Balloon dilation of benign small bowel strictures using double balloon enteroscopy: 5-year review from a single tertiary referral center

AbstractBackgroundSmall bowel strictures are an uncommon but difficult problem to evaluate and treat. They can cause significant morbidity, and surgery has historically been the only definitive treatment option. We assessed outcomes of endoscopic dilation of benign small bowel strictures using double balloon enteroscopy (DBE).MethodsRetrospective study of 13 patients from January 2007 to December 2011 who underwent DBE and balloon dilation for benign small bowel strictures at a single tertiary referral center.ResultsA total of 16 DBEs were performed in 13 patients (11 males, median age 60) for benign small bowel strictures using DBE. Final stricture etiology included Crohn's disease 4, nonsteroidal anti-inflammatory drugs 4, anastomotic stricture 3, radiation enteritis 1, and adhesions 1. Technical success was achieved in 12/13 (92%) and clinical success in 10/13 (77%) patients with a median follow-up of 46 months. Surgery was required in three patients: one technical failure to reach the stricture, one adverse event (perforation), and one recurrence.ConclusionBalloon dilation of small bowel strictures using DBE is a reasonably safe and feasible alternative to surgery in selected cases. Larger prospective series would be required to confirm its benefit

Implementation of FishCORAL-PRSA Web-Based Information System for Asid Gulf Project

The Fisheries, Coastal Resources and Livelihood (FishCORAL) project of the Department of Agriculture – Bureau of Fisheries and Aquatic Resources (DA-BFAR) aimed to address the alarming poverty incidence of the fishing communities and provide protection and conservation of coastal resources. This study developed and implemented a web-based information system designed to serve as repository of resources and socio-economic assessments for Asid Gulf. The study used Rational Unified Process (RUP) methodology which utilizes open libraries, application programming interface (APIs) and Geographical Information system (GIS) tools. Information gathered from field surveys and community validation through project components are the primary basis in designing the system components. The developed system provided a wide-range of information in the interest of the fisheries and aquatic resources management. Some of the features include the updated socio-economic profile, aquatic ecology and habitat assessments, baselines of the primary water quality parameters for marine waters, updated fisheries industry profile, and GIS maps of Asid gulf. Government agencies, local government units (LGUs), and partner institutions can use the information in terms of education, livelihood, agriculture and fisheries, health and crafting the coastal resource management plan. The implementation of the system is one of the government efforts to improve the governance capability through the development of internet-based technologies across all stakeholders and agencies for a more efficient operation which shall promote good governance and digital transformation to enhance the organization and intergovernmental coordination.</jats:p

Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations

IntroductionTransportation is a common barrier to colonoscopy completion for colorectal cancer (CRC) screening. The study aims to identify the barriers, facilitators, and process recommendations to implement a rideshare non-emergency medical transportation (NEMT) intervention following colonoscopy completion within a safety-net healthcare setting.MethodsWe used informal stakeholder engagement, story boards—a novel user-centered design technique, listening sessions and the nominal group technique to identify the barriers, facilitators, and process to implementing a rideshare NEMT program following colonoscopy completion in a large safety-net healthcare system.ResultsBarriers to implementing a rideshare NEMT intervention for colonoscopy completion included: inability to expand an existing NEMT program beyond Medicaid patients and lack of patient chaperones with rideshare NEMT programs. Facilitators included: commercially available rideshare NEMT platforms that were lower cost and had shorter wait times than the alternative of taxis. Operationalizing and implementing a rideshare NEMT intervention in our healthcare system required the following steps: 1) identifying key stakeholders, 2) engaging stakeholder groups in discussion to identify barriers and solutions, 3) obtaining institutional sign-off, 4) developing a process for reviewing and selecting a rideshare NEMT program, 5) executing contracts, 6) developing a standard operating procedure and 7) training clinic staff to use the rideshare platform.DiscussionRideshare NEMT after procedural sedation is administered may improve colonoscopy completion rates and provide one solution to inadequate CRC screening. If successful, our rideshare model could be broadly applicable to other safety-net health systems, populations with high social needs, and settings where procedural sedation is administered.</jats:sec