ABSTRACT
Arsenic transport in alluvial aquifers is usually constrained due to arsenic adsorption on iron oxides. In karstic aquifers, however, arsenic contamination may spread to further extensions mainly due to favorable hydrogeochemical conditions. In this study, we i) determined the spatial and temporal behavior of arsenic in water in an alluvial-karstic geological setting using field and literature data, ii) established whether a contaminated aquifer exists using field and literature piezometric data and geophysical analysis, iii) studied the local geology and associated arsenic contaminated water sources to specific aquifers, iv) revealed and modeled subsoil stratigraphy, and v) established the extent of arsenic exposure to the population. We found arsenic contamination (up to 91.51 mg/l) in surface and shallow groundwater (<15 m), where water flows from west to east through a shallow aquifer, paleochannels and a qanat within an alluvial-karst transition that favors the spreading and transport of arsenic along 8 km as well as the increase of arsenic exposure to the population (up to 3.6 mgAs/kghair). Results from this study contribute to understanding arsenic transport in semi-arid, mining-metallurgical, and urban environments, where the presence of karst could favor arsenic transport to remote places and exacerbate arsenic exposure and impact in the future.
ABSTRACT
Enmarcado dentro del proyecto "Indicadores de calidad en endoscopia digestiva", liderado por la Sociedad Española de Patología Digestiva (SEPD), el objetivo de esta investigación es proponer los procedimientos e indicadores de estructura, proceso y resultado necesarios para aplicar y evaluar la calidad en la gastroscopia. Primero, se ha diseñado un diagrama con los pasos a seguir durante el procedimiento de gastroscopia. En segundo lugar, un grupo de expertos en calidad asistencial y/o endoscopia han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos, incluidas las gastroscopias. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y el análisis de la literatura seleccionada. Se ha identificado para gastroscopias un total de nueve indicadores de procesos (uno de preprocedimiento y ocho de procedimiento). La calidad de la evidencia se ha analizado aplicando la escala de clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)
Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale
Subject(s)
Humans , Gastroscopy/statistics & numerical data , Quality of Health Care/classification , Quality Indicators, Health Care/classification , Colonoscopy/statistics & numerical data , Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Gastroscopy/methods , Quality Improvement/trendsABSTRACT
Within the project "Quality indicators in digestive endoscopy", pioneered by the Spanish Society for Digestive Diseases (SEPD), the objective of this research is to suggest the structure, process, and results procedures and indicators necessary to implement and assess quality in the gastroscopy setting. First, a chart was designed with the steps to be followed during a gastroscopy procedure. Secondly, a team of experts in care quality and/or endoscopy performed a qualitative review of the literature searching for quality indicators for endoscopic procedures, including gastroscopies. Finally, using a paired analysis approach, a selection of the literature obtained was undertaken. For gastroscopy, a total of nine process indicators were identified (one preprocedure, eight intraprocedure). Evidence quality was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification scale.
Subject(s)
Duodenoscopy/standards , Gastroscopy/standards , Quality Indicators, Health Care , Duodenoscopy/methods , Endoscopy, Gastrointestinal/standards , Esophagoscopy/methods , Esophagoscopy/standards , Gastroscopy/methods , Humans , Quality ImprovementABSTRACT
El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de endoscopia digestiva. En este tercer resultado se proponen procedimientos e indicadores de la colangiopancreatografía retrógrada endoscópica (CPRE). Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la CPRE. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), ha realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la CPRE. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de seis indicadores específicos, independientemente de los ya descritos comunes, todos de proceso (dos de preprocedimiento y cuatro de procedimiento). Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en Grading of Recommendations Assessment, Development and Evaluation) GRADE
The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification
Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde/methods , Quality of Health Care/statistics & numerical data , Digestive System Diseases/diagnostic imaging , Quality Indicators, Health Care/statistics & numerical data , Peer Review, Health Care , Reproducibility of Results , Reproducibility of Results , Antibiotic Prophylaxis/methodsABSTRACT
The goal of the project encompassing the present paper is to propose useful quality procedures and indicators in order to improve quality in digestive endoscopy units. In this third part outcome procedures and indicators are suggested for endoscopic retrograde cholangiopancreatography (ERCP). First, a diagram of pre- and post-ERCP steps was developed. A group of experts in healthcare quality and/or endoscopy, under the shelter of the Spanish Society of Digestive Diseases (Sociedad Española de Patología Digestiva - SEPD), carried out a qualitative review of the literature regarding quality indicators for ERCP. Then, a paired analysis was used for the selection of identified references. A total of six specific indicators, apart from the common indicators already described, were identified, all of them process indicators (two pre-procedure and four post-procedure). Evidence quality was analyzed for each indicator using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/standards , Quality Improvement , Quality Indicators, Health Care , Decision Trees , HumansABSTRACT
El objetivo del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este segundo resultado se proponen procedimientos e indicadores de la colonoscopia. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la colonoscopia. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva (SEPD), han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en la colonoscopia. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se han identificado un total de 13 indicadores específicos, independientemente de los ya descritos comunes, de los cuales diez son de proceso (uno de preprocedimiento, siete de procedimiento y dos de posprocedimiento) y tres, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation)
The aim of the project this paper is part of was to propose quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. In this second issue, procedures and indicators are suggested regarding colonoscopy. First, a diagram charting the previous and subsequent steps of colonoscopy was designed. A group of experts in health care quality and/or endoscopy, under the auspices of the Sociedad Española de Patología Digestiva (SEPD), performed a qualitative review of the literature regarding colonoscopy-related quality indicators. Subsequently, using a paired-analysis method, the aforementioned literature was selected and analyzed. A total of 13 specific indicators were found aside of the common markers elsewhere described, ten of which are process-related (one pre-procedure, seven procedure, and two post-procedure markers) while the remaining three are outcome-related. Quality of evidence was assessed for each one of them using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) classification
Subject(s)
Humans , Colonoscopy/methods , Colonoscopy/standards , Quality Indicators, Health Care/standards , Quality Improvement , Hospital Units/organization & administrationABSTRACT
Georatusin (1), featuring a highly reduced, methylated polyketide moiety fused to a tryptophan by an amide and ester bond forming a 13-membered ring, was produced by the soil fungus Geomyces auratus. An HMQC-COSY spectrum was measured to build up the connectivities despite the overlapping proton signals. DQF-COSY, HETLOC, J-HMBC, and ROESY were implemented to determine the relative configuration of the flexible moiety. Georatusin (1) shows specific antiparasitic activities against Leishmania donovani and Plasmodium falciparum without obvious cytotoxicity. The biosynthesis of 1 was also proposed.
Subject(s)
Ascomycota , Antiparasitic Agents , Molecular Structure , Peptides , PolyketidesABSTRACT
El objetivo general del proyecto en el que se inscribe este trabajo es proponer procedimientos e indicadores de calidad y seguridad útiles para facilitar la mejora de la calidad en unidades de Endoscopia Digestiva. En este primer resultado se proponen procedimientos e indicadores comunes a las pruebas de endoscopia digestiva. Primero, se ha diseñado un diagrama de los pasos previos y consecutivos a la realización de la endoscopia digestiva. Un grupo de expertos en calidad asistencial y/o endoscopia, bajo el amparo de la Sociedad Española de Patología Digestiva, han realizado una revisión cualitativa de la literatura haciendo referencia a la búsqueda de indicadores de calidad en los procedimientos endoscópicos. Posteriormente, por un procedimiento de análisis por pares se ha hecho la selección y análisis de la literatura seleccionada. Se ha identificado un total de 20 indicadores, de los cuales siete son de estructura; once, de proceso (cinco de preprocedimiento, tres de procedimiento y tres de posprocedimiento); y dos, de resultado. Se ha analizado la calidad de la evidencia de cada uno de ellos aplicando la clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) (AU)
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification (AU)
Subject(s)
Humans , Endoscopy, Digestive System/instrumentation , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/statistics & numerical data , Quality Indicators, Health Care/statistics & numerical data , Digestive System , Projects , Colonoscopy/methods , Patient-Centered Care , Conscious Sedation/trendsABSTRACT
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.
