underwent effective rehabilitation to gain maximum achievable independence in functional activities. [Cukurova Med J 2014; 39(2.000: 392-398

  6. Extracting Backbones from Weighted Complex Networks with Incomplete Information

    Directory of Open Access Journals (Sweden)

    Liqiang Qian

    2015-01-01

    Full Text Available The backbone is the natural abstraction of a complex network, which can help people understand a networked system in a more simplified form. Traditional backbone extraction methods tend to include many outliers into the backbone. What is more, they often suffer from the computational inefficiency—the exhaustive search of all nodes or edges is often prohibitively expensive. In this paper, we propose a backbone extraction heuristic with incomplete information (BEHwII to find the backbone in a complex weighted network. First, a strict filtering rule is carefully designed to determine edges to be preserved or discarded. Second, we present a local search model to examine part of edges in an iterative way, which only relies on the local/incomplete knowledge rather than the global view of the network. Experimental results on four real-life networks demonstrate the advantage of BEHwII over the classic disparity filter method by either effectiveness or efficiency validity.

  7. Α Markov model for longitudinal studies with incomplete dichotomous outcomes.

    Science.gov (United States)

    Efthimiou, Orestis; Welton, Nicky; Samara, Myrto; Leucht, Stefan; Salanti, Georgia

    2017-03-01

    Missing outcome data constitute a serious threat to the validity and precision of inferences from randomized controlled trials. In this paper, we propose the use of a multistate Markov model for the analysis of incomplete individual patient data for a dichotomous outcome reported over a period of time. The model accounts for patients dropping out of the study and also for patients relapsing. The time of each observation is accounted for, and the model allows the estimation of time-dependent relative treatment effects. We apply our methods to data from a study comparing the effectiveness of 2 pharmacological treatments for schizophrenia. The model jointly estimates the relative efficacy and the dropout rate and also allows for a wide range of clinically interesting inferences to be made. Assumptions about the missingness mechanism and the unobserved outcomes of patients dropping out can be incorporated into the analysis. The presented method constitutes a viable candidate for analyzing longitudinal, incomplete binary data.

  8. Cooperation under Incomplete Information on the Discount Factors

    CERN Document Server

    Maor, C

    2010-01-01

    In the repeated Prisoner's Dilemma, when every player has a different discount factor, the grim-trigger strategy is an equilibrium if and only if the discount factor of each player is higher than some threshold. What happens if the players have incomplete information regarding the discount factors? In this work we look at repeated games in which each player has incomplete information regarding the other player's discount factor, and ask when a pair of grim-trigger strategies is an equilibrium. We provide necessary and sufficient conditions for such strategies to be an equilibrium. We characterize the states of the world in which the strategies are not triggered, i.e., the players cooperate, in such equilibria (or $\\epsilon$-equilibria), and ask whether these "cooperation events" are close to those in the complete information case, when the information is "almost" complete, in several senses.

  9. Data fusion techniques for incomplete measurement of trajectory

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    This paper focuses on data processing for incomplete measurementof trajectory (IMT) in aerospace mea- surement and control. The IMT means that the principal equipment loses the measured data during some intervals so that trajectory parameters (position, velocity, etc.) cannot be determined independently. Based on a joint model for trajectory estimation with reduced parameter, a fusion way is put forth by making full use of measured data from auxiliary equipment with lower precision. In the superposition intervals of measurement between principal and auxiliary equipment, the technique of diagnosing and estimating system errors is applied to improving the estimate precision of trajectory parameters (TP) and determining the precision after data fusion. In practical test, this method operates so successfully that it can not only provide complete TP but improve their precision remarkably. Meanwhile, this way is also applicable to other problems of incomplete measurement.

  10. Incomplete ossification of the atlas in dogs with cervical signs.

    Science.gov (United States)

    Warren-Smith, Christopher M R; Kneissl, Sibylle; Benigni, Livia; Kenny, Patrick J; Lamb, Christopher R

    2009-01-01

    Osseous defects affecting the atlas were identified in computed tomography and magnetic resonance images of five dogs with cervical signs including pain, ataxia, tetraparesis, or tetraplegia. Osseous defects corresponded to normal positions of sutures between the halves of the neural arch and the intercentrum, and were compatible with incomplete ossification. Alignment between the portions of the atlas appeared relatively normal in four dogs. In these dogs the bone edges were smooth and rounded with a superficial layer of relatively compact cortical bone. Displacement compatible with unstable fracture was evident in one dog. Concurrent atlantoaxial subluxation, with dorsal displacement of the axis relative to the atlas, was evident in four dogs. Three dogs received surgical treatment and two dogs were treated conservatively. All dogs improved clinically. Incomplete ossification of the atlas, which may be associated with atlantoaxial subluxation, should be considered in the differential diagnosis of dogs with clinical signs localized to the cranial cervical region.

  11. Orbito-palpebral reconstruction in two cases of incomplete cryptophthalmos.

    Science.gov (United States)

    Morax, S; Herdan, M L; Hurbli, T

    1992-01-01

    Two cases of congenital symblepharon (variant of cryptophthalmos) are reported. Cryptophthalmos is a very rare congenital defect, with incomplete or complete failure in the development of one or both eyelids with skin recovering the anterior segment. Surgical treatment is described including expansion of the conjunctival fornix with eyeball conservation if possible. At the same time or later, the upper eyelid is reconstructed by inferior eyelid flap. The ophthalmic features of cryptophthalmos and its systemic associations are reviewed.

  12. ANALYSIS OF INCOMPLETE STOCK MARKET WITH JUMP-DIFFUSION UNCERTAINTY

    Institute of Scientific and Technical Information of China (English)

    Xiuli Chao; Indrajit Bardhan

    2002-01-01

    This paper studies incomplete stock market that includes discontinuous priceprocesses. The discontinuity is modeled by very general point processes admitting onlystochastic intensities. Prices are driven by jump-diffusion uncertainty and have randombut predictable jumps. The space of risk-neutral measures that are associated with themarket is identified and related to fictitious completions. The construction of replicatingportfolios is discussed, and convex duality methods are used to prove existence of optimalconsumption and investment policies for a problem of utility maximization.

  13. Incomplete Lineage Sorting: Consistent Phylogeny Estimation From Multiple Loci

    CERN Document Server

    Mossel, Elchanan

    2008-01-01

    We introduce a simple algorithm for reconstructing phylogenies from multiple gene trees in the presence of incomplete lineage sorting, that is, when the topology of the gene trees may differ from that of the species tree. We show that our technique is statistically consistent under standard stochastic assumptions, that is, it returns the correct tree given sufficiently many unlinked loci. We also show that it can tolerate moderate estimation errors.

  14. Distributed control systems with incomplete and uncertain information

    Science.gov (United States)

    Tang, Jingpeng

    Scientific and engineering advances in wireless communication, sensors, propulsion, and other areas are rapidly making it possible to develop unmanned air vehicles (UAVs) with sophisticated capabilities. UAVs have come to the forefront as tools for airborne reconnaissance to search for, detect, and destroy enemy targets in relatively complex environments. They potentially reduce risk to human life, are cost effective, and are superior to manned aircraft for certain types of missions. It is desirable for UAVs to have a high level of intelligent autonomy to carry out mission tasks with little external supervision and control. This raises important issues involving tradeoffs between centralized control and the associated potential to optimize mission plans, and decentralized control with great robustness and the potential to adapt to changing conditions. UAV capabilities have been extended several ways through armament (e.g., Hellfire missiles on Predator UAVs), increased endurance and altitude (e.g., Global Hawk), and greater autonomy. Some known barriers to full-scale implementation of UAVs are increased communication and control requirements as well as increased platform and system complexity. One of the key problems is how UAV systems can handle incomplete and uncertain information in dynamic environments. Especially when the system is composed of heterogeneous and distributed UAVs, the overall system complexity is increased under such conditions. Presented through the use of published papers, this dissertation lays the groundwork for the study of methodologies for handling incomplete and uncertain information for distributed control systems. An agent-based simulation framework is built to investigate mathematical approaches (optimization) and emergent intelligence approaches. The first paper provides a mathematical approach for systems of UAVs to handle incomplete and uncertain information. The second paper describes an emergent intelligence approach for UAVs

  15. Probing of incomplete fusion dynamics by spin-distribution measurement

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Pushpendra P. [Accelerator Laboratory, Department of Physics, A.M. University, Aligarh (UP) 202002 (India); NP Group, Inter-University Accelerator Center, PO Box 10502, New Delhi 110067 (India)], E-mail: pushpendrapsingh@gmail.com; Singh, B.P. [Accelerator Laboratory, Department of Physics, A.M. University, Aligarh (UP) 202002 (India)], E-mail: bpsinghamu@gmail.com; Sharma, M.K.; Gupta, Unnati [Accelerator Laboratory, Department of Physics, A.M. University, Aligarh (UP) 202002 (India); Kumar, Rakesh [NP Group, Inter-University Accelerator Center, PO Box 10502, New Delhi 110067 (India); Singh, D. [Accelerator Laboratory, Department of Physics, A.M. University, Aligarh (UP) 202002 (India); Singh, R.P.; Murlithar, S. [NP Group, Inter-University Accelerator Center, PO Box 10502, New Delhi 110067 (India); Ansari, M.A.; Prasad, R. [Accelerator Laboratory, Department of Physics, A.M. University, Aligarh (UP) 202002 (India); Bhowmik, R.K. [NP Group, Inter-University Accelerator Center, PO Box 10502, New Delhi 110067 (India)], E-mail: ranjan@iuac.ernet.in

