Impact of scribing history and physical notes and procedure reports on endoscopist efficiency during routine procedures: a proof-of-concept study

BACKGROUND: Efficiency is an important aspect of endoscopic practice that has received limited study. We evaluated the impact of scribing electronic pre-procedure history and physical examinations, and electronic procedure reports on endoscopist efficiency. METHODS: We used a stopwatch to measure the time between the procedures (scope out to scope in), pre-procedure patient assessment time, and procedure report generation time for 180 consecutive procedures performed by a single endoscopist with or without a scribe for recording history and physical and procedure reports. Schedulers were unaware of whether a scribe would be present. RESULTS: Mean times for recording the pre-procedure history and physical and procedure reports were reduced by 34% (p = 0.001) and 71% (p < 0.0001), respectively, when scribes were used. The mean time saved by the endoscopist from scribing the history and the physical and procedure reports was 2.12 and 1.59 min, respectively. When both processes were scribed, the endoscopist spent 42% (p = 0.033) longer in the recovery area (absolute mean increase 1.01 min) compared with when no scribes were utilized. The total time saved per 6.5-h procedure block with both scribes averaged to 41.7 min. CONCLUSION: The use of scribes to record history and physical examination notes and procedure reports saved enough endoscopist time to allow additional procedures or longer procedures, or to free the time for other tasks

Faster colonoscope withdrawal time without impaired detection using EndoRings

Background and study aims:  Mucosal exposure devices on the colonoscope tip have improved detection. We evaluated detection and procedure times in colonoscopies performed with EndoRings. Patients and methods:  We had 14 endoscopists in a university practice trial EndoRings. We compared detection and procedure times to age- and indication-matched procedures by the same endoscopists. Results:  There were 137 procedures with EndoRings. The adenoma detection rate was 44 % with EndoRings vs. 39 % without ( P  = 0.39). Mean adenomas per colonoscopy (standard deviation) was 1.2 (2.3) with EndoRings vs. 0.9 (1.6) without ( P  = 0.055). Mean insertion time with EndoRings was 6.2 (3.2) minutes vs. 6.6 (6.7) minutes without ( P  = 0.81). Mean withdrawal time with EndoRings in all patients with or without polypectomy was 12.2 (5.3) minutes and 16.1 (10.3) minutes without ( P  = 0.0005). Conclusion:  EndoRings may allow faster withdrawal during colonoscopy without any reduction in detection. Prospective trials with mucosal exposure devices targeting procedure times as primary endpoints are warranted

High-definition colonoscopy versus Endocuff versus EndoRings versus Full-Spectrum Endoscopy for adenoma detection at colonoscopy: a multicenter randomized trial

Background Devices used to improve polyp detection during colonoscopy have seldom been compared with each other. Methods We performed a 3-center prospective randomized trial comparing high-definition (HD) forward-viewing colonoscopy alone to HD with Endocuff to HD with EndoRings to the Full Spectrum Endoscopy (FUSE) system. Patients were age ≥50 years and had routine indications and intact colons. The study colonoscopists were all proven high-level detectors. The primary endpoint was adenomas per colonoscopy (APC) Results Among 1,188 patients who completed the study, APC with Endocuff (APC Mean ± SD 1.82 ± 2.58), EndoRings (1.55 ± 2.42), and standard HD colonoscopy (1.53 ± 2.33) were all higher than FUSE (1.30 ± 1.96,) (p<0.001 for APC). Endocuff was higher than standard HD colonoscopy for APC (p=0.014) . Mean cecal insertion times with FUSE (468 ± 311 seconds) and EndoRings (403 ± 263 seconds) were both longer than with Endocuff (354 ± 216 seconds) (p=0.006 and 0.018, respectively). Conclusions For high-level detectors at colonoscopy, forward-viewing HD instruments dominate the FUSE system, indicating that for these examiners image resolution trumps angle of view. Further, Endocuff is a dominant strategy over EndoRings and no mucosal exposure device on a forward-viewing HD colonoscope

Finding High Risk Persons with Internet Tests to Manage Risk—A Literature Review with Policy Implications to Avoid Violent Tragedies, Save Lives and Money

The goal is to share policy implications of sensitive, specific internet-based tests in place of current approaches to lowering violence, namely fewer mass murders, suicides, homicides. When used, internet-based tests save lives and money. From 2009-2015, a Chicago field test had 324 fewer homicides (saving $2,089,848,548, ROI=6.42). In 60 yrs., conventional approaches for high risk persons (e.g.,. inappropriately releasing poor, severely mentally ill) led to unnecessary expense including yearly: (a) 300 mass murders (59$100/test, require 2-4 hrs

Finding High Risk Persons with Internet Tests to Manage Risk—A Literature Review with Policy Implications to Avoid Violent Tragedies, Save Lives and Money

The goal is to share policy implications of sensitive, specific internet-based tests in place of current approaches to lowering violence, namely fewer mass murders, suicides, homicides. When used, internet-based tests save lives and money. From 2009-2015, a Chicago field test had 324 fewer homicides (saving $2,089,848,548, ROI=6.42). In 60 yrs., conventional approaches for high risk persons (e.g.,. inappropriately releasing poor, severely mentally ill) led to unnecessary expense including yearly: (a) 300 mass murders (59$100/test, require 2-4 hrs

Pedagogy of Science Teaching Tests: Formative assessments of science teaching orientations

A critical aspect of teacher education is gaining pedagogical content knowledge of how to teach science for conceptual understanding. Given the time limitations of college methods courses, it is difficult to touch on more than a fraction of the science topics potentially taught across grades K-8, particularly in the context of relevant pedagogies. This research and development work centers on constructing a formative assessment resource to help expose pre-service teachers to a greater number of science topics within teaching episodes using various modes of instruction. To this end, 100 problem-based, science pedagogy assessment items were developed via expert group discussions and pilot testing. Each item contains a classroom vignette followed by response choices carefully crafted to include four basic pedagogies (didactic direct, active direct, guided inquiry, and open inquiry). The brief but numerous items allow a substantial increase in the number of science topics that pre-service students may consider. The intention is that students and teachers will be able to share and discuss particular responses to individual items, or else record their responses to collections of items and thereby create a snapshot profile of their teaching orientations. Subsets of items were piloted with students in pre-service science methods courses, and the quantitative results of student responses were spread sufficiently to suggest that the items can be effective for their intended purpose