Subject(s)
Endoscopy, Digestive System/standards , Digestive System Diseases/diagnostic imaging , Humans , Quality Indicators, Health CareABSTRACT
INTRODUCTION: Iron deficiency is a common cause of anaemia in non-dialysis chronic kidney disease (ND-CKD). Controversies exist about the optimal route of administration for iron therapy. Liposomal iron, a new generation oral iron with high gastrointestinal absorption and bioavailability and a low incidence of side effects, seems to be a promising new strategy of iron replacement. Therefore, we conducted a study to determine whether liposomal iron, compared with intravenous (IV) iron, improves anaemia in ND-CKD patients. METHODS: In this randomized, open-label trial, 99 patients with CKD (stage 3-5, not on dialysis) and iron deficiency anaemia [haemoglobin (Hb) ≤12 g/dL, ferritin ≤100 ng/mL, transferrin saturation ≤25%] were assigned (2:1) to receive oral liposomal iron (30 mg/day, Group OS) or a total dose of 1000 mg of IV iron gluconate (125 mg infused weekly) (Group IV) for 3 months. The patients were followed-up for the treatment period and 1 month after drug withdrawal. The primary end point was to evaluate the effects of the two treatments on Hb levels; the iron status, compliance and adverse effects were also evaluated. RESULTS: The short-term therapy with IV iron produced a more rapid Hb increase compared with liposomal iron, although the final increase in Hb was similar with either treatment; the difference between the groups was statistically significant at the first month and such difference disappeared at the end of treatment. After iron withdrawal, Hb concentrations remained stable in Group IV, while recovered to baseline in the OS group. The replenishment of iron stores was greater in the IV group. The incidence of adverse event was significantly lower in the oral group (P < 0.001), and the adherence was similar in the two groups. CONCLUSIONS: Our study shows that oral liposomal iron is a safe and efficacious alternative to IV iron gluconate to correct anaemia in ND-CKD patients, although its effects on repletion of iron stores and on stability of Hb after drug discontinuation are lower.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Gluconates/administration & dosage , Iron Compounds/administration & dosage , Liposomes/administration & dosage , Renal Insufficiency, Chronic/complications , Administration, Intravenous , Administration, Oral , Anemia, Iron-Deficiency/etiology , Female , Humans , Male , Middle AgedABSTRACT
Iron supplementation is essential for the treatment of anemia in the chronic kidney disease (CKD) population. Liposomial iron is a preparation of ferric pyrophosphate carried within a phospholipidic membrane. Compared to other oral formulations, it is well absorbed from the gut and demonstrates high bioavailability together with a lower incidence of side effects. The aim of our study was to evaluate the effectiveness of treatment with liposomial iron compared to intravenous iron in a CKD population with anemia and iron deficiency. Our study is a single-center, prospective, randomized, fourth-phase study. Enrollment for the study began in October 2011 and CKD 3, 4 and 5 patients were randomized to receive either intravenous iron or liposomial iron in a 1:2 ratio. The primary outcome was set as the increase of hemoglobin from baseline. The secondary outcomes were the reduction of erythropoietin dosage by at least 25% in patients treated with erythropoiesis-stimulating agents and an increase in serum ferritin of 100 ng/ml from baseline values. In the preliminary study, 21 patients were analyzed, 14 of whom were treated with oral liposomial iron and 7 with intravenous iron. The observed increase of hemoglobin at 8 weeks compared to baseline was similar in both groups but was significant in the liposomial group only.
