Orientador: José Murilo Robilotta Zeitune / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T01:24:40Z (GMT). No. of bitstreams: 1 Queiroz_MorganaTerezinhaAlvesde_M.pdf: 3260768 bytes, checksum: 2aa8029cc1328e9fe42d3e132b96826a (MD5) Previous issue date: 2012 / Resumo: A endoscopia digestiva alta (EDA) é um dos exames mais indicados para a investigação das doenças do trato digestivo alto. Normalmente, é executada em hospitais de alta complexidade e em clínicas especializadas; porém a sua grande demanda tem feito com que estes exames sejam realizados com maior frequência em centros de média complexidade. Dessa forma, este estudo teve por objetivos analisar retrospectivamente os diagnósticos de EDA realizados numa população de atendimento primário da região sudoeste do município de Campinas, São Paulo, Brasil, no período de 2000 a 2007, definindo a taxa de exames normais e a prevalência das principais doenças no tubo digestivo alto e correlacionando esses diagnósticos com faixa etária, gênero e origem de atendimento; estabelecer a prevalência do Helicobacter pylori em um segmento da população estudada, de acordo com as doenças diagnosticadas; e, finalmente, oferecer subsídios para a implantação de um modelo de atendimento primário de EDA na rede pública. Este estudo foi desenvolvido a partir dos laudos de EDA arquivados no setor especializado do referente serviço e que foram analisados de modo descritivo e estatístico. A pesquisa para H. pylori foi realizada em 2.822 (56,44%) dos pacientes, através da histologia e/ou teste da urease. A qualidade do serviço foi determinada pela ausência de complicações e pela resposta a um questionário ilustrativo aplicado a uma parcela dos pacientes. As análises estatísticas foram realizadas pelo SAS (Statistical Analysis System), o nível de significância 5% (p<0,05), utilizando-se testes Qui-quadrado e exato de Fisher, e regressão logística para os cálculos de razões de risco (Odds ratio). Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino; com idade de 40 a 49 anos, independente do gênero.As mulheres tiveram dois picos prevalentes nas faixas etárias 18-29 anos e 40-49 anos; entre os homens a prevalência foi a partir de 60 anos.A maior frequência das doenças no segmento esofágico, no total de EDAs, foi de 25,96%;entre estas, esofagites 21,32% (597 do tipo erosiva e 469 do tipo não erosiva),neoplasias esofágicasmalignas 0,30% (três do tipoprecoce e 12 do tipoavançada). No segmento gástrico,a prevalência foi 79,74%, sendo gastrites crônicas 75,82%, úlcera gástrica9,10% e neoplasias malignas gástricas 0,58% (dez do tipo precoce e 19 do tipo avançada). Já nosegmento duodenal,o índice de anormalidades foide 32,96%, sendoúlcera duodenal19,34% e duodenites 17,74%. Entre os pacientes que realizaram a pesquisa para H. pylori, notou-se prevalência significativa naqueles com úlcera duodenal (49.07%). Exames endoscópicos normais foram verificados em 604 pacientes (12,08%) com valores estatisticamente representativos na faixa etária de 18 a 29 anos e no gênero feminino. Assim, após o estudo, chegou-se à conclusão de que é viável a implantação da EDA diagnóstica no atendimento primário de saúde, com equipe bem estruturada, favorecendo a ausência de índice de complicação decorrente do procedimento, o que também foi confirmado pela avaliação favorável expressa voluntariamente por alguns pacientes / Abstract: Upper digestive tract endoscopy (UDTE) is one of the most highly indicated exams for the investigation of upper digestive tract diseases. It is normally performed in high-complexity hospitals and specialized clinics; however, the high demand for UDTE examinations and the growing number of professionals specializing in endoscopic techniques have resulted in a higher availability of these procedures at medium-complexity healthcare facilities. So, the objectives of this study were to analyze the diagnoses obtained from UDTE examinations performed in a population of primary care patients from the Southwestern region of Campinas, São Paulo, Brazil, in the period from 2000 to 2007, defining the percentage of normal examinations and the prevalence of main diseases of the upper digestive tract and correlating these diagnoses with age, gender and source of referral; to establish the prevalence of Helicobacter pylori in one segment of the studied