One physician’s response to a Dallas Medical Journal survey has evoked angry retorts and refueled discussion about inequities between male and female physicians. Dallas County Medical Society members were asked if there was a pay gap between male and female physicians, and if so, how it could be remedied.
Nurses who handle patients on a regular basis are likely to get injured, sooner or later. According to the U.S. Bureau of Labor Statistics, nursing has the highest rate of nonfatal occupational injuries of any profession, (yes, even higher than construction workers or factory employees), and an American Nursing Association survey revealed that 62 percent of nurses indicated that the risk of developing a disabling musculoskeletal disorder was a top health and safety concern.
The safety and comfort of patients undergoing colonoscopy is of paramount importance to hospitals, providers, and of course, the patients themselves. But what about the physicians performing the procedure? It might be news to those outside the field, but gastroenterologists are commonly injured on the job. A review of current literature found that musculoskeletal complaints are extremely common among GIs; the incidence of pain and injuries ranges from 29% up to 89%. Another study indicated that 45% of endoscopists undergo physical therapy to combat pain, 26.8% get steroid injections, and 13.3% require surgery.
What do we really know about fiber and colon health? Certainly, if you believe media reports and marketing campaigns, you might think that fiber was the panacea for a wide variety of ailments. Cereals, supplements, and snack bars labeled as “rich in fiber” are touted to be healthy for your colon.
Observational studies indicate that colonoscopy lowers colorectal cancer (CRC) rates and mortality in the general population. In support of these findings, a large-case control study showed that the procedure can significantly reduce the incidence of CRC and CRC-related mortality. However, colonoscopy may not be optimally effective for right-sided lesions. This might be due, in large part, to sessile serrated adenomas (SSAs).
The Definition of “Difficult”
A difficult colonoscopy is one “in which the endoscopist has trouble getting through the entire colon or fails to do so,” said Dr. Jerome Waye, in an interview with the journal Gastroenterology & Hepatology. Difficult colonoscopies are problematic because they can result in longer-than-expected procedure times, incomplete procedures, and higher risks.
If Colonoscopy Is the Gold Standard, Why Is Compliance So Low?
In 2018, 50,630 people in the United States will die of colorectal cancer, according to the American Cancer Society. It is the third leading cause of cancer-related deaths in men and women in this country.
What is looping?
During colonoscopy, looping is a frequent challenge. It occurs when the colonoscope stretches and distends the colon in response to the physician’s efforts to advance the scope forward. Typically once a loop has formed, it must be straightened before the procedure can continue. Looping is most common in the sigmoid colon, although it can occur anywhere the scope encounters a barrier.
Part of what makes colonoscopy the gold standard for colon cancer screening is its safety profile. The risk of serious complications is low (perforations and post-procedure bleeding occur in only 0.05% and 0.3% of colonoscopies, respectively). Yet according to a study out of Yale, a far larger percentage of patients return to the emergency room (ER) within seven days of colonoscopy, with far-reaching impacts on cost and patient satisfaction.
What’s driving Propofol use for colonoscopy, better patient care or a better bottom line?
Just 10 years ago, moderate sedation—a combination of short-acting anxiety and pain medications administered by a gastroenterologist—was used in more than 80% of all colonoscopies in the U.S. Yet over the past decade, the use of deep sedation (aka, MAC) has risen sharply. A recent study of over 6.6 million patients undergoing GI procedures found that by 2010, 33.7% of Medicare patients and 38.3% of commercially insured patients received MAC for their colonoscopy. By 2013, these figures had risen to 47.6% and 53.0%, respectively. And today those numbers are even higher.