Post-endoscopic procedure satisfaction scores: Can we improve?

AIM To organize post-procedure satisfaction data into a useful reference and analyze patient-centered parameters to find trends that influence patient satisfaction.METHODS A robust database of two cohorts of outpatients that underwent an endoscopic procedure at Georgetown University Hospital at two separate three-month intervals ranging from November 2012 to January 2013 and November 2015 to January 2016 was compiled. Time of year was identical to control for weather/seasonal issues that may have contributed to the patient experience. The variables recorded included age, sex, body mass index(BMI), type of procedure, indication for procedure, time of the procedure, length of the procedure, type of prep used, endoscopist, satisfactory score, and comments/reasons for score. For continuous variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, and ANOVA as appropriate. For categorical variables, differences in proportions between two groups were tested by χ~2 test. Correlation test and linear regression analyses were conducted to examine relationships between length of procedure and continuous predictors. A P value < 0.05 used to indicate statistically significant relationship.RESULTS The primary outcome of this study was to assess if telephone outreach after an endoscopic intervention was a satisfactory method of obtaining post-procedure satisfaction scores from patients at a tertiary care center. With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5%(508/1256 patients) from a prior completion rate of 3.4%(31/918) with the mail out survey initially. There was a statistically significant improved response rate pre and post intervention with P < 0001. The secondary outcome of this study was to assess if we could use predictive analytics to identify independent predictors of procedure length, such as gender, age, type of procedure, time of procedure, or BMI. The combined pre and post intervention data was used in order to optimize the power to identify independent predictors of procedure length. The total number of patient's data analyzed was 2174. There was no statistically significant difference in procedure length between males and females with P value 0.5282. However, there was a small(1 min), but statistically significant difference(P = 0.0185) in procedure length based on the time of day the procedure took place, with afternoon procedures having a longer duration than morning procedures. The type of procedure was an independent predictor of procedure length as demonstrated with P value < 0.0001. There is a statistically significant correlation between age and procedure length, although it is only a weak relationship with a correlation coefficient < 0.3. Contrary to patient age, BMI did not have a statistically significant correlation with procedure length(P = 0.9993), which was also confirmed by linear regression analysis.CONCLUSION Our study proves calling patients after endoscopy improves post-procedure satisfaction response rates and changing procedural time allotment based on patient characteristics would not change endoscopic workflow.

Endoscopic ultrasonography-guided fine needle aspiration:Relatively low sensitivity in the endosonographer population

AIM： To assess the characteristics and quality of endoscopic ultrasonography-guided fine needle aspiration （EUS-FNA） in a large panel of endosonographers.METHODS： A survey was conducted during the 13th annual live course of endoscopic ultrasonography （EUS） held in Amsterdam, Netherlands. A 2-page question- naire was developed for the study. Content validity of the questionnaire was determined based on input by experts in the field and a review of the relevant literature. It contained 30 questions that pertained to demographics and the current practice for EUS-FNA of responders, including sampling technique, sample processing, cytopathological diagnosis and sensitivity of EUS-FNA for the diagnosis of solid mass lesions. One hundred and sixty-one endosonographers whoattended the course were asked to answer the survey. This allowed assessing the current practice of EUS-FNA as well as the self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions. We also examined which factors were associated with a self-reported sensitivity of EUS-FNA for the diagnosis of solid mass lesions 〉 80%.RESULTS： Completed surveys were collected from 92 （57.1%） of 161 endosonographers who attended the conference. The endosonographers had been practio ing endoscopy and EUS for 22.5 4. 7.8 years and 4.8 4- 4.1 years, respectively; one third of them worked in a hospital with an annual caseload 〉 100 EUS-FNA. Endoscopy practices were located in 29 countries, in- cluding 13 countries in Western Europe that totaled 75.3% of the responses. Only one third of endosonog raphers reported a sensitivity for the diagnosis of solid mass lesions 〉 80% （interquartile range of sensitivities, 25.0%-75.0%）. Factors independently associated with a sensitivity 〉 80% were （1） 〉 7 needle passes for pancreatic lesions or rapid on-site cytopathological evaluation （ROSE） （P 〈 0.0001）, （2） a high annual hospital caseload （P = 0.024） and （3） routine isolation of microcores from EUS-FNA samples （P = 0.042）. ROSE was routinely available to 27.9% of respondents. For lymph nodes and pancreatic masses, a maximum of three needle passes was performed by approximately two thirds of those who did not have ROSE. Microcores were routinely harvested from EUS-FNA samples by approximately one third （37.2%） of survey respondents.CONCLUSION： EUS-FNA sensitivity was considerably lower than reported in the literature. Low EUS-FNA sensitivity was associated with unavailability of ROSE, few needle passes, absence of microcore isolation and low hospital caseload.

Survey of Genomics Approaches to Improve Bioenergy Traits in Maize,Sorghum and Sugarcane

Bioenergy crops currently provide the only source of alternative energy with the potential to reduce the use of fossil transportation fuels in a way that is compatible with existing engine technology, including in developing countries. Even though bioenergy research is currently receiving considerable attention, many of the concepts are not new, but rather build on intense research efforts from 30 years ago. A major difference with that era is the availability of genomics tools that have the potential to accelerate crop improvement significantly. This review is focused on maize, sorghum and sugarcane as representatives of bioenergy grasses that produce sugar and/or lignocellulosic biomass. Examples of how genetic mapping, forward and reverse genetics, highthroughput expression profiling and comparative genomics can be used to unravel and improve bioenergy traits will be presented.

Measuring Exterior Housing Quality in Four Older-Urban Neighbourhoods in Windsor, Ontario

Four theoretically-deduced hypotheses about geographical and temporal variations in exterior housing quality within a neighbourhood are summarized as a renovation- or deterioration-of-self effect, a contagion-down-the-street effect, a distance-from-riverbank effect, and a distance-from core effect. These hypotheses are tested with data for the exterior conditions of hundreds of single- detached (-like) houses that have been individually surveyed twice with the same instrument in four older-urban neighbourhoods in Windsor, Ontario, Canada. Each surveyed house’s rated conditions of 12 exterior attributes are in particular utilized to calculate its overall exterior quality as a percentage above or below normal. Findings are that houses’ exteriors had average “normal” weathered conditions for Canada. Even so, overall exterior housing qualities in three neighbourhoods exemplified a hypothesized deterioration-of-self effect and proximity-to-core effect, as they had especially declined from their original survey to their resurvey for houses located near to a core such as downtown or a casino. In addition, the hypothesized distance-from-riverbank effect was observed in one neighbourhood where overall exterior housing quality linearly deteriorated with farther distance from a riverbank. Finally, overall exterior housing qualities had no observable contagion-down-the-street effect, and so, residents were not reacting positively or negatively to their neighbours’ maintenance and improvement of their homes’ exteriors. The practical implications of the study’s findings are discussed in the conclusion.