    2009-01-12

    Aiming to probe incomplete fusion dynamics in {sup 16}O + {sup 169}Tm system, spin-distributions of various reaction products populated via xn-, {alpha}/2{alpha}xn-channels have been measured at E{approx}5.6MeV/nucleon. Prompt {gamma}-rays in coincidence with fast charged particles (Z=1,2) have been recorded to achieve the information about involved reaction processes on the basis of their experimentally observed spin-populations during de-excitation. The experimentally observed spin-distributions for direct-{alpha}-emitting channels (associated with incomplete fusion) have been found to be distinctly different than that observed for fusion-evaporation (complete fusion) channels. The mean value of driving input angular momenta associated with various direct-{alpha}/2{alpha}xn-channels have been found to be higher than that observed for fusion-evaporation xn/{alpha}xn-channels, and increases with direct-{alpha}-multiplicity in forward cone. Experimentally measured, normalized production yields of fusion-evaporation xn/{alpha}xn-channels have been found to be in good agreement with the predictions of theoretical model code PACE4. Further, in order to understand the feeding probability in both complete and incomplete fusion reaction products, an attempt has been made to generate feeding intensity profiles from spin-distribution data. It has been observed that the complete fusion products are strongly fed over a broad spin range, while incomplete fusion products are found to be less fed and/or the population of lower spin states are strongly hindered.

  16. Incomplete McCune-Albright Syndrome: A Case Report

    OpenAIRE

    Nagehan Aslan

    2014-01-01

    Fibrous dysplasia of bone is a genetic, non-inheritable disease that can cause bone pain, bone deformities and fracture. It has a large clinic spectrum from benign monostotic fibrous dysplasia to McCune-Albright syndrome. Rare McCune-Albright syndrome is characterized by precocious puberty, cafe au lait spots and fibrous dysplasia. Herein we presented a case who was preferred to hospital with pathological fractures and diagnosed with Incomplet McCune Albright syndrome because of the lack of e...

  17. Cleanup delays at hazardous waste sites: an incomplete information game

    OpenAIRE

    Rausser, Gordon C.; Simon, Leo K.; Zhao, Jinhua

    1999-01-01

    This paper studies the incentives facing Potentially Responsible Parties at a hazardous waste site to promote excessive investigation of the site and thus postpone the beginning of the remediation phase of the cleanup. We model the problem as an incomplete information, simultaneous-move game between PRPs. We assume that PRP's liability shares are predetermined. Each PRP's type is its private information about the precision of its own records relating to the site. A strategy for a PRP is a fun...

  18. On the forecast of periodic events from incomplete records

    Directory of Open Access Journals (Sweden)

    Naunihal Singh

    1962-10-01

    Full Text Available In practice several natural phenomena like wind direction, death rates, egg production ,etc. follow circular normal distribution. In this paper the problem of estimating the parameters of this distribution from incomplete records has been worked out by the method of maximum likelihood. Second order partial derivatives are given to determine the standard error of the estimates. A numerical example is added to illustrate the practical application of the method.

  19. Simulated data supporting inbreeding rate estimates from incomplete pedigrees

    Science.gov (United States)

    Miller, Mark P.

    2017-01-01

    This data release includes:(1) The data from simulations used to illustrate the behavior of inbreeding rate estimators. Estimating inbreeding rates is particularly difficult for natural populations because parentage information for many individuals may be incomplete. Our analyses illustrate the behavior of a newly-described inbreeding rate estimator that outperforms previously described approaches in the scientific literature.(2) Python source code ("analytical expressions", "computer simulations", and "empricial data set") that can be used to analyze these data.

  20. UNILATERAL INCOMPLETE SUPERFICIAL PALMAR ARCH: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Subhankar Chakraborty

    2015-12-01

    Full Text Available The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA.Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA.The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side. The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.

