Pediatric endoscopy across multiple clinical settings:Efficiency and adverse events

BACKGROUND Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood,and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings.Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner.However,there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments.We hypothesized that there are significant differences in efficiency between settings.AIM To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.METHODS A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy(EGD)or combined EGD and colonoscopy performed between January 1,2014 and May 31,2018 by 6 experienced pediatric gastroenterologists in three different clinical settings,including a tertiary care hospital operating room,community hospital operating room,and free-standing pediatric ambulatory endoscopy center at a community hospital.The following strict guidelines were used to schedule patients at all three locations:age greater than 6 mo;American Society of Anesthesiologists class 1 or 2;normal craniofacial anatomy;no anticipated therapeutic intervention(e.g.,foreign body retrieval,stricture dilation);and,no planned or anticipated hospitalization post-procedure.Data on demographics,times,admission rates,and adverse events were collected.Endoscopist time(elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering)and patient time(elapsed time from patient registration to that patient exiting the operating room or endoscopy suite)were calculated to assess efficiency.RESULTS In total,58%of the cases were performed in the tertiary care operating room.The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations.Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room(63.3±21.5 min vs 51.4±18.9 min,P<0.001)and 7 min longer compared to the endoscopy center(vs 56.6±19.3 min,P<0.001).Patient time at the tertiary care operating room was 11 min longer compared to the community operating room(133.2±39.9 min vs 122.3±39.5 min,P<0.001)and 9 min longer compared to the endoscopy center(vs 124.9±37.9 min;P<0.001).When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations,endoscopist,and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room.Adverse events from procedures occurred in 0.1%(n=2)of cases performed in the tertiary care operating room,with 2.2%(n=35)of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.CONCLUSION Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

Contribution to the Improvement of the Petroleum Products Delivery Policy by the Implementation of a Computer System Based on the Dijkstra Method

The distribution and marketing of petroleum products are the sources of energy for the various activities of human society and household supply. We spent our time researching the competitive factors to reduce the time of distribution of petroleum products, by setting up a computer system based on Dijkstra’s algorithm our contribution will solve a real problem of delivery with direct targeting of gas stations. We set up a tool to help to map based on the method of operational research starting with the identification of delivery point, mapping and then applying the algorithm. Mainly the graph theory and the optimal path in a network by a short path using the method of Dijkstra for the design we used the UML language, the programming we used the JAVA language with very appreciable results to finish with a conclusion.