Faculty Bibliography

The growing importance of colonoscopy in the prevention of colorectal cancer has stimulated an effort to identify and track quality indicators for this procedure. Several factors have been identified so far which are readily measurable and in many cases have been associated with improved patient outcomes. There is also ample evidence of variations in performance of this procedure. As a result, gathering data about quality indicators may play a vital role in the process of continuous quality improvement. Quality indicators for colonoscopy in colorectal cancer prevention are described along with the evidence that supports their use in benchmarking, quality reporting, and continuous quality improvement.

Leaks after laparoscopic sleeve gastrectomy can be challenging to manage. Nonoperative management is preferred after the immediate postoperative period. No single treatment is effective in all cases. The best approach is to be persistent, to utilize a multidisciplinary team and to apply one or more endoscopic therapies, often in combination. We present a case of persistent leak after laparoscopic sleeve gastrectomy that highlights these issues

One consequence of recent health care reform efforts has been an increasing focus on defining and delivering high-quality care. Esophagogastroduodenoscopy (EGD) is a fundamental procedure for endoscopists and quality indicators for measurement have been proposed. These indicators are classified temporally as preprocedural, intraprocedural, and postprocedural. Although some indicators are evidence based, many are derived from expert consensus and may require further validation. An ideal quality indicator is easy to measure at the time of service, correlates well with patient outcome and experience, and has enough variation in practice to allow differentiation between good and poor performers. Among the many proposed quality measurements, it remains uncertain which best meet such criteria. Beyond compliance with reporting quality indicators for EGD, successful endoscopy practices will embrace quality improvement initiatives that collect, organize, and analyze their performance data to improve patient outcomes and the patient endoscopic experience. In recognition of these forthcoming changes, organizations have developed national repositories to assist endoscopy groups in this effort. These initiatives to first gauge and then improve the quality of EGD must lead in parallel to the development of standardized criteria for competency that can be adopted by all programs in which endoscopy is taught, regardless of specialty. 2012 Elsevier Inc

BACKGROUND:Lung transplantation is the recognized therapy for end-stage respiratory failure. Many serious medical complications have been described occurring from months to years after lung transplantation, often necessitating admission to an intensive care unit (ICU). We examined the factors associated with death. METHODS:All consecutive lung transplant recipients who were readmitted to the ICU > 30 days after transplantation from 2000 to 2009 were included in this retrospective study. Data were collected regarding demographic parameters, ICU stay, and outcome. RESULTS:During the study period, 40 patients were admitted to the ICU. The main pre-transplant diagnosis was idiopathic pulmonary fibrosis, followed by chronic obstructive pulmonary disease. Most patients (93%) required mechanical ventilation during their ICU stay. The main reason for ICU admission was septic shock in 22 patients (55%). An organism was isolated from 19 of these patients; in 11 patients, the organism was multidrug resistant. The ICU mortality was 62.5%. Non-survivors were characterized by more frequent readmissions to hospital (p = 0.02), a higher admission Sequential Organ Failure Assessment score (p = 0.02), an admission diagnosis of sepsis (87.5% vs 37.5% for all other diagnoses, p < 0.001), and a requirement for mechanical ventilation (p = 0.02). The incidence of bronchiolitis obliterans syndrome was also significantly higher in non-survivors (p = 0.02). CONCLUSIONS:Severe sepsis remains the most important factor associated with a poor outcome after readmission to ICU. New strategies are required to alter the course of this common complication of lung transplantation.