Subject(s)
Anemia, Iron-Deficiency/drug therapy , Diphosphates/administration & dosage , Iron/administration & dosage , Administration, Intravenous , Anemia, Iron-Deficiency/etiology , Female , Humans , Liposomes , Male , Middle Aged , Prospective Studies , Renal Insufficiency, Chronic/complicationsABSTRACT
Fundamento y objetivos: Antes de iniciar programas de cribado de cáncer colorrectal es necesario evaluar la calidad de la colonoscopia. Nos propusimos desarrollar un grupo de indicadores de calidad en colonoscopia fácilmente aplicables y determinar la variabilidad de su cumplimiento. Pacientes y método: A partir de la bibliografía se elaboraron 21 indicadores potenciales de calidad que se sometieron a un proceso de selección en el que se determinó su validez facial, de contenido, fiabilidad y viabilidad de su medición. Se estimó la variabilidad del cumplimiento de los indicadores mediante el coeficiente de variación (CV) y del cumplimiento de estándares mediante la ji al cuadrado. Resultados: Seis indicadores superaron el proceso de selección: consentimiento informado, medicación administrada, colonoscopia completa, complicaciones, pólipos extirpados y recuperados y detección de adenomas de colon en mayores de 50 años. Se incluyeron un total de 1.928 colonoscopias procedentes de 8 centros hospitalarios. Cada centro incluyó el mismo número de colonoscopias seleccionadas mediante muestreo aleatorizado simple con sustitución. Existía una importante variabilidad en el cumplimiento de algunos indicadores y estándares: medicación administrada (CV del 43%; p<0,01), registro de complicaciones (CV del 37%; p<0,01), todos los pólipos extirpados y recuperados (CV del 12%; p<0,01) y detección de adenomas en pacientes de más de 50 años (CV del 2%; p<0,01).Conclusiones: Hemos validado 6 indicadores de calidad en colonoscopia fácilmente medibles. Existe una importante variabilidad en el cumplimiento de algunos indicadores y estándares, lo que aconseja el desarrollo de programas de mejora de la calidad en colonoscopia antes de la implantación del cribado de cáncer colorrectal (AU)
Background and objectives: Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. Patients and methods: After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of ÷2. Results: Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). Conclusions: We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening (AU)
Subject(s)
Humans , Colonoscopy/standards , Colorectal Neoplasms/diagnosis , Reproducibility of Results , Quality Indicators, Health CareABSTRACT
BACKGROUND AND OBJECTIVES: Before starting programs for colorectal cancer screening it is necessary to evaluate the quality of colonoscopy. Our objectives were to develop a group of quality indicators of colonoscopy easily applicable and to determine the variability of their achievement. PATIENTS AND METHODS: After reviewing the bibliography we prepared 21 potential indicators of quality that were submitted to a process of selection in which we measured their facial validity, content validity, reliability and viability of their measurement. We estimated the variability of their achievement by means of the coefficient of variability (CV) and the variability of the achievement of the standards by means of chi(2). RESULTS: Six indicators overcome the selection process: informed consent, medication administered, completed colonoscopy, complications, every polyp removed and recovered, and adenoma detection rate in patients older than 50 years. 1928 colonoscopies were included from eight endoscopy units. Every unit included the same number of colonoscopies selected by means of simple random sampling with substitution. There was an important variability in the achievement of some indicators and standards: medication administered (CV 43%, p<0.01), complications registered (CV 37%, p<0.01), every polyp removed and recovered (CV 12%, p<0.01) and adenoma detection rate in older than fifty years (CV 2%, p<0.01). CONCLUSIONS: We have validated six quality indicators for colonoscopy which are easily measurable. An important variability exists in the achievement of some indicators and standards. Our data highlight the importance of the development of continuous quality improvement programmes for colonoscopy before starting colorectal cancer screening.
