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| 1 | Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy显示文摘AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in series.For both oral and anal DBE,fluoroscopy time was reduced by greater than 50% over the course of 802 total procedures performed.Sub-group analysis was conducted on therapeutic and diagnostic groups.Out of 802 procedures,a total of 434 were considered therapeutic.Argon plasma coagulation was by far the most common therapeutic intervention performed.There was no evidence of a difference in length examined or fluoroscopy exposure among oral DBE for diagnostic and therapeutic procedures,P = 0.91 and P = 0.32 respectively.The median(IQR) for length was 235 cm(range:178-280 cm) for diagnostic vs 230 cm(range:180-275 cm) for therapeutic procedures;additionally,fluoroscopy time median(IQR) was 180 s(range:110-295 s) and 162 s(range:102-263 s) for no intervention and intervention.However,there was a significant difference in procedure duration among oral DBE(P < 0.001).The median(IQR) was 80 min(range:60-97 min) and 94 min(range:77-110 min) for diagnostic and therapeutic interventions respectively.CONCLUSION:For a single endoscopist,increased DBE experience with number of performed procedures is associated with increased efficiency and decreased resource utilization. | Neal C Patel William C Palmer Kanwar R Gill David Cangemi Nancy Diehl Mark E Stark | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，3： | 2 |
| 2 | Evaluation of downstream effects of specialty chemicals in the Bayer process显示文摘 | David O O Lawrence J C Peter A D Anthony E G Nancy L P | 1991 | Light Metals1991，，： | 1 |
| 3 | Heat treatment and fruit ripening显示文摘 | Robert E P Nancy J C | 2000 | Postharvest Biology and Technology2000，21，1： | 1 |
| 4 | Molecular simulation of sucrose solutions near the glass transition temperature显示文摘 | Nancy C E Paul B C Juan J P | 2001 | J Phys Chem A2001，105，4： | 1 |
| 5 | Validation of Companion Diagnostic for Detection of Mutations in Codons 12 and 13 of the KRAS Gene in Patients with Metastatic Colorectal Cancer: Analysis of the NCIC CTG CO.17 Trial显示文摘 | Harbison Christopher T Horak Christine E Ledeine Jean-Marie Mukhopadhyay Pralay Malone Daniel P O’Callaghan Chris Jonker Derek J Karapetis Christos S Khambata-Ford Shirin Gustafson Nancy Trifan Ovidiu C Chang Shao-Chun Ravetto Paul Green Geo | 2013 | Archives of Pathology & Laboratory Medicine2013，，6： | 1 |
| 6 | Survivable network analysis method显示文摘 | Nancy R M Robert J E Linger R C | 2000 | SEI Technical Report2000，13，： | 1 |
| 7 | Review of roadside wildflower programsand assessment of feasibility in Ontario,Downsville显示文摘 | JUANNITA E NANCY C | 1990 | Ontario Ministry of Transportation Research and Development Branch1990，，5： | 1 |
| 8 | Heat treatment and fruit ripening显示文摘 | Robert E P Nancy J C | 2000 | Postharvest Biology and Technology2000，21，1： | 1 |
| 9 | Interim clinical outcomes in the collaborative initial glaucoma treatment study comparing initial treatment randomized to medications or surgery显示文摘 | Paul R Lichter David C Musch Brenda W Gillespie Kenneth E Guire Nancy K Janz Patricia A Wren M.P.H.Richard P Mills | 2001 | Ophthalmology2001，，11： | 1 |
| 10 | Slash pile burning effects on soil biotic and chemical properties and plant establishment : Recommendation for amelioration显示文摘 | JUL1E E K NANCY C J COVINGTON W W | 2004 | Restoration Ecology2004，12，1： | 1 |
| 11 | The integration of problem-based learning strategies in distance education显示文摘 | Nancy E Kylie H Betty C | 1999 | Nurse Educator1999，24，1： | 1 |
| 12 | Occurrence of extended spectrum and AmpC β-lactamases in blood stream isolates of Klebsiella pneumonia :isolates harbor plasmid-mediated FOX-5 and ACT-1 AmpC β-1actamases显示文摘 | PHILIP E D NANCY D H MICHAEL W C | 2003 | J Clin Microb2003，41，2： | 1 |
| 13 | Exploring the material basis for health :Characteristics of parks in Montreal neighborhoods with contrastinghealth outcomes显示文摘 | STEPHANIE E C NANCY A R | 2006 | Health and Place2006，12，4： | 1 |
| 14 | Evolutionary analysis of human H2N2 and early H3N2 influenza viruses: evidence for genetic divergence and multiple reassortment among H2N2 and/or H3N2 viruses 显示文摘 | Stephen E L Nancy J C Alexander K | 2004 | Int Congr2004，1263，： | 1 |
| 15 | Early inpatient rehabilitation after elective hip and knee arthroplasty显示文摘 | Michael C Thomas E Nancy W | 1998 | J Am Med Associat1998，18，5： | 1 |
| 16 | Bril: a novel bone specific modu- lator of mineralization显示文摘 | Moffatt P Gaumond M H Salois P Sellin K Bes- sette M C Godin E de Oliveira P T Atkins G J Nanci A Thomas G | 2008 | Journal of Bone and Mineral Research: the official journal of the American Society for Bone and Mineral Research2008，23，14： | 1 |
| 17 | Iso- lation and characterization of adenosine nucleosidase from yellow lupin (Lupinus luteus)显示文摘 | Ekram Abusamhadneh Nancy E McDonald Paul C Kline | 2000 | Plant Science2000，，153： | 1 |
| 18 | Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis显示文摘 | Serign J Ceesay Climent Casals-Pascual Jamie Erskine Samuel E Anya Nancy O Duah Anthony JC Fulford Sanie SS Sesay Ismaela Abubakar Samuel Dunyo Omar Sey Ayo Palmer Malang Fofana Tumani Corrah Kalifa A Bojang Hilton C Whittle Brian M Greenwood David J Conw | 2008 | The Lancet2008，，9649： | 1 |
| 19 | Resources for physical activity participation: Does availability and accessibility differ by neighborhood soci- oeconomic status? 显示文摘 | PAUL A ESTABROOKS REBECCA E LEE NANCY C GYURCSIK | 2003 | Annals Behavioral Med2003，25，2： | 1 |
| 20 | Critical weed - free period for ' Beauregard' sweetpotato ( lpomoea batatas ) 显示文摘 | Jessica E S Nancy G C David W M | 2003 | Weed Technolo- gy2003，17，4： | 1 |
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