Same-day colonoscopy preparation with Senna alkaloids and bisacodyl tablets:A pilot study

AIM:To evaluate the efficacy of same-day bowel preparation with Senna alkaloids combined with bisacodyl tablets in routine colonoscopy procedures.METHODS:Between March and June 2013,a sameday bowel preparation was implemented in our endoscopy unit.The preparation consisted of a semi-liquid,fiber-free diet one day prior to the procedure,with two bisacodyl tablets after lunch and dinner,and 250 mL of Senna alkaloid with 1.5 L of drinking water at 6 am the day of the procedure.The quality control parameters of colonoscopy were evaluated and implemented according to the guidelines of the American Society for Gastrointestinal Endoscopy.The pre-procedure,duringprocedure and post-procedure patient data were collected and analyzed:(1) pre-procedure(age,gender,comorbid diseases,colonoscopy indications,complete lack of compliance with the bowel preparation protocol);(2) during-procedure(sedation dose,duration of colonoscopy,withdrawal time,cecal intubation rate,polyp detection rate,Boston Bowel Preparation Scores and presence of foam and clear liquid); and(3) postprocedure(visual analogue scale score,pain during the procedure,patient satisfaction and premature withdrawal due to the insufficient bowel preparation).RESULTS:A total of 75 patients were included in this study with a mean age of 54.64 ± 13.29 years; 53.3%(40/75) were female and 46.7%(35/75) were male.A complete lack of compliance with the bowel preparation protocol was seen in 6.7% of patients(5/75).The mean total duration of colonoscopy was 16.12 ± 6.51 min,and the mean withdrawal time was 8.89 ± 4.07 min.The cecal intubation rate was 93.8%(61/64) and the polyp detection rate was 40%(30/75).The mean Boston Bowel Preparation Score was 7.38 ± 1.81,with the following distribution:right colon,2.34 ± 0.89; transverse colon,2.52 ± 0.67; left colon,2.52 ± 0.63.The mean visual analogue scale score was 4.59 ± 1.57.Due to insufficient bowel preparation,seven patients(7/75; 9.3%) were asked to repeat the procedure.Of these,five patients had poor or modest compliance with the protocol,and two patients reported constipation.Premature withdrawal due to insufficient bowel preparation was 2.7%(2/75).The overall satisfaction with the protocol was 86.7%(65/75),with patients reporting they would prefer the same protocol in a repeat procedure.CONCLUSION:The same-day administration of Senna alkaloids appears to be a safe and effective bowel cleansing protocol for colonoscopy procedures.

Safety of same-day endoscopic ultrasound and endoscopic retrograde cholangiopancreatography under conscious sedation

AIM: To assess the tolerability and safety of same-day tandem procedures, endoscopic ultrasound (EUS) followed by endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation. METHODS: A retrospective review was conducted at Loma Linda University Medical Center, a tertiary-care center. All 54 patients who underwent EUS followed by ERCP (group A) from 2004 to 2006 were included in the study. A second group of 56 patients who underwent EUS only (group B), and a third group of 53 patients who underwent ERCP only (group C) during the same time period were selected consecutively as control groups for comparison. RESULTS: Conscious sedation was used in 96% of patients in group A. Mean dosages of meperidine and midazolam used in group A were signifi cantly higher than in group B or C. Mean recovery time in group A was not statistically longer than in group B or C. Therewas no signifi cant difference in the incidence of sedation-related and procedural-related complications. CONCLUSION: Tandem EUS/ERCP procedure can be safely performed under conscious sedation with minimal adverse events. Combined procedures, however, are associated with higher dosages of sedatives, and slightly longer recovery time.

