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

Wii Fit™ exercise therapy for the rehabilitation of ankle sprains: Its effect compared with physical therapy or no functional exercises at all

Lateral ankle sprains represent the most common sports-related injuries. The Nintendo Wii Fit™ could be useful in the treatment of ankle sprains. The aim of this study was to compare the effectiveness of exercise training using the Wii Fit™ in ankle sprain patients: (a) with physical therapy; and (b) a control group not receiving any treatment. Ninety lateral ankle sprain patients were randomized to a Wii Fit™, physical therapy, or control group. We assessed the following outcome measures before, and 6 weeks after starting the allocated treatment: Foot and Ankle Ability Measure, pain during rest and walking, delay before return to sport, patient satisfaction, and effectiveness of the allocated treatment. Six weeks after the baseline measures, foot and ankle ability scores had improved in all groups, and pain had decreased during walking (P  0.050). In conclusion, the Wii Fit™ could be used as an exercise therapy to treat ankle sprain patients. However, Wii Fit™ was not more effective than only physical therapy, or no exercise therapy at all. Patients who did not receive treatment showed similar results as people who got any kind of exercise therapy

Water chemistry and soil radon survey at the Poas volcano (Costa Rica)

International audienceRadon-in-soil monitoring at the Poas volcano (Costa Rica) has been performed together with water chemistry from the hot crater lake since 1981 and 1983 respectively. The results are discussed as a function of the eruptive evolution of the volcano over a 13 years period (1981-1994). It is shown that no definitely clear precursory radon signals have been recorded. On the contrary, ionic species concentrations are likely to be considered good precursors, together with the temperature variations of the crater lake water

Burial Diagenesis of the Eocene Sobrarbe Delta (Ainsa Basin, Spain) Inferred From Dolomitic Concretions

International audienceLittle attention has been focused on the burial diagenesis of deltas deposited on active foreland-basin margins, where tectonics is likely to strongly impact fluid–rock interactions. A petrographic, geochemical, and microthermometric study of several fractured dolomite concretions and enclosing prodelta marls provides insights into the evolution of burial diagenesis in the Eocene Sobrarbe deltaic complex (Ainsa Basin, Spain), and more generally, on the paleohydrology of the South Pyrenean foreland basin.Shallow burial diagenesis was controlled by microbial activity in marine-derived porewaters. Microbial sulfate reduction was first responsible for the formation of pyrite and early calcite, followed by the growth of dolomite concretions during methanogenesis. Subsequent diagenesis was limited to temperatures and depth of less than approximately 75°C and 2 km, respectively. Diagenesis was recorded in porous bioturbation traces and septarian fractures found inside dolomite concretions, as well as in tectonic shear fractures. Neomorphic tabular barite, found only in the bioturbation traces, is interpreted to have formed early in marine-derived porewaters. Septarian fractures were then filled by Fe-rich calcite and centimeter-size celestine. Stable isotopes indicate that calcite probably formed in meteoric-derived waters coming from the overlying fluvial delta plain. The sulfur isotope composition of celestine is compatible with precipitation in waters of mixed parentage, but the exact origin of dissolved sulfate remains poorly constrained. In tectonic fractures, celestine precipitated coevally with calcite displaying evidence of strong fluid–rock interaction. Dissolved sulfate may have migrated to the fractures during active tectonics from the late Eocene to the Oligocene.The paragenesis and the proposed paleohydrologic model are similar to those previously described for other deltaic systems deposited in active foreland basins, including the South Pyrenean foreland basin. These features point to common diagenetic processes in syntectonic foreland-basin deltas, involving both meteoric and marine fluid sources. Similar to passive margin settings, early diagenesis appears to be controlled mainly by relative variations of sea level, whereas during further burial, the development of permeable tectonic fractures is likely to facilitate the influx of basinal or continental waters into fine slope deposits, impacting the diagenetic record. These results emphasize the importance of fracture development in the fluid-flow regime of syntectonic foreland-basin deltas. They demonstrate the necessity to take this parameter into account in fluid-flow modeling of foreland-basin margins

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

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

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

Overall detection rate in fair and insufficient preparation.

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

Quality criteria for colonoscopy (N = 10).

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