population based on the diagnosed diseases; and to offer supporting data for the implementation of a UDTE primary care model in the public healthcare system. The design of this retrospective study was based on the UDTE reports filed with the specialized department that offers the service. Descriptive and statistical analyses were performed on these reports. The quality of the service was assessed, based on the absence of complications and on the answers given to an illustrative questionnaire applied to a portion of the patients who underwent UDTE examinations. The statistical analyses were performed with the SAS (Statistical Analysis System) software, with a significance level of 5% (p<0.05). The tests applied were Chi-square and Fisher's exact test, as well as logistic regression for the calculation of odds ratios. During the general descriptive analysis, it was observedthat the majority of examinations was conducted on female patients; and on patients ages 40-49, irrespective of gender. There were two peaks of age prevalence among women (18-29 and 40-49 y.o.); among men, the prevalent age groupwas 60 y.o. and older. Among the 5,000 analyzed UDTE examinations, the prevalence of esophageal segment disease was 25.96%, including erosive and non-erosive esophagitis(21.32%); and early and advanced esophageal cancer (0.30%). Prevalence of disease in the gastric segment was 79.74%, including chronic gastritis (75.82%), gastric ulcers (9.10%) and gastric cancer (0.58%). In the duodenal segment, the rate of abnormalities was 32.96%, including duodenal ulcers (19.34%) and duodenitis (17.74%). Out of the 5,000 examinations, a total of 2,822 patients (56.44%) were selected for H. pylori testing using the histological and/or urease methods, to investigate the correlation of this bacterium with gastric and duodenal ulcers, as well as gastritis identified as micronodular after endoscopic examination. Normal endoscopic examinations were assessed from 604 patients (12.08%), which presented statistically representative values for the 18-29 years old age group and the female gender. In conclusion, with this study, the implementation of diagnostic UDTE using a well-structured medical team is a viable option in primary healthcare. Besides, according to the favorable assessments expressed voluntarily by some patients, the procedure does not produce complications / Mestrado / Clinica Medica / Mestre em Clinica Medica

Les endoscopes utilisés en gastro-entérologie ne permettent pas d’obtenir une réelle chirurgie dans le tube digestif en passant par les voies naturelles. Cette thèse a pour ambition de pallier ce manquement grâce au développement d’une plate-forme de triangulation universelle. Cette plateforme donne la possibilité au gastro-entérologue d’augmenter de manière significative ses possibilités thérapeutiques en lui permettant de réaliser des actes chirurgicaux de base tels que “soulever-couper” et “suturer” les tissus. Ces actes ne peuvent être réalisés qu’extrêmement difficilement avec les endoscopes conventionnels. Ils constituent pourtant les éléments essentiels en vue de traiter l’obésité morbide ou le traitement du reflux gastro-oesophagien par les voies naturelles. La caractéristique principale de la plate-forme développée dans cette thèse est son universalité lui permettant une utilisation avec pratiquement n’importe quel type d’endoscope et outils thérapeutiques existants sur le marché. La plate-forme a obtenu le marquage CE. Des études cliniques ont été réalisées avec cet instrument dans le cadre du traitement de l’obésité. Cette thèse comprend également une méthodologie de conception pour des guidages flexibles utilisés dans le domaine médical. Cette méthodologie basée sur l’élaboration d’abaques théoriques permet, d’une part, à partir des desiderata du médecin, d’identifier les paramètres externes (rigidité, longueur.) d’un guidage flexible et ce peu importe le type de guidage utilisé et, d’autre part, de déduire les paramètres internes associés à ces paramètres externes pour un type de guidage particulier: un élastomère renforcé par un ressort hélicoïdal. La méthode a été appliquée `a posteriori `a la plate-forme de triangulation et donne, dans ce cas, de bons résultats. Flexible endoscopes used in gastro-enterology do not allowed a real surgery in the gastrointestinal