  1. Colonoscopic polyp detection rate is stable throughout the workday including evening colonoscopy sessions [v1; ref status: indexed, http://f1000r.es/3cf

    Directory of Open Access Journals (Sweden)

    David Thurtle

    2014-05-01

    Full Text Available Objective: Polyp detection rate (PDR is an accepted measure of colonoscopy quality. Several factors may influence PDR including time of procedure and order of colonoscopy within a session. Our unit provides evening colonoscopy lists (6-9 pm. We examined whether colonoscopy performance declines in the evening. Design: Data for all National Health Service (NHS outpatient colonoscopies performed at Norfolk and Norwich University Hospital in 2011 were examined. Timing, demographics, indication and colonoscopy findings were recorded. Statistical analysis was performed using multivariate regression. Results: Data from 2576 colonoscopies were included: 1163 (45.1% in the morning, 1123 (43.6% in the afternoon and 290 (11.3% in the evening.  Overall PDR was 40.80%. Males, increasing age and successful caecal intubation were all significantly associated with higher polyp detection. The indications ‘faecal occult blood screening’ (p<0.001 and ‘polyp surveillance’ (p<0.001 were strongly positively associated and ‘anaemia’ (p=0.01 was negatively associated with PDR. Following adjustment for  covariates, there was no significant difference in PDR between sessions. With the morning as the reference value, the odds ratio for polyp detection in the afternoon and evening were 0.93 (95% CI = 0.72-1.18 and 1.15 (95%CI = 0.82-1.61 respectively. PDR was not affected by rank of colonoscopy within a list, sedation dose or trainee-involvement. Conclusions: Time of day did not affect polyp detection rate in clinical practice. Evening colonoscopy had equivalent efficacy and is an effective tool in meeting increasing demands for endoscopy. Standardisation was shown to have a considerable effect as demographics, indication and endoscopist varied substantially between sessions. Evening sessions were popular with a younger population

  2. Impact of fair bowel prep on adenoma and serrated polyp detection: Data from the New Hampshire Colonoscopy Registry using a standardized preparation quality rating

    Science.gov (United States)

    Anderson, Joseph C.; Butterly, Lynn; Robinson, Christina M.; Goodrich, Martha; Weiss, Julia E.

    2014-01-01

    Background The effect of colon preparation quality on adenoma detection rates (ADR) is unclear, partly due to lack of uniform colon preparation ratings in prior studies. The New Hampshire Colonoscopy Registry collects detailed data from colonoscopies statewide, using a uniform preparation quality scale after the endoscopist has cleaned the mucosa. Objective To compare the overall and proximal ADR and serrated polyp detection rates (SDR) in colonoscopies with differing levels of colon preparation quality. Design Cross-sectional. Setting New Hampshire statewide registry. Patients Patients undergoing colonoscopy. Interventions We examined colon preparation quality for 13,022 colonoscopies, graded using specific descriptions provided to endoscopists. ADR and SDR are the number of colonoscopies with at least one adenoma or serrated polyp (excluding those in the rectum/sigmoid) detected divided by the total number of colonoscopies, for the preparation categories: optimal (excellent/good), fair, and poor. Main outcome measurements Overall/proximal ADR/SDR. Results The overall detection rates in examinations with fair colon preparation (SDR: 8.9%; 95% CI, 7.4–10.7) (ADR: 27.1% 95% CI, 24.6–30.0) were similar to rates observed in colonoscopies with optimal preparations (SDR: 8.8%; 95% CI, 8.3–9.4) (ADR: 26.3%; 95% CI, 25.6–27.2). This finding was also observed for rates in the proximal colon. A logistic regression model (including withdrawal time) found that proximal ADR was statistically lower in the poor preparation category (odds ratio=0.45; 95% CI, 0.24–0.84; p<0.01) than in adequately prepped colons. Limitations Homogeneous population. Conclusions In our sample, there was no significant difference in overall or proximal ADR or SDR between colonoscopies with fair versus optimal colon preparations. Poor colonic preparations may reduce proximal ADR. PMID:24818550

  3. Virtual Colonoscopy

    Science.gov (United States)

    ... ray machine from taking clear images of the lining of your intestine. You may need to follow a clear liquid ... air has a small risk of perforating the lining of the large intestine. The doctor may need to treat perforation with ...

  4. Understanding Colonoscopy

    Science.gov (United States)

    ... doctor slowly advances a colonoscope through your large intestine to examine the lining. Your doctor will examine the lining again as ... entire colon to where it meets the small intestine. Although another ... (a sample of the colon lining) to be analyzed. Biopsies are used to identify ...

  5. Hallazgos extracolónicos en estudios de colonoscopía virtual Extracolonic findings in virtual colonoscopy studies

    Directory of Open Access Journals (Sweden)

    Andrés J. Quaranta

    2011-06-01

    poner a los HEC en el contexto general del paciente.Purpose. Analize the presence and type of extra-colonic findings (ECF in virtual colonoscopy (VC exams and evaluate the behavior after the diagnosis. Materials and Methods. 100 VC exams were retrospectively analyzed in search of ECF regardless of the outcome of the VC. The study population consisted of 62 women and 38 men with an average age of 63. The purpose of the exam included asymptomatic patients for screening as well as patients with apparent diagnosis of neoplasm pathology and cases which came with incomplete optical colonoscopies. The studies were carried out with a Philips Brilliance of 64 detector rows with specific protocol for VC. All patients received bowel cleansing and barium-based fecal tagging. The ECF were categorized as being of low, moderate or high importance. The findings of low or no importance are those benign alterations or those alterations that are unlikely to require further examination. Moderate importance ECF are defined as alterations that do not require immediate treatment but that will probably need investigation or treatment later. High importance ECF involve significant alterations that require surgical treatment, medical intervention or new tests in short term. Results. Out of 100 patients, 66 presented ECF. In total there were 122 ECF that were distributed as follows, 61% of low importance, 26% of moderate importance and 13% of high importance. Conclusions. Extracolonic evaluation needs to be handled with extreme care and judgement by the physician who interprets the study and also by the one who receives it. It is crucial to place ECF in the general context of the patient.

  6. Usefulness of Routine Terminal Ileoscopy and Biopsy during Colonoscopy in a Tropical Setting: A Retrospective Record-Based Study

    Directory of Open Access Journals (Sweden)

    Hasitha Srimal Wijewantha

    2014-01-01

    Full Text Available Introduction. Available evidence for routine terminal ileoscopy during colonoscopy is equivocal. We investigated the place of routine terminal ileoscopy and biopsy during colonoscopy, in a tropical setting. Materials and Methods. All consenting adults undergoing colonoscopy had routine TI and biopsy. Patients with right iliac fossa (RIF pain, diarrhoea, anaemia, suspected inflammatory bowel disease (IBD, and raised inflammatory markers were defined as Group A and all others undergoing colonoscopy as Group B. Results. Caecal intubation and TI were achieved in 988/1096 (90.15% and 832/1096 (75.9% cases, respectively. 764/832(91.8% patients were included in final analysis. 81/764 (10.6% patients had either macroscopic (34/81 or microscopic (47/81 abnormalities of terminal ileum; 20/81 had both. These were CD (28/47, tuberculosis (TB (6/47, ileitis due to resolving infection (8/47, and drug-induced ileitis (5/47. 27/81 with macroscopically normal ileum had CD (18/27, ileitis due to resolving infection (5/27 and drug-induced ileitis (4/27 on histology. 12/764 (1.57% patients with macroscopically normal colon had ileal CD (8/12, drug-induced ileitis (2/12, and resolving ileal infection (2/12 on histology. 47/764 (6.15% patients had ileal pathology that influenced subsequent management. These were significantly higher in Group A (43/555 (8% than in Group B (4/209 (1.9% (P=0.0048, χ2=7.968. Conclusion. TI and biopsy improve diagnostic yield of colonoscopy in patients with RIF pain, diarrhoea, anaemia, suspected IBD, and raised inflammatory markers.

  7. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy.

    Science.gov (United States)

    Ferlitsch, Monika; Reinhart, Karoline; Pramhas, Sibylle; Wiener, Caspar; Gal, Orsolya; Bannert, Christina; Hassler, Michaela; Kozbial, Karin; Dunkler, Daniela; Trauner, Michael; Weiss, Werner

    2011-09-28

    Although some studies have shown that men are at greater age-specific risk for advanced colorectal neoplasia than women, the age for referring patients to screening colonoscopy is independent of sex and usually recommended to be 50 years. To determine and compare the prevalence and number needed to screen (NNS) for adenomas, advanced adenomas (AAs), and colorectal carcinomas (CRCs) for different age groups in men and women. Cohort study of 44,350 participants in a national screening colonoscopy program over a 4-year period (2007 to 2010) in Austria. Prevalence and NNS of adenomas, AAs, and CRCs in different age groups for men and women. The median ages were 60.7 years (interquartile range [IQR], 54.5-67.5 years) for women and 60.6 years (IQR, 54.3-67.6 years) for men, and the sex ratio was nearly identical (51.0% [22,598] vs 49.0% [21,572]). Adenomas were found in 19.7% of individuals screened (95% CI, 19.3%-20.1%; n = 8743), AAs in 6.3% (95% CI, 6.1%-6.5%; n = 2781), and CRCs in 1.1% (95% CI, 1.0%-1.2%; n = 491); NNS were 5.1 (95% CI, 5.0-5.2), 15.9 (95% CI, 15.4-16.5), and 90.9 (95% CI, 83.3-100.0), respectively. Male sex was significantly associated with a higher prevalence of adenomas (24.9% [95% CI, 24.3%-25.4%] vs 14.8% [95% CI, 14.3%-15.2%]; P prevalence of AAs in 50- to 54-year-old individuals was 5.0% (95% CI, 4.4%-5.6%) in men but 2.9% (95% CI, 2.5%-3.4%) in women (adjusted P = .001); the NNS in men was 20 (95% CI, 17.8-22.6) vs 34 in women (95% CI, 29.1-40; adjusted P = .001). There was no statistical significance between the prevalence and NNS of AAs in men aged 45 to 49 years compared with women aged 55 to 59 years (3.8% [95% CI, 2.3%-6.1%] vs 3.9% [95% CI, 3.3%-4.5%] and 26.1 [95% CI, 16.5-44.4] vs 26 [95% CI, 22.5-30.2]; P = .99). Among a cohort of Austrian individuals undergoing screening colonoscopy, the prevalence and NNS of AAs were comparable between men aged 45 to 49 years and women aged 55 to 59 years.

