September 23rd, 2011 by M. Brian Fennerty, M.D. in Research
No Comments »
The right side of the colon seems to be the Achilles heel of colonoscopy because polyps there tend to be flat and harder to find, and we confer the least protection from later colon cancer in that zone.
A recent article summary in Journal Watch Gastroenterology concludes that when we see a right-sided colon polyp, we may have missed another, so we should go back and look again.
This provocative recommendation represents a major change in the way we normally perform colonoscopy. But the issue is, and always has been, how to identify and remove all polyps from the colon.
So the questions I have Read more »
*This blog post was originally published at Gut Check on Gastroenterology*
August 14th, 2011 by ChristopherChangMD in Health Tips, Opinion
No Comments »
I was informed about this interesting concept on ABC news…
With many aging baby boomers tapping into cosmetic surgery in order to look younger, some are taking it a step further to “sound” younger as well with a “voice lift”.
For some, it’s not right to look 10-20 years younger after a facelift but still sound like 70 years old.
A hoarse voice with aging is not unusual, but a surgical “voice-lift” is not necessarily the first step that should be taken.
First things first… Read more »
*This blog post was originally published at Fauquier ENT Blog*
August 3rd, 2011 by Michael Kirsch, M.D. in Opinion, Research
2 Comments »
Most of us born several decades ago, recall the futuristic book Fantastic Voyage by Isaac Asimov, where a miniaturized crew traveled through a human body to cure a scientist who has a blot clot lodged in his brain. Ironically, miniaturized medical care is now upon us while books are at risk of becoming obsolete.
I hope that gastroenterologists won’t become obsolete, at least until my last kid graduates from college.
I perform an amazing diagnostic procedure called wireless capsule endoscopy (WCE), when patients swallow a camera. Once swallowed, this miniaturized camera takes its own fantastic voyage through the alimentary canal. The test is used primarily to identify sources of internal bleeding within the 20 feet of small intestine, which are beyond the reach of gastroenterologists’ conventional scopes. I have performed over 200 of these examinations, and I am still awestruck when I watch a ‘movie’ of someone’s guts. While most examinations do not reveal significant findings, I have seen dramatic lesions that were bleeding before my eyes. WCE can crack a cold medical case wide open.
Here’s a typical view of the small bowel as seen by the cruising camera: Read more »
*This blog post was originally published at MD Whistleblower*
May 24th, 2011 by M. Brian Fennerty, M.D. in Health Tips
No Comments »
I have noticed that we all think we are the best endoscopist around (in my case, that is indeed true!). However, we really never measured colonoscopy skill as a “patient-centered” metric and instead often use speed, efficiency, sedation needs, etc. when judging our colleagues. What is more important than these measures, however, is whether we find and remove adenomas, thereby preventing colon cancer downstream in our patients.
A number of surrogate markers for quality colonoscopy and polyp detection have been used in the past, including scope-withdrawal time from the cecum. But the one measure that has been the best predictor of quality is an endoscopist’s ADR (adenoma detection rate). In fact, this is the most reliable quality measure yet determined, and it may become the basis for being paid for these procedures in the not so distant future.
So I need to ask you:
1) Do you know your ADR?
2) Do you or does your group compare your ADR to other endoscopists within your endoscopy unit or practice?
3) Is there a program to increase ADR in low performers in your endoscopy unit?
4) Do you use your ADR as a marketing tool?
5) What is your take on the ADR as a quality measure?
I look forward to hearing from you on this topic!
*This blog post was originally published at Gut Check on Gastroenterology*
