Endoscopists attitudes on the publication of "quality" data for endoscopic procedures: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Whilst the public now have access to mortality & morbidity data for cardiothoracic surgeons, such "quality" data for endoscopy are not generally available. We studied endoscopists' attitudes to and the practicality of this data being published.</p> <p>Methods</p> <p>We sent a questionnaire to all consultant gastrointestinal (GI) surgeons, physicians and medical GI specialist registrars in the Northern region who currently perform GI endoscopic procedures (n = 132). We recorded endoscopist demographics, experience and current data collection practice. We also assessed the acceptability and utility of nine items describing endoscopic "quality" (e.g. mortality, complication & completion rates).</p> <p>Results</p> <p>103 (78%) doctors responded of whom 79 were consultants (77%). 61 (59%) respondents were physicians. 77 (75%) collect any "quality" data. The most frequently collected item was colonoscopic completion rate. Data were most commonly collected for appraisal, audit or clinical governance. The majority of doctors (54%) kept these data only available to themselves, and just one allowed the public to access this. The most acceptable data item was annual number of endoscopies and the least was crude upper GI bleeding mortality. Surgeons rated information less acceptable and less useful than physicians. Acceptability and utility scores were not related to gender, length of experience or current activity levels. Only two respondents thought all items totally unacceptable and useless.</p> <p>Conclusion</p> <p>The majority of endoscopists currently collect "quality" data for their practice although these are not widely available. The endoscopists in this study consider the publication of their outcome data to be "fairly unacceptable/not very useful" to "neutral" (score 2–3). If these data were made available to patients, consideration must be given to both its value and its acceptability.</p

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

A Prospective, Observational Study Describing Patients Characteristic, Endoscopic Diagnoses and Therapies, and the use and effetcs on Clinical Outcomes of Red Blood Cell Transfusion

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Changes in The Compressive and Tensile Yield Strengths During Uniaxial Cyclic Loading

80 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1983.Many of the multiaxial unified-creep plasticity theories which have been proposed as a means to improve design at elevated temperatures have suffered from the drawback that the manner in which the state variables change is difficult to measure. A unified creep-plasticity theory for uniaxial loading which uses the yield strengths in tension, Y(,1), and compression, Y(,2), as the state variables is investigated as the means of improving the formulation of such theories. The yield strengths are easily measured and can be readily transformed to the state variables commonly used in the multiaxial theories.The yield strengths were measured during a completely reversed cyclic strain amplitude history for 304 stainless steel at 23(DEGREES)C and 600(DEGREES)C, and for Inconel 751 at 788(DEGREES)C and 927(DEGREES)C. The data from these experiments were then plotted in the (Y(,1),Y(,2)) plane and a geometric model of how the state variables change during loading was constructed.The model clearly demonstrates that on each loading reversal kinematic hardening is the predominate type of hardening. The observed limit cycle behavior of the state variables requires that there be an isotropic softening, or decrease in the elastic range, at the beginning of each reversal. This is followed by a rapid isotropic hardening at the end of the reversal. However, this behavior was obscured by the scatter in the data which was on the order of 10 percent of the elastic range.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD