Quality and safety of screening colonoscopies performed by primary care physicians with standby specialist support.

BACKGROUND: Expanding the population's access to colonoscopy screening can reduce colorectal cancer disparities. Innovative strategies are needed to address the prevailing 50% colonoscopy screening gap, partly attributable to inadequate specialist workforce. This study examined the quality of colonoscopies by primary care physicians (PCPs) with standby specialist support at a licensed ambulatory surgery center. METHODS: Retrospective data on 10,958 consecutive colonoscopies performed by 51 PCPs on 9815 patients from October 2002 to November 2007 were used to calculate the rates of cecal intubation, detection of polyps, adenomas, advanced neoplasia and cancer, adverse events, and time taken for endoscope insertion and withdrawal. The center's protocol requires a 2-person technique (using a trained technician), polyp search and removal during both scope insertion and withdrawal, and onsite expert always available for rescue assistance (either navigational or therapeutic). FINDINGS: Mean patient age was 58.3 (+/-10.9) years, 48.0% were male, and 48.1% African-American. The cecal intubation rate was 98.1%, polyp detection rate 63.1%, hyperplastic polyp 27.5%, adenoma 29.9%, advanced neoplasia 5.7%, cancer 0.63%, major adverse events 0.06% (including 2 perforations; no death). Mean insertion and withdrawal times were 14.4 (+/-9.3) and 10.9 (+/-6.8) minutes, respectively; 13.2 (+/-8.6) and 8.0 (+/-4.5) minutes without polyps found, and 15.1 (+/-9.6) and 12.5 (+/-7.3) minutes when > or =1 polyp was found. CONCLUSIONS: In the largest published study of PCP-performed colonoscopies with standby specialist support, we observed performance quality indicators and lesion detection rates that are comparable to documented rates for experienced gastroenterologists. Systems that use PCPs with specialist backup support enable high-quality colonoscopy performance by PCPs.

Restaurant industry preparedness against intentional food contamination: results of a South Carolina survey.

Food safety and food defense are both responsibilities of public health agencies. Food safety practices within restaurants are regulated by state and local public health laws based on the US Food and Drug Administration Model Food Code. However, little is known about preemptive practices against intentional food-borne outbreaks within restaurants. The researchers administered a survey to a 50 percent random sample of South Carolina's restaurants, a state that relies heavily on tourism and the restaurant industry for its economic well-being. The survey received a response rate of 15 percent. The food defense practice items fall under three functional categories: employee management and training practices; vendor and delivery-related practices; and physical facilities and operational security practices. This study presents the results, classified by geographic region. Findings indicate some key areas of vulnerability that need attention to protect the public from mass food outbreaks due to intentional contamination. Of concern, there is much variation in practices by geographic region. On the basis of the survey, recommendations are made to improve restaurant preparedness against food-borne outbreaks from terrorism and malevolent contamination.