Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample

There is concern that mental and physical fatigue among endoscopists over the course of the day will lead to lower adenoma detection rate (ADR). There are mixed findings in the prior literature on whether such an association exists. The aim of this study was to measure the association between the number of colonoscopies performed in a day and ADR and withdrawal time. We analyzed 86,624 colonoscopy and associated pathology reports between October 2013 and September 2015 from 131 physicians at two medical centers. A previously validated natural language processing program was used to abstract relevant data. We identified the order of colonoscopies performed in the physicians' schedule and calculated the ADR and withdrawal time for each colonoscopy position. The ADR for our overall sample was 29.9 (CI 29.6-30.2). The ADR for colonoscopies performed at the 9th + position was significantly lower than those at the 1st-4th or 5th-8th position, 27.2 (CI 25.8-28.6) versus 29.9 (CI 29.5-30.3), 30.2 (CI 29.6-30.9), respectively. Withdrawal time steadily decreased by colonoscopy position going from 11.6 (CI 11.4-11.9) min for the 1st colonoscopy to 9.6 (8.9-10.3) min for the 9th colonoscopy. In our study population, ADR and withdrawal time decrease by roughly 7 and 20%, respectively, by the end of the day. Our results imply that rather than mental or physical fatigue, lower ADR at the end of the day might be driven by endoscopists rushing

The impact of exclusion criteria on a physician’s adenoma detection rate

BACKGROUND: The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature on which colonoscopy examinations should be excluded when measuring a physician’s ADR. OBJECTIVE: To examine the impact of varying the colonoscopy exclusion criteria on physician ADR. DESIGN: We applied different exclusion criteria used in 30 prior studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR. SETTING: A private practice colonoscopy center affiliated with the University of Illinois College of Medicine. PATIENTS: Data on 20,040 colonoscopy examinations and associated pathology notes performed by 11 gastroenterologists from July 2009 to May 2013. MAIN OUTCOME MEASUREMENTS: ADR across all colonoscopy exainations, each physician’s ADR, and ADR ranking. RESULTS: There were 28 different exclusion criteria used when measuring ADR. Each study used a different combination of these exclusion criteria. The fraction of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0 to 93.1%. The mean ADR across all colonoscopy examination was 35.9%. The change in mean ADR after applying the 28 exclusion criteria ranged from −4.6 to +3.1 percentage points. However, the exclusion criteria impacted each physician’s ADR relatively equally, and therefore physicians’ rankings via ADR were stable. LIMITATIONS: ADR assessment was limited to a single private endoscopy center. CONCLUSIONS: There is wide variation in the exclusion criteria used when measuring ADR. Although these exclusion criteria can impact overall ADR, the relative rankings of physicians by ADR were stable. A consensus definition on which exclusion criteria are applied when measuring ADR is needed

As Apocynaceae s. str. da região de Bauru, São Paulo, Brasil The Apocynaceae s. str. of the Bauru region, São Paulo State, Brazil

Este trabalho consistiu no levantamento das Apocynaceae na Região de Bauru, centro-oeste do estado de São Paulo, em diferentes tipos de vegetação. Foram encontradas 25 espécies, distribuídas em 15 gêneros, representadas nesta ordem: Forsteronia G. Mey., cinco espécies; Aspidosperma Mart., quatro espécies; Mandevilla Lindl., três espécies; Prestonia R. Br., duas espécies, e Condylocarpon Desf., Hancornia Gomez, Himatanthus Willd. ex Roem. et Schult., Macrosiphonia Müll.Arg., Mesechites Müll.Arg., Odontadenia Benth., Peltastes Woodson, Rhodocalyx Müll.Arg., Secondatia A. DC., Tabernaemontana L. e Temnadenia Miers, uma espécie cada. São apresentadas chaves de identificação, descrições e ilustrações das espécies, além de dados de distribuição geográfica, floração e frutificação.<br>The present study describes a survey of the Apocynaceae in different types of vegetation, in the region of Bauru, in the Center-West of São Paulo State. Of the 25 species encountered, distributed into 15 genera, representation ranges as follows: Forsteronia G. Mey, five species; Aspidosperma Mart., four species; Mandevilla Lindl., three species; Prestonia R. Br., two species; and Condylocarpon Desf., Hancornia Gomez, Himatanthus Willd. ex Roem. et Schult., Macrosiphonia Müll. Arg., Mesechites Müll. Arg., Odontadenia Benth, Peltastes Woodson, Rhodocalyx Müll Arg., Secondatia A. DC., Tabernaemontana L. and Temnadenia Miers, one species each. In addition to both distribution data, and flowering and fruiting times, identifications keys, descriptions and illustrations of the species are presented