Subject(s)
Colonoscopy/standards , Quality Indicators, Health Care , Humans , Reproducibility of ResultsABSTRACT
INTRODUCTION: Gastrointestinal endoscopy causes discomfort and pain in patients. Sedation reduces anxiety and pain. Its use, however, continues to be a controversial issue and it varies greatly from one country to another. The use of sedation in Spanish gastrointestinal endoscopy (GIE) units is unknown. AIM: To determine the use of sedation in Spanish GIE units. MATERIALS AND METHODS: A 24-question survey on the use of sedation was distributed among 300 Spanish GIE units. RESULTS: Surveys were answered by 197 GIE units (65%), which had performed 588,326 endoscopies over the past 12 months. Sedation was used in more than 20% of gastroscopies performed at 55% of the GIE units, and more than 20% of colonoscopies were sedated at 71% of the units; endoscopic retrograde cholangiopancreatography (ERCP) is almost always performed under sedation. The most common drugs were midazolam for gastroscopy and midazolam and pethidine for colonoscopy and ERCP; propofol is used by anesthetists; pulse oximetry is used at 77% of GIE units; 42% of the GIE units fill in a nursing record; 52% of GIE units have recovery rooms and 91% have a cardiac arrest trolley. CONCLUSION: The use of sedation in endoscopy varies greatly in Spain. It is seldom used in gastroscopy; it is more frequent in colonoscopy, and in ERCP it is the norm. In most GIE units sedation is controlled by the endoscopist with pulse oximetry. The most commonly used drugs are benzodiazepines, on their own for gastroscopy and combined with opioids for colonoscopy and ERCP.
Subject(s)
Anesthesia/statistics & numerical data , Conscious Sedation/statistics & numerical data , Endoscopy, Gastrointestinal/methods , Anesthesia/methods , Conscious Sedation/methods , Endoscopy, Gastrointestinal/adverse effects , Hospital Units/statistics & numerical data , Humans , Hypnotics and Sedatives , Meperidine , Midazolam , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Propofol , SpainABSTRACT
BACKGROUND AND AIM: The aim of this study was to determine the main quality problems perceived by patients in gastrointestinal endoscopy through a satisfaction survey. PATIENTS AND METHODS: A total of 321 patients from five gastrointestinal endoscopy units were included. Telephone interviews using a previously validated questionnaire on several aspects related to the procedure were carried out. Pareto analyses were performed to pinpoint the most common aspects among the vital few causes at each medical center. Based on the questionnaire, the satisfaction indicators were calculated for each center: the overall satisfaction score (the sum of the responses to the eight questions) and the rate of perceived problems (number of questions with a negative response divided by the number of questions asked). RESULTS: The most frequent aspects among the vital few were waiting time for an appointment and discomfort during the examination, since both factors were included in the vital few in four of the five medical centers. Significant differences were found among centers in the overall satisfaction score (questionnaire score) (p < 0.001) and for the rate of perceived problems (p < 0.001). CONCLUSION: According to the patients, the most problematic aspects were waiting time until the day of the appointment and discomfort during the examination. Perceived quality differed among the participating centers.
Subject(s)
Endoscopy, Gastrointestinal/psychology , Patient Satisfaction/statistics & numerical data , Adult , Aged , Colonoscopy/adverse effects , Colonoscopy/psychology , Colonoscopy/statistics & numerical data , Endoscopy, Gastrointestinal/adverse effects , Endoscopy, Gastrointestinal/statistics & numerical data , Female , Gastroscopy/adverse effects , Gastroscopy/psychology , Gastroscopy/statistics & numerical data , Hospitals, Public , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Pain/etiology , Pain/psychology , Sampling Studies , Spain , Surveys and Questionnaires , Waiting ListsABSTRACT
BACKGROUND/AIMS: To assess the achievement of quality standards of colonoscopy at six endoscopy units. METHODOLOGY: Three indicators were used to assess the quality of 1056 colonoscopies performed at six hospitals: cecal intubation; adequate colon cleansing; and removal and recovery of all detected polyps. Analyses were performed on the total number of colonoscopies and on colonoscopies in which polyps were actually detected. The accomplishment of each indicator and a global compound index of all three indicators, named the Problem Rate, were analyzed. Results from each endoscopy unit were compared to previously established standards. RESULTS: Adequate colon cleansing was the most frequent problem for quality in all centers; adequate colon preparation was 67% (range 50 to 84%). The cecum was reached in 84% of all colonoscopies (range 76 to 90%). 75% of all patients (range 28. 79%) had all polyps excised and recovered. All centers had rates below standard for one or several indicators (p<0.01, all cases). Two of the participant hospitals had an overall problem rate above the estimated standard (p<0.01). CONCLUSIONS: There is a significant variation in the achievement of quality standards of colonoscopy between endoscopy units. Colon cleansing is the most frequent quality problem for colonoscopy.