tract passing through natural orifices. This thesis aimed to overcome these limitations by developing a universal triangulation platform. This platform allows the gastro-enterologist to significantly increase his therapeutic possibilities by enabling him to perform basic surgical procedures such as "lifting-cutting" and "suturing" the tissues. These procedures can only be performed with extreme difficulty with conventional endoscopes. They are, however, the essential elements for the treatment of morbid obesity or gastroesophageal reflux through natural orifice. The main feature of the platform developed in this thesis is its universality allowing it to be used with any type of endoscopes and existing tools available on the market. The platform has obtained the CE marking. Clinical studies have been conducted with this instrument for treatment of obesity. This thesis includes also a design methodology for flexible guides used in the medical field. This methodology, based on the elaboration of theoretical abacuses, allows, firstly, from the physician's specifications, to identify the external parameters (rigidity, length .) of the flexible guide regardless of the type of the used guide. Secondly, it allows to determine the internal parameters associated with these external parameters for a particular type of guide: an elastomer reinforced by a helical spring. The method was applied a posteriori to the triangulation platform and, in this case, gives good results. / Doctorat en Sciences de l'ingénieur et technologie / info:eu-repo/semantics/nonPublished

Upper airway endoscopy at rest has been the diagnostic method of choice for diagnosing equine upper respiratory tract (URT) disease since its development in the 1970´s. The development of high-speed treadmill endoscopy (HSTE) improved the sensitivity of URT endoscopy by allowing the examiner to observe the horse’s nasopharynx and larynx during exercise. However, the level of exertion achieved during HSTE may not always represent that achieved during normal exercise as surface, rider, tack, and environmental variables are altered. Recently, the development of dynamic overground endoscopy (DOE) has addressed some of those shortcomings. A retrospective study was undertaken to describe the upper airway abnormalities detected during DOE in horses presenting with poor performance and/or abnormal respiratory noise in South Africa. Patient records of Thoroughbred racehorses undergoing DOE from November 2011 to August 2012 by the Onderstepoort Veterinary Academic Hospital were reviewed. Data collected included signalment, primary complaint, distance exercised, maximum speed attained, and dynamic airway abnormalities detected. XIII A second study was carried out to evaluate agreement within and among examiners of three grading systems for laryngeal function at exercise. The grading systems assessed were an existing system for grading axial deviation of aryepiglottic folds (ADAF), a modified system for grading recurrent laryngeal neuropathy (RLN) at exercise, and a proposed system for grading vocal cord collapse (VCC). For investigation of intra-observer variability, recordings were watched by two of the investigators at the same time, on two different occasions, in real time, slow motion, and at frame-by-frame speed. To evaluate inter-observer variability, recordings were watched by four investigators on one occasion, as described for investigation of intra-observer variability, and scoring sheets completed. Kappa agreement was calculated for both intra- and inter-observer sessions. Fifty-two horses that underwent DOE for investigation of poor performance and/or abnormal respiratory noise were identified. The main abnormalities detected included dorsal displacement of the soft palate (DDSP) (13/52 horses, 25%); recurrent laryngeal neuropathy (RLN) (17/52 horses, 33%); axial deviation of the aryepiglottic folds (ADAF) (21/52 horses, 40%) and vocal cord collapse (VCC) (18/52 horses, 35%). A total of 40 horses presented one or more abnormalities of the URT (77%). Fifteen horses (29%) had a single abnormality, and 25 horses (48%) had multiple abnormalities. Results at frame-by-frame speed from the intra-observer evaluations for all the conditions showed substantial agreement for RLN by both observers (K = 74 - 80). Intra-observer evaluations for VCC were moderate to substantial (K 53 – 63). ADAF was the most difficult URT abnormality to assess for both observers, and agreement within observers was only fair to moderate (K = 36 - 52). Inter-observer evaluations for RLN showed substantial to moderate agreement (K = 62). Inter-observer evaluations for VCC showed moderate agreement (K = 47 – 54), and inter-observer evaluations for ADAF showed only slight to fair agreement and were the lowest for all the conditions (K = 14 – 22). This study showed that DOE is a useful technique for providing valuable information about disease of the URT. Finding multiple abnormalities in 48% of horses examined using DOE suggests that DOE may be indicated even for those horses with an obvious abnormality found during resting endoscopy. The intra-observer evaluations showed that RLN had higher agreement values than those for ADAF and VCC at all speeds, and that ADAF had lower agreement values than those for VCC and RLN at all speeds. Inter-observer agreement was less than intra-observer agreement, presumably because more observers were involved in the inter-observer assessment. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Companion Animal Clinical Studies / unrestricted

Introduction – Le but de ce travail était de développer un modèle expérimental endoscopique de chirurgie bariatrique par technique NOTES, simple, reproductible et de le valider à la fois sur le plan clinique (faisabilité, tolérance) et sur le plan métabolique (physiopathologie et mode d’action). Matériels et méthodes - Les études furent menées au sein du CERC et de l’unité INSERM UMRS 1260. L’animal étudié fut le cochon domestique, âgé de 3 à 4 mois, sains et non obèse. Les endoscopies étaient réalisées à l’aide d’un gastroscope double canal opérateur et de matériel d’endoscopie couramment disponible. Plusieurs étapes de développement furent mises en place de la confection d’un modèle animal d’anastomose gastro-jéjunale par technique endoscopique NOTES exclusive à l’évaluation de l’impact métabolique d’un modèle de by-pass gastrique à visée bariatrique utilisant l’anastomose gastro-jéjunale par apposition prothétique luminale. Résultats – Le modèle d’anastomose gastro-jéjunale choisi pour sa faisabilité et son innocuité fut développé par apposition des lumières digestives gastriques et grêliques avec prothèse en technique NOTES trans digestive. L’évaluation métabolique expérimentale du by-pass gastrique utilisant ce mode opératoire permit de constater une amélioration significative de l’insulino-résistance non véhiculées par le GLP-1. Conclusion – Le concept d’anastomose digestive par NOTES exclusive et apposition luminale prothétique est établi et le modèle de by-pass endoscopique utilisant ce mode opératoire est faisable semblant présenter un impact métabolique significatif. / Introduction - The aim of this study was to develop an endoscopic experimental model of NOTES bariatric surgery using a simple, reproducible technique and to validate it both clinically (feasibility, tolerance) and metabolically (pathophysiology and action plan). Materials and Methods - The studies were conducted within the CERC and INSERM UMRS 1260 unit. The animal was the pig, aged 3 to 4 months, healthy and not obese. Endoscopies were performed using a dual channel gastroscope operator and the endoscopy equipment currently available. Several development stages were set up from the development of an animal model of gastrointestinal anastomosis using an exclusive endoscopic NOTES procedure to the evaluation of the metabolic impact of gastric bypass bariatric model described using the gastrointestinal anastomosis by luminal apposing stent technique. Results - The gastro-jejunal anastomosis model chosen for its feasibility and safety was developed by luminal apposing gastric and small bowel digestive lumens with a specific metallic covered stent and NOTES technique. The experimental evaluation of the metabolic gastric bypass using this procedure allowed to observe a significant improvement in insulin resistance none mediated by GLP-1 and incretin effect. Conclusion - The concept of anastomosis with luminal apposing stent and exclusive NOTES technique is established and endoscopic bypass model using this procedure is feasible pretend to present a significant metabolic impact.