  8. Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia

    Institute of Scientific and Technical Information of China (English)

    Daphnée Beaulieu; Alan Barkun; Myriam Martel

    2012-01-01

    AIM:To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable.METHtODS:Consecutive colonoscopy reports of patients at average/high risk screening,or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly,using a commercial computerized endoscopic report generator.A separate institutional database providing pathological results.Required documentation included patient demographics,history,procedure indications,technical descriptions,colonoscopy findings,interventions,unplanned events,follow-up plans,and pathology results.Reports abstraction employed a standardized glossary with 10% independent data validation.Sample size calculations determined the number of reports needed.RESULTS:Two hundreds and fifty patients (63.2 ±10.5 years,female:42.8%,average risk:38.5%,personal/family history of CRN:43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice:17.1 ± 8.5 years).Procedural indication and informed consent were always documented.14% provided a previous colonoscopy date (past polypremoval information in 25%,but insufficient in most to determine surveillance intervals appropriateness).Most procedural indicators were recorded (exam date:98.4%,medications:99.2%,difficulty level:98.8%,prep quality:99.6%).All reports noted extent of visualization (cecum:94.4%,with landmarks noted in 78.8%-photodocumentation:67.2%).No procedural times were recorded.One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%,size in 65.8%,morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare:18%,snare cautery:31.5%,unrecorded:20.7%),84.7% were retrieved.Adenomas were noted in 24.8%(advanced adenomas:7.6%,cancer:0.4%) in this population with varying previous colonic investigations.CONCLUSION:This audit reveals lacking reported items

  9. Determination of the upper and lower limits of the mechanistic stoichiometry of incompletely coupled fluxes. Stoichiometry of incompletely coupled reactions.

    Science.gov (United States)

    Beavis, A D; Lehninger, A L

    1986-07-15

    A rationale is formulated for the design of experiments to determine the upper and lower limits of the mechanistic stoichiometry of any two incompletely coupled fluxes J1 and J2. Incomplete coupling results when there is a branch at some point in the sequence of reactions or processes coupling the two fluxes. The upper limit of the mechanistic stoichiometry is given by the minimum value of dJ2/dJ1 obtained when the fluxes are systematically varied by changes in steps after the branch point. The lower limit is given by the maximum value of dJ2/dJ1 obtained when the fluxes are varied by changes in steps prior to the branch point. The rationale for determining these limits is developed from both a simple kinetic model and from a linear nonequilibrium thermodynamic treatment of coupled fluxes, using the mechanistic approach [Westerhoff, H. V. & van Dam, K. (1979) Curr. Top. Bioenerg. 9, 1-62]. The phenomenological stoichiometry, the flux ratio at level flow and the affinity ratio at static head of incompletely coupled fluxes are defined in terms of mechanistic conductances and their relationship to the mechanistic stoichiometry is discussed. From the rationale developed, experimental approaches to determine the mechanistic stoichiometry of mitochondrial oxidative phosphorylation are outlined. The principles employed do not require knowledge of the pathway or the rate of transmembrane leaks or slippage and may also be applied to analysis of the stoichiometry of other incompletely coupled systems, including vectorial H+/O and K+/O translocation coupled to mitochondrial electron transport.

  10. PROSPECTING EXPLORATION

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>20082879 Chen Yaoyu(No.3 Geology and Mineral Exploration Team,Gansu Provincial Bureau of Geology and Mineral Exploration and Development,Lanzhou 730050,China); Gong Quansheng Discussion on the Division of Deposit Scale and the Index of Ore Prospecting(Gansu Geology,ISSN 1004—4116,CN62—1191/P,16(3),2007,p.6—11,4 tables,6 refs.) Key words:prospecting and exploration of mineral

  11. [A case of gallstone ileus treated with electrohydraulic lithotripsy guided by colonoscopy].