Subject(s)
Colonoscopy/standards , Adult , Aged , Colonic Polyps/surgery , Female , Humans , Male , Middle Aged , Quality Assurance, Health CareABSTRACT
FUNDAMENTO Y OBJETIVO: El objetivo de nuestro trabajo fuedeterminar los principales problemas de calidad desde elpunto de vista del paciente en la endoscopia digestiva medianteun cuestionario de satisfacción.PACIENTES Y MÉTODOS: Cinco unidades de endoscopia digestivaincluyeron a un total de 321 pacientes. Se realizó unaencuesta telefónica sobre diversos aspectos relacionados conla prueba utilizando un cuestionario previamente validado.Se realizó un análisis de Pareto para cada centro para averiguarcuáles eran los aspectos más representados entre lospoco vitales. A partir del cuestionario se calcularon dos indicadoresde satisfacción para cada centro: la puntuación globalde satisfacción (suma de los valores de las respuestas alas 8 cuestiones) y la tasa de problemas percibidos (númerode preguntas con respuesta negativa dividido por el númerode preguntas realizadas).RESULTADOS: Los aspectos más representados en los poco vitalesfueron el tiempo de espera para la cita y las molestiasdurante la exploración, pues ambos aparecían en los pocovitales de 4 de los 5 centros. Había diferencias significativasentre los centros para la puntuación global de satisfacción(puntuación del cuestionario) (p < 0,001) y para la tasa deproblemas percibidos (p < 0,001).CONCLUSIÓN: Los aspectos más problemáticos desde el puntode vista de los pacientes son el tiempo de espera hasta el díade la cita y las molestias durante la exploración. Hay diferenciasen la calidad percibida entre los centros participantes
BACKGROUND AND AIM: The aim of this study was to determinethe main quality problems perceived by patients in gastrointestinalendoscopy through a satisfaction survey.PATIENTS AND METHODS: A total of 321 patients from fivegastrointestinal endoscopy units were included. Telephoneinterviews using a previously validated questionnaire on severalaspects related to the procedure were carried out. Paretoanalyses were performed to pinpoint the most commonaspects among the vital few causes at each medical center.Based on the questionnaire, the satisfaction indicators werecalculated for each center: the overall satisfaction score (thesum of the responses to the eight questions) and the rate ofperceived problems (number of questions with a negativeresponse divided by the number of questions asked).RESULTS: The most frequent aspects among the vital fewwere waiting time for an appointment and discomfort duringthe examination, since both factors were included in thevital few in four of the five medical centers. Significant differenceswere found among centers in the overall satisfactionscore (questionnaire score) (p < 0.001) and for the rate ofperceived problems (p < 0.001).CONCLUSION: According to the patients, the most problematicaspects were waiting time until the day of the appointmentand discomfort during the examination. Perceivedquality differed among the participating centers
Subject(s)
Humans , Endoscopy, Gastrointestinal/statistics & numerical data , Patient Satisfaction , Waiting Lists , Quality of Health Care , Quality of Health Care , Health Care Surveys/statistics & numerical data , Gastrointestinal Diseases/diagnosisABSTRACT
BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentage of venous blood bypasses the lung filter and may increase these substances in blood. PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patients previously attended for detection of RLS with transcranial Doppler ultrasound. The presence and grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS. RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for other FGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p < 0.05 for other FGD). CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies.