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

BACKGROUND Endoscopic submucosal dissection(ESD)is an established technique for the treatment of early gastrointestinal neoplasia.Generally,multi-day(M-D)admission is required for patients undergoing ESD due to potential complications.AIM To evaluate the feasibility of a same-day(S-D)discharge strategy for ESD of the esophagus or stomach.METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital.The propensity score matching(PSM)method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups.Intraoperative and postoperative parameters were compared between the matched groups.RESULTS Among the 479 patients reviewed,470 patients,including 91 in the S-D group and 379 in the M-D group,fulfilled the inclusion and exclusion criteria.Following PSM,78 patients in each group were paired using the 1:1 nearest available score match algorithm.No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events(AEs).Tumor size,complete resection rate,and procedural duration were comparable between the groups.The S-D group demonstrated a significantly shorter length of hospital stay(P<0.001)and lower overall medical expenses(P<0.001)compared with the M-D group.CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD,and the procedural-related AEs can be managed successfully.

The Current State of Transradial Access:A Perspective on Transradial Outcomes,Learning Curves,and Same-Day Discharge

The adoption of transradial access in the United States and internationally has been growing over the past few years.In the population of patients presenting with acute coronary syndromes,particularly ST-elevation myocardial infarction,transradial access has the benefit of fewer vascular and bleeding complications and lower mortality rates over transfemoral access.We will examine the current evidence supporting transradial access for several patient populations,including those patients presenting with acute coronary syndromes.We will review the literature regarding the learning curve for transradial access with new operators,as well as experienced transfemoral operators new to transradial access.Finally,we will investigate the role of transradial access in same-day discharge for stable patients undergoing percutaneous coronary intervention.

Same-day single-dose vs large-volume split-dose regimens of polyethylene glycol for bowel preparation:A systematic review and meta-analysis

BACKGROUND Split-dose regimens(SpDs)of 4 L of polyethylene glycol(PEG)have been established as the“gold standard”for bowel preparation;however,its use is limited by the large volumes of fluids required and sleep disturbance associated with night doses.Meanwhile,the same-day single-dose regimens(SSDs)of PEG has been recommended as an alternative;however,its superiority compared to other regimens is a matter of debate.AIM To compare the efficacy and tolerability between SSDs and large-volume SpDs PEG for bowel preparation.METHODS We searched MEDLINE/PubMed,the Cochrane Library,RCA,EMBASE and Science Citation Index Expanded for randomized trials comparing(2 L/4 L)SSDs to large-volume(4 L/3 L)SpDs PEG-based regimens,regardless of adjuvant laxative use.The pooled analysis of relative risk ratio and mean difference was calculated for bowel cleanliness,sleep disturbance,willingness to repeat the procedure using the same preparation and adverse effects.A random effects model or fixed-effects model was chosen based on heterogeneity analysis among studies.RESULTS A total of 18 studies were included.There was no statistically significant difference of adequate bowel preparation(relative risk=0.97;95%CI:0.92-1.02)(14 trials),right colon Boston Bowel Preparation Scale(mean difference=0.00;95%CI:-0.04,0.03)(9 trials)and right colon Ottawa Bowel Preparation Scale(mean difference=0.04;95%CI:-0.27,0.34)(5 trials)between(2 L/4 L)SSDs and large-volume(4 L/3 L)SpDs,regardless of adjuvant laxative use.The pooled analysis favored the use of SSDs with less sleep disturbance(relative risk=0.52;95%CI:0.40,0.68)and lower incidence of abdominal pain(relative risk=0.75;95%CI:0.62,0.90).During subgroup analysis,patients that received low-volume(2 L)SSDs showed more willingness to repeat the procedure using the same preparation than SpDs(P<0.05).No significant difference in adverse effects,including nausea,vomiting and bloating,was found between the two arms(P>0.05).CONCLUSION Regardless of adjuvant laxative use,the(2 L/4 L)SSD PEG-based arm was considered equal or better than the large-volume(≥3 L)SpDs PEG regimen in terms of bowel cleanliness and tolerability.Patients that received low-volume(2 L)SSDs showed more willingness to repeat the procedure using the same preparation due to the low-volume fluid requirement and less sleep disturbance.

Split-dose vs same-day bowel preparation for afternoon colonoscopies:A meta-analysis of randomized controlled trials

BACKGROUND Quality of bowel preparation in afternoon colonoscopies has been a struggle.Currently,a choice of same-day preparation(SaD)or split-dose preparation(SpD)exists;however,randomized controlled trials’results have varied.AIM To examine the outcomes of SaD and SpD for afternoon colonoscopies.METHODS An extensive literature search was conducted using multiple databases.Only randomized controlled trials(RCTs)in adults that compared SaD to SpD with Ottawa bowel preparation score(OBPS)were included.Odds ratio(OR)or mean difference was used to analyze outcomes.RESULTS Eleven RCTs were included(n=1846).No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD(OR 0.77;95%CI:-0.57-1.03;P=0.07;I2=5%).Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula(polyethylene glycol)(OR 0.83;95%CI:0.51-1.35;P=0.46;I2=39%)as well as receiving same formula and volume(4 L polyethylene glycol)(OR 1.14;95%CI:0.65-2.01;P=0.64;I2=0%).CONCLUSION In patients undergoing afternoon colonoscopies,SaD is comparable with SpD in terms of satisfactory bowel preparation.Further studies are needed to validate these results and determine the optimal formula and dosages.

Application of a new daytime surgery and same-day discharge mode in cataract clinic

Background:This study aims to investigate the application and effect of a new daytime surgery and same-day discharge mode in cataract clinic.Methods:Two hundred patients with cataract intended to undertake daytime surgery from August 2019 to January 2020 in the Cataract department were enrolled for the study.Among them,100 patients from January 2020 with the new daytime surgery and same-day discharge were the experimental group.While the other 100 patients without the designated set-up from August 2019 worked as a control group.The length and cost of hospitalization,the length of waiting for the elevator,the patient satisfaction,and the awareness rate of health education were evaluated.Results:After application of the new daytime surgery and same-day discharge set-up,the patients’satisfaction rate increased from 91%to 95%,and the rate of awareness of health education increased from 87%to 90%,the difference was statistically significant(χ^(2)=0.61,P=0.04 andχ^(2)=0.22,P=0.01).The length of hospitalization,hospitalization costs and waiting time for elevators were much reduced than those without this set-up.Conclusions:The application of the cataract daytime surgery and same-day discharge set-up can effectively alleviate the overcrowding of the ward environment,reduce the workload of medical staff,and improve patient satisfaction.Therefore,the daytime surgery and same-day discharge set-up has wide clinical applications.

Same-day delivery time-guarantee problem in online retail

This study introduces the same-day delivery time-guarantee(SDDTG)problem for supporting online retail.In the SDDTG,orders are placed online and are processed and delivered from a depot to customer locations in the same day.The problem seeks optimal delivery time guarantees to offer customers as they consider making purchases to increase purchase decision likelihood while accounting for delivery-related,supply-side costs that can affect profits.Time guarantees are decision variables rather than parameters(as is typical)and are designed around anticipated customer satisfaction levels and purchase likelihoods.Delivery deadlines are not merely given to customers once they make their purchases,but rather the attractiveness of the offered delivery guarantees affects whether they make their purchases,i.e.,whether demand is realized.The problem is conceptualized as a multistage,stochastic,mixed-integer program in which uncertainties associated with customer reaction to delivery time guarantee offers and their arrival over time are captured.Given a shrinking horizon over a fixed planning horizon,the multi-stage program is approximated by a series of two-stage programs.A parallelized progressive hedging solution methodology is proposed and insights from its application on a case study.The problem recognizes tradeoffs between meeting promised delivery times and capturing the market.

Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond

With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions,the number of procedures has significantly increased.With the increase in procedures,also comes an increase in cost.In view of this,efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity.Same-day discharge(SDD)after invasive cardiac procedures improves resource utilization and patient satisfaction.SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions.This is not the case for the majority of structural heart procedures.With the coronavirus disease 2019 pandemic,safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority.In light of this,it is prudent to assess the feasibility of SDD in several structural heart procedures.In this review we highlight the feasibility of SDD in a carefully selected population,by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion,patent foramen ovale/atrial septal defect closure,Mitra-clip,and trans-catheter aortic valve replacement procedures.