To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy ra...To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.展开更多
AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at averag...AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior col6rectal neoplasia （CRN） by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional da- tabase providing pathological results. Required documen- tation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a stan- dardized glossary with 10% independent data validation. Sample size calculations determined the number of re- ports needed.RESULTS： Two hundreds and fifty patients （63.2± 10.5 years, female： 42.8%, average risk： 38.5%, per- sonal/family history of CRN： 43.3%/20.2%） were scoped in June 2009 by 8 gastroenterologists and 3 surgeons （mean practice： 17.1 ± 8.5 years）. Procedural indica- tion and informed consent were always documented. 14% provided a previous colonoscopy date （past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness）. Most procedural indicators were recorded （exam date： 98.4%, medications： 99.2%, difficulty level： 98.8%, prep quality： 99.6%）. All reports noted extent of visualization （cecum： 94.4%, with landmarks noted in 78.8% - photodocu- mentation： 67.2%）. No procedural times were recorded. One hundred and eleven had polyps （44.4%） with ana- tomic location noted in 99.1%, size in 65.8%, morphol- ogy in 62.2%; removal was by cold biopsy in 25.2% （cold snare： 18%, snare cautery： 31.5%, unrecorded： 20.7%）, 84.7% were retrieved. Adenomas were noted in 24.8% （advanced adenomas： 7.6%, cancer： 0.4%） in this population with varying previous colonic investigations. CONCLUSION： This audit reveals lacking reported ite- ms, justifying additional research to optimize quality of reporting.展开更多
文摘To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.
基金Supported by The Research Scholar (Chercheur National) of the Fonds de la Recherche en Santé du Québec
文摘AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior col6rectal neoplasia （CRN） by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional da- tabase providing pathological results. Required documen- tation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a stan- dardized glossary with 10% independent data validation. Sample size calculations determined the number of re- ports needed.RESULTS： Two hundreds and fifty patients （63.2± 10.5 years, female： 42.8%, average risk： 38.5%, per- sonal/family history of CRN： 43.3%/20.2%） were scoped in June 2009 by 8 gastroenterologists and 3 surgeons （mean practice： 17.1 ± 8.5 years）. Procedural indica- tion and informed consent were always documented. 14% provided a previous colonoscopy date （past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness）. Most procedural indicators were recorded （exam date： 98.4%, medications： 99.2%, difficulty level： 98.8%, prep quality： 99.6%）. All reports noted extent of visualization （cecum： 94.4%, with landmarks noted in 78.8% - photodocu- mentation： 67.2%）. No procedural times were recorded. One hundred and eleven had polyps （44.4%） with ana- tomic location noted in 99.1%, size in 65.8%, morphol- ogy in 62.2%; removal was by cold biopsy in 25.2% （cold snare： 18%, snare cautery： 31.5%, unrecorded： 20.7%）, 84.7% were retrieved. Adenomas were noted in 24.8% （advanced adenomas： 7.6%, cancer： 0.4%） in this population with varying previous colonic investigations. CONCLUSION： This audit reveals lacking reported ite- ms, justifying additional research to optimize quality of reporting.