    Science.gov (United States)

    Shin, Kyung Hwa; Kim, Dong Uk; Choi, Moon Gi; Kim, Won Jin; Ryu, Dong Yup; Lee, Bong Eun; Kim, Gwang Ha; Song, Geun Am

    2011-02-01

    A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.

  12. Morganella morganii Peritonitis Associated with Continuous Ambulatory Peritoneal Dialysis (CAPD) after Colonoscopy.

    Science.gov (United States)

    Kimura, Yukihiro; Ito, Ayano; Miyamoto, Kanyu; Suga, Norihiro; Miura, Naoto; Kasagi, Tomomichi; Yamagishi, Yuka; Mikamo, Hiroshige; Imai, Hirokazu

    2016-01-01

    A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/μL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/μL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.

  13. Social Interactions under Incomplete Information: Games, Equilibria, and Expectations

    Science.gov (United States)

    Yang, Chao

    My dissertation research investigates interactions of agents' behaviors through social networks when some information is not shared publicly, focusing on solutions to a series of challenging problems in empirical research, including heterogeneous expectations and multiple equilibria. The first chapter, "Social Interactions under Incomplete Information with Heterogeneous Expectations", extends the current literature in social interactions by devising econometric models and estimation tools with private information in not only the idiosyncratic shocks but also some exogenous covariates. For example, when analyzing peer effects in class performances, it was previously assumed that all control variables, including individual IQ and SAT scores, are known to the whole class, which is unrealistic. This chapter allows such exogenous variables to be private information and models agents' behaviors as outcomes of a Bayesian Nash Equilibrium in an incomplete information game. The distribution of equilibrium outcomes can be described by the equilibrium conditional expectations, which is unique when the parameters are within a reasonable range according to the contraction mapping theorem in function spaces. The equilibrium conditional expectations are heterogeneous in both exogenous characteristics and the private information, which makes estimation in this model more demanding than in previous ones. This problem is solved in a computationally efficient way by combining the quadrature method and the nested fixed point maximum likelihood estimation. In Monte Carlo experiments, if some exogenous characteristics are private information and the model is estimated under the mis-specified hypothesis that they are known to the public, estimates will be biased. Applying this model to municipal public spending in North Carolina, significant negative correlations between contiguous municipalities are found, showing free-riding effects. The Second chapter "A Tobit Model with Social

  14. Balloon dacryocystoplasty: Incomplete versus complete obstruction of the nasolacrimal system

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Sang Hoon; Han, Young Min; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul [Chung Ang University College of Medicine, Seoul (Korea, Republic of); Song, Ho Young [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    1993-07-15

    Balloon dilatation of nasolacrimal drainage apparatus was attempted for the treatment of stenoses or obstructures of the nasolacrimal system in 49 eyes of 41 consecutive patients with complete obstructions and 16 eyes of 14 patients with incomplete obstructions. These two groups were compared with regards to the effectiveness of balloon dacryocystoplasty. All patients suffered from severe epiphora had already undergone multiple probings. A 0.018 inch hair or ball guide wire was introduced through the superior punctum into the inferior meatus of the nasal cavity and pulled out through the nasal aperture using a hemostat under nasal endoscopy. A deflated angiography balloon catheter was then introduced in a retrograde direction and dilated under fluoroscopic control. No major complications occurred in any of the patients. At 7 days after balloon dilatation, 25 of 49 eyes with complete obstruction demonstrated improvement in epiphora (initial success rate: 51.0%) and among them 17 eyes showed complete resolution of symptoms. Reocclusion occurred in 12 of the 25 eyes with initial improvement at the 2 months follow up. For the 16 eyes with incomplete obstruction, and improvement of epiphora was attained in 11 eyes (initial success rate 68.8%): 5 of these eyes showed complete resolution of epiphora, and 3 was failed to maintain initial improvement at the 2 month follow up. Although this study demonstrate that results of balloon dacryocystoplasty are not encouraging because of the high failure and recurrence rate, balloon dacryocystoplasty is a simple and safe nonsurgical technique that can be used to treat for obstructions of the nasolacrimal system. In addition, balloon dacryocystoplasty shows better results in incomplete obstruction than in complete obstruction than complete obstruction of the nasolacrimal system.

