Quality Indicators for Colonoscopy Procedures: A Prospective Multicentre Method for Endoscopy Units

BACKGROUND AND AIMS: Healthcare professionals are required to conduct quality control of endoscopy procedures, and yet there is no standardised method for assessing quality. The topic of the present study was to validate the applicability of the procedure in daily practice, giving physicians the ability to define areas for continuous quality improvement. METHODS: In ten endoscopy units in France, 200 patients per centre undergoing colonoscopy were enrolled in the study. An evaluation was carried out based on a prospectively developed checklist of 10 quality-control indicators including five dependent upon and five independent of the colonoscopy procedure. RESULTS: Of the 2000 procedures, 30% were done at general hospitals, 20% at university hospitals, and 50% in private practices. The colonoscopies were carried out for a valid indication for 95.9% (range 92.5-100). Colon preparation was insufficient in 3.7% (range 1-10.5). Colonoscopies were successful in 95.3% (range 81-99). Adenoma detection rate was 0.31 (range 0.17-0.45) in successful colonoscopies. CONCLUSION: This tool for evaluating the quality of colonoscopy procedures in healthcare units is based on standard endoscopy and patient criteria. It is an easy and feasible procedure giving the ability to detect suboptimal practice and differences between endoscopy-units. It will enable individual units to assess the quality of their colonoscopy techniques

Quel avenir pour l'industrie nucléaire ? Les réponses des dirigeants de l'industrie nucléaire française

La RGN a demandé aux responsables des principaux établissements et groupes industriels français travaillant dans le domaine de l'énergie nucléaire de synthétiser en un court développement leur analyse sur l'évolution des activités nucléaires dans les prochaines années. Cette analyse introduit la question essentielle à laquelle nous les avons invités à répondre : comment voyez-vous l'avenir du «nucléaire» de votre entreprise et quelles orientations stratégiques avez-vous définies dans ce domaine pour la prochaine période ? Nous remercions les «grands patrons» du secteur nucléaire français d'avoir bien voulu répondre à ces interrogations prospectives

Overall detection rate in fair and insufficient preparation.

<p>Overall detection rate in fair and insufficient preparation.</p

Detection rates for adenoma and advanced adenoma and colonoscopy success.

<p>Expressed per 100 colonoscopies.</p

Patient characteristics and procedural data (n = 2000).

*<p>Expressed per 100 colonoscopies;</p>**<p>% MD: percent of missing data.</p

Quality criteria for colonoscopy (N = 10).

<p>Quality criteria for colonoscopy (N = 10).</p

Patient characteristics and procedural data per centre (n = 2000).

*<p>Expressed per 100 colonoscopies.</p

Le Temps de la mémoire : le flux, la rupture, l’empreinte

L’expérience essentielle du rapport au Temps est un champ particulièrement riche sur le plan imaginaire et symbolique. Comment cerner ce rapport au temps ? Comment mettre en mot les bribes, les sédiments, les quêtes de la mémoire ? Les contributions rassemblées dans ce volume, s’attachant à la longue durée, de l’antiquité à l’époque contemporaine, témoignent d’une heureuse confluence des interrogations : la mémoire veut capturer le flux du temps révolu, elle affronte les ruptures du fil temporel, elle occulte ou révèle le traumatisme, elle déchiffre l’empreinte, le vestige dont il importe de retrouve j’origine et le sens. Dans cette entreprise complexe, l’équivoque s’associe à l’oubli, la voix doit assurer une transmission incertaine ; l’histoire et la fiction veulent, chacune à sa manière, faire surgir l’architecture du temps passé, recomposer les lieux et les moments. Le discours de mémoire est une texture dont l’écriture littéraire, tout particulièrement, suggère les déchirements. La mémoire serait-elle un « sixième sens à elle seule » (J.Y. Tadié) ? La diversité des contributions dans ce volume est fondée sur la pluridisciplinarité des approches et des interprétations. La symbolique individuelle ou collective, les témoignages communautaires ou personnels, les croyances enracinées dans les patrimoines proposent leurs énigmes, secrets et révélations, qui concernent aussi bien l’anthropologue que le psychanalyste, les historiens et les spécialistes de la littérature et de l’art. Le Moi, gardien inquiet de sa propre-mémoire, rejoint alors, en une communauté riche de sens, les passeurs de mémoire qui usent de leur voix singulière pour tisser le rapport au temps collectif. La traque du temps passé, l’inquiétude de la quête, l’incertitude du devenir au miroir de la mémoire, contribuent à la constitution des identités, dans nos sociétés comme dans les autres cultures

High Risk of Anal and Rectal Cancer in Patients With Anal and/or Perianal Crohn’s Disease

International audienceBackground & AimsLittle is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn’s disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn’s perianal disease followed up in the Cancers Et Surrisque Associé aux Maladies Inflammatoires Intestinales En France (CESAME) cohort.MethodsWe collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn’s disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex.ResultsAmong the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn’s lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn’s disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03).ConclusionsIn an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn’s disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer