ABSTRACT
BACKGROUND AND AIM: The objective of this study is to identify and describe risk factors and complications in endoscopic procedures. METHODS: This review presents the complications and the accompanying risk factors that were described in the selected full-text articles. The relevant full-text articles were found in Pubmed, ISI Web of Science and the CINAHL database. RESULTS: The search resulted in 238 abstracts, 50 of which were finally selected for full-text analysis. The different types of endoscopic procedures each have specific complications, but bleeding and perforation occur in all procedures. It was found that bleeding, perforation, cardiovascular and respiratory complications were common complications.Furthermore, morbidity and mortality have been associated with risk factors such as older age, high ASA class and sedation. CONCLUSION: Endoscopy is not without risk, although the prevalence of complications is low. Most complications seenin this analysis, are linked to known risk factors. Some complications might be preventable or avoidable, given a more systematic and comprehensive approach pre-, per- and postprocedural. The creation and implementation of an endoscopic safety checklist could be an -important supportive tool in lowering complications.
Subject(s)
Cardiovascular Diseases/epidemiology , Endoscopy/adverse effects , Gastrointestinal Hemorrhage/epidemiology , Pneumonia, Aspiration/epidemiology , Adult , Cardiovascular Diseases/mortality , Endoscopy/mortality , Endoscopy/statistics & numerical data , Gastrointestinal Hemorrhage/mortality , Humans , Hypoxia/epidemiology , Hypoxia/mortality , Pneumonia, Aspiration/mortality , Risk FactorsABSTRACT
BACKGROUND: Despite thorough analyses of the analytical performance of Clostridium difficile tests and test algorithms, the financial impact at hospital level has not been well described. Such a model should take institution-specific variables into account, such as incidence, request behaviour and infection control policies. AIM: To calculate the total hospital costs of different test algorithms, accounting for days on which infected patients with toxigenic strains were not isolated and therefore posed an infectious risk for new/secondary nosocomial infections. METHODS: A mathematical algorithm was developed to gather the above parameters using data from seven Flemish hospital laboratories (Bilulu Microbiology Study Group) (number of tests, local prevalence and hospital hygiene measures). Measures of sensitivity and specificity for the evaluated tests were taken from the literature. List prices and costs of assays were provided by the manufacturer or the institutions. The calculated cost included reagent costs, personnel costs and the financial burden following due and undue isolations and antibiotic therapies. Five different test algorithms were compared. FINDINGS AND CONCLUSION: A dynamic calculation model was constructed to evaluate the cost:benefit ratio of each algorithm for a set of institution- and time-dependent inputted variables (prevalence, cost fluctuations and test performances), making it possible to choose the most advantageous algorithm for its setting. A two-step test algorithm with concomitant glutamate dehydrogenase and toxin testing, followed by a rapid molecular assay was found to be the most cost-effective algorithm. This enabled resolution of almost all cases on the day of arrival, minimizing the number of unnecessary or missing isolations.
Subject(s)
Bacteriological Techniques/economics , Bacteriological Techniques/methods , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Cross Infection/diagnosis , Diarrhea/diagnosis , Sentinel Surveillance , Algorithms , Cost-Benefit Analysis , Hospital Costs , HumansABSTRACT
OBJECTIVES: This study aimed to establish acceptable quality control ranges for temocillin disk diffusion tests and Etest(®) minimal inhibitory concentrations. METHODS: According to Clinical and Laboratory Standards Institute (CLSI) guideline, a Tier 2 quality control study was performed and involves seven laboratories. Each of them tested 10 replicates of two quality control strains (Escherichia coli ATCC 25922 and E. coli ATCC 35218) on three different media lots and, for disk diffusion, two disk lots. RESULTS: Proposed zone diameter quality control ranges were 12-25 mm for E. coli ATCC 25922 and 19-28 mm for E. coli ATCC 35218. Proposed Etest quality control ranges were 3-24 mg/l for E. coli ATCC 25922 and 2-6 mg/l E. coli ATCC 35218. CONCLUSION: Based on our results, we would advise the use of E. coli ATCC 35218 as QC strain for temocillin susceptibility testing and Etest because ranges obtained are narrower than with E. coli ATCC 25922 and do not overlap temocillin breakpoint.
Subject(s)
Disk Diffusion Antimicrobial Tests/standards , Escherichia coli , Penicillins , Quality Control , Reference StandardsABSTRACT
We describe the case of a malignant arthritis of the knee. This is the first description with an oesophageal adenocarcinoma being the primary site of the malignancy. Diagnosis of this rare condition can be made by cytological examination of joint fluid or by synovial biopsy. X-ray of the joint can, as in our case, be negative. There is no standard therapy and the prognosis seems to be poor. Although rare, malignant synovitis represents an important differential diagnosis in patients with an unexplained monoarthritis, as it can be the first sign of malignancy or the only site of metastic disease.
Subject(s)
Adenocarcinoma/secondary , Esophageal Neoplasms/pathology , Knee Joint/pathology , Synovial Membrane/pathology , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
We describe the case of a 71-years-old man in chronic hospital hemodialysis who was admitted to the hospital because of symptomatic hypoglycemia. We discovered that this was due to a documented intoxication with cibenzoline, an antiarrhythmic drug, used to treat (supra-)ventricular tachyarrhythmia. In addition we made a short review of the literature concerning cibenzoline intoxication.