Subject(s)
Foramen Ovale, Patent/complications , Irritable Bowel Syndrome/complications , Cross-Sectional Studies , Female , Foramen Ovale, Patent/physiopathology , Humans , Male , Middle AgedABSTRACT
FUNDAMENTO Y OBJETIVO: El síndrome de intestino irritable (SII) y el foramen oval permeable(FOP) tienen una prevalencia similar en la población general, afectan más a mujeres y se relacionancon otras enfermedades como la migraña. La presencia de FOP con cortocircuito (shunt) derecha izquierda (CDI) podría alterar el metabolismo de ciertas sustancias como la serotonina, muy relacionadas con el SII. Sin embargo, hasta la fecha no se ha estudiado la posibleasociación entre ambas entidades.PACIENTES Y MÉTODO: Se ha realizado una encuesta telefónica para determinar la presencia de SII enpacientes atendidos previamente para detección de CDI mediante ultrasonografía Doppler transcraneal.Se analizó la presencia y el grado de CDI y se los comparó con los de sujetos sin síntomas gastrointestinales (NoGI). Se utilizaron los criterios de Roma II para el diagnóstico de SII u otra enfermedad funcional gastrointestinal (EFGI), y el consenso de Venecia-1999 para el CDI.RESULTADOS: De 180 pacientes encuestados, 33 (18,3%) tenían SII y 62 (34,4%), otra EFGI.Tenían CDI un 41% de los NoGI, un 64% de los pacientes con SII y un 68% de los pacientes con otra EFGI (odds ratio [OR] = 2,56; p < 0,05 para SII, y OR = 3,06; p < 0,01 para otra EFGI). Los patrones masivos de CDI se registraron en el 27% de los NoGI, en el 39% de lospacientes con SII y en el 45% de los afectados por otra EFGI (OR = 1,73; p = 1 para SII, y OR = 2,21; p < 0,05 para otra EFGI).CONCLUSIONES: Se encontró mayor prevalencia de CDI cardíaco por FOP en pacientes con SII y otros trastornos funcionales digestivos. Su posible relación etiopatogénica debería considerarse en futuros estudios
BACKGROUND AND OBJECTIVE: Both irritable bowel syndrome (IBS) and patent foramen ovale (PFO) have a similar prevalence in the general population, affect more commonly women and are related to comorbidities such as migraine. In IBS there are alterations in the metabolism of certain substances like serotonin. In the presence of PFO with a right- to left-shunt (RLS), a percentageof venous blood bypasses the lung filter and may increase these substances in blood.PATIENTS AND METHOD: A phone interview was done to determine the presence of IBS in patientspreviously attended for detection of RLS with transcranial Doppler ultrasound. The presenceand grade of RLS was analyzed and compared with subjects without gastrointestinal symptoms (NoGI). Rome II criteria were used to diagnose IBS or other functional gastrointestinal disorder (FGD) and Venice 1999 consensus were used for the diagnosis of RLS.RESULTS: Thirthy-three (18.3%) of 180 interviewed patients had IBS and 62 (34.4%) other FGD. RLS was found in 41% of NoGI patients, 64% of patients with IBS and 68% of patients with other FGD (odds ratio [OR] = 2.56; p < 0.05 for SII, and OR = 3.06; p < 0.01 for otherFGD). RLS with a massive pattern was registered in en 27% of NoGI patients, 39% of patients with IBS and 45% of patients with other FGD (OR = 1.73; p = 1 for IBS, and OR = 2.21; p <0.05 for other FGD).CONCLUSIONS: We found a higher prevalence of cardiac RLS through a PFO in patients with IBS and other FGD. A possible etiopathogenic relationship must be considered in future studies