  15. Blink rate, incomplete blinks and computer vision syndrome.

    Science.gov (United States)

    Portello, Joan K; Rosenfield, Mark; Chu, Christina A

    2013-05-01

    Computer vision syndrome (CVS), a highly prevalent condition, is frequently associated with dry eye disorders. Furthermore, a reduced blink rate has been observed during computer use. The present study examined whether post task ocular and visual symptoms are associated with either a decreased blink rate or a higher prevalence of incomplete blinks. An additional trial tested whether increasing the blink rate would reduce CVS symptoms. Subjects (N = 21) were required to perform a continuous 15-minute reading task on a desktop computer at a viewing distance of 50 cm. Subjects were videotaped during the task to determine their blink rate and amplitude. Immediately after the task, subjects completed a questionnaire regarding ocular symptoms experienced during the trial. In a second session, the blink rate was increased by means of an audible tone that sounded every 4 seconds, with subjects being instructed to blink on hearing the tone. The mean blink rate during the task without the audible tone was 11.6 blinks per minute (SD, 7.84). The percentage of blinks deemed incomplete for each subject ranged from 0.9 to 56.5%, with a mean of 16.1% (SD, 15.7). A significant positive correlation was observed between the total symptom score and the percentage of incomplete blinks during the task (p = 0.002). Furthermore, a significant negative correlation was noted between the blink score and symptoms (p = 0.035). Increasing the mean blink rate to 23.5 blinks per minute by means of the audible tone did not produce a significant change in the symptom score. Whereas CVS symptoms are associated with a reduced blink rate, the completeness of the blink may be equally significant. Because instructing a patient to increase his or her blink rate may be ineffective or impractical, actions to achieve complete corneal coverage during blinking may be more helpful in alleviating symptoms during computer operation.

  16. Information storage capacity of incompletely connected associative memories.

    Science.gov (United States)

    Bosch, Holger; Kurfess, Franz J.

    1998-07-01

    In this paper, the memory capacity of incompletely connected associative memories is investigated. First, the capacity is derived for memories with fixed parameters. Optimization of the parameters yields a maximum capacity between 0.53 and 0.69 for hetero-association and half of it for autoassociation improving previously reported results. The maximum capacity grows with increasing connectivity of the memory and requires sparse input and output patterns. Further, parameters can be chosen in such a way that the information content per pattern asymptotically approaches 1 with growing size of the memory.

  17. Incomplete McCune-Albright Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    Nagehan Aslan

    2014-08-01

    Full Text Available Fibrous dysplasia of bone is a genetic, non-inheritable disease that can cause bone pain, bone deformities and fracture. It has a large clinic spectrum from benign monostotic fibrous dysplasia to McCune-Albright syndrome. Rare McCune-Albright syndrome is characterized by precocious puberty, cafe au lait spots and fibrous dysplasia. Herein we presented a case who was preferred to hospital with pathological fractures and diagnosed with Incomplet McCune Albright syndrome because of the lack of endocrine hyperfunction and developed early puberty at clinical course.

  18. Rough Set Approach to Incomplete Multiscale Information System

    Science.gov (United States)

    Yang, Xibei; Qi, Yong; Yu, Dongjun; Yu, Hualong; Song, Xiaoning; Yang, Jingyu

    2014-01-01

    Multiscale information system is a new knowledge representation system for expressing the knowledge with different levels of granulations. In this paper, by considering the unknown values, which can be seen everywhere in real world applications, the incomplete multiscale information system is firstly investigated. The descriptor technique is employed to construct rough sets at different scales for analyzing the hierarchically structured data. The problem of unravelling decision rules at different scales is also addressed. Finally, the reduct descriptors are formulated to simplify decision rules, which can be derived from different scales. Some numerical examples are employed to substantiate the conceptual arguments. PMID:25276852

  19. Incomplete block SSOR preconditionings for high order discretizations

    Energy Technology Data Exchange (ETDEWEB)

    Kolotilina, L. [Steklov Mathematical Institute, St. Petersburg (Russian Federation)

    1994-12-31

    This paper considers the solution of linear algebraic systems Ax = b resulting from the p-version of the Finite Element Method (FEM) using PCG iterations. Contrary to the h-version, the p-version ensures the desired accuracy of a discretization not by refining an original finite element mesh but by introducing higher degree polynomials as additional basis functions which permits to reduce the size of the resulting linear system as compared with the h-version. The suggested preconditionings are the so-called Incomplete Block SSOR (IBSSOR) preconditionings.

  20. Uniform Asymptotic Expansion for the Incomplete Beta Function

    Science.gov (United States)

    Nemes, Gergő; Olde Daalhuis, Adri B.

    2016-10-01

    In [Temme N.M., Special functions. An introduction to the classical functions of mathematical physics, A Wiley-Interscience Publication, John Wiley & Sons, Inc., New York, 1996, Section 11.3.3.1] a uniform asymptotic expansion for the incomplete beta function was derived. It was not obvious from those results that the expansion is actually an asymptotic expansion. We derive a remainder estimate that clearly shows that the result indeed has an asymptotic property, and we also give a recurrence relation for the coefficients.