ABSTRACT
Background: The rates of perforation and bleeding are important quality measures of colonoscopy performance. Objective: The objective of this article is to assess the frequency of colonoscopy-related bleeding and perforation in Swedish counties and to relate these findings to patient characteristics. Method: Data on 593,308 colonoscopies performed on adults from 2001 to 2013 were retrieved from Swedish inpatient and outpatient registers. Covariates were assessed in a multivariate Poisson regression model. The correlation between perforation and bleeding was calculated with Pearson's bivariate correlation formula. Results: The relative frequency of bleeding and perforation vary across counties (bleeding: 0.02%-0.27%; perforation: 0.02%-0.27%). There were significant positive correlations between the relative frequency of bleeding and perforation at the county level, both including (r = 0.792, p < 0.001) and excluding polypectomies r = 0.814 (p < 0.001). The relative risks of these conditions in the counties ranged from 0.12, p < 0.001, to 1.53, p = 0.05 (bleeding) and from 0.17, p = 0.002, to 2.42, p < 0.001 (perforation). Conclusions: There are substantial differences in colonoscopy performance in Sweden. These differences do not seem to be explained by patient characteristics.
Subject(s)
Colonoscopy/adverse effects , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/etiology , Intestinal Perforation/epidemiology , Intestinal Perforation/etiology , Adult , Aged , Aged, 80 and over , Comorbidity , Female , Gastrointestinal Hemorrhage/history , Geography, Medical , History, 21st Century , Humans , Intestinal Perforation/history , Male , Middle Aged , Public Health Surveillance , Sweden/epidemiologyABSTRACT
The name of Hans Selye is mostly known worldwide as the discoverer of stress reaction. Yet, he made numerous other seminal and clinically relevant discoveries. Namely, since he had a focused research on steroid hormones originating from the adrenal cortex that play a crucial role in stress response, he was the first who introduced about 70 years ago the first classification of steroids that is still valid nowadays. This is based on three objective facts: (a) the names of steroid groups are identical with their organ of origin (e.g., corticoids from the adrenal cortex, testoids/androgens from the testis); (b) chemical structures of the steroids are identical within a group (e.g., all corticoids have pregnane nucleus with 21 carbon atoms); and (c) the biological effects are homogenous within a group (e.g., all glucocorticoids exert catabolic effect, while androgens are anabolic). It should be emphasized that Selye also discovered in animal models the pro-inflammmatory effect of mineralocorticoids and the anti-inflammatory properties of glucocorticoids, about 8-10 years before Nobel Prize was awarded to a physician for the first clinical use of adrenocorticotrop hormone and cortisone. Last, but not least, Selye was the first who recognized about 70 years ago the occurence of stress ulcers in humans, based on clinical reports on the huge increase in the number of perforated gastric anti-duodenal ulcers during bombings of London in World War II. The subsequent ulcer research by Selye`s former students and their contemporaries resulted in the recognition of anti-duodenal ulcer effect of dopamine, and the central gastroprotective actions of thyreotrop releasing hormone and endogenous opioids. Thus, Hans Selye made much more contributions to medical science and clinical practice than 'just' the discoverer of biologic stress response.