Les procédures gastro-intestinales de l’oesophage impliquent un contrôle ou une surveillance périodique de l'anatomie interne (réalisation de multiples biopsies le long de l’oesophage). Le suivi et la relocalisation inter-opératoires de ces sites de biopsies (pour un même patient opéré plusieurs fois) est un challenge bien connu. L'objectif de cette thèse est de proposer une solution informatisée afin de guider le gastroentérologue pendant de telles procédures. Nous proposons un cadre novateur utilisant un système de suivi électromagnétique pour réaliser des enregistrements d'intervention de l’oesophage, couplant la vidéo à la profondeur de l'endoscope inséré. Ces enregistrements sont ensuite utilisés afin de repositionner l'endoscope de façon précise sur des sites de biopsie préalablement ciblés. Cette navigation consiste en une synchronisation vidéo entre la vue endoscopique courante et celles des surveillances endoscopiques précédentes enregistrées. Une première version de notre système est évaluée de manière incrémentale sur des données d'abord synthétiques puis réelles recueillies sur des cochons. Les résultats montrent que la relocalisation est obtenue avec une précision de l'ordre de 10mm, considérée comme largement acceptable par les experts. En outre, une expérience qualitative simulant une tâche réelle de relocalisation de site de biopsie, évaluée par 10 gastroentérologues, démontre les avantages du système de guidage assisté. Ce cadre est finalement étendu afin d'améliorer encore la précision de la relocalisation à partir d'une sélection optimale de l'image vidéo pré-enregistrée dont le point de vue est le plus proche de celui de l'image endoscopique courante / Gastrointestinal (GI) procedures, specifically, oesophageal interventions involve periodic monitoring or surveillance of the internal anatomy, which involve obtaining biopsies at different regions along the oesophagus. The tracking and relocalization of these biopsy sites ``inter-operatively'' poses a significant challenge for providing targeted treatments. This thesis, clarifies the concept of relocalization, and analyses the need for a platform to aide GI endoscopy. Based on the understanding of the clinical context in oesophageal procedures; a novel framework to use electromagnetic tracking system is proposed, which is used to perform a ``recording'' of an intervention. This framework and the recording is then used to provide a guided navigation to the GI expert, during a follow-up surveillance endoscopy; for accurate re-positioning of the endoscope at previously targeted sites. This is achieved using inter-operative video synchronization, and the various steps involved in achieving this are described in this thesis. A careful analysis of noise affecting the system is performed, to propose quantitative analysis using synthetic and realdata collected on pigs. A set of qualitative experiments were also proposed using 10 experts to indicate benefit to the GI community. The quantitative experiment indicated that the relocalization was achieved with an accuracy of 10mm, and the qualitative experiments showed that the biopsy site relocalization rate improved from 47.5% to 94%. The thesis then proceeds to provide two additional improvements using additional information collected during the GI intervention for a complete solution

Introducción: La hemorragia digestiva alta (HDA) es una de las emergencias más frecuentes en medicina. Parte de su abordaje incluye la realización de una segunda endoscopia de control programada llamada “second look” (SL) con el propósito de reducir la incidencia de resangrado. No obstante, existe controversia en cuando su indicación y utilidad. Objetivo: Evaluar la efectividad del SL en la prevención del resangrado intrahospitalario en pacientes adultos con HDA no variceal. Métodos: Se llevó a cabo un estudio de cohorte retrospectivo sobre 1 144 pacientes con diagnóstico de HDA admitidos en la Unidad de Hemorragia Digestiva de un centro de referencia de la Seguridad Social en Lima, Perú; durante los años 2012 y 2014. La variable de respuesta fue el resangrado y la variable de exposición fue la programación a SL. Además se midió la hemoglobina al ingreso, comorbilidades, trasfusión de paquetes globulares y variables endoscópicas. Se calculó la incidencia acumulada (IA), riesgo relativo (RR), efectividad y mediante un modelo lineal generalizado de familia Poisson link log con errores estándar robustos se estimaron razones de tasas de incidencia (RTI). Resultados: La IA global de resangrado fue de 24,48% (n=280). Se encontró diferencia significativa entre las incidencias acumuladas (IA) entre el grupo de SL y el grupo de control (11,7 % vs 29,0 %, respectivamente, p<0,01). El RR fue 0,40 (IC95%:0,29-0,56) y la efectividad fue de 59,81% (IC95%: 44,17-71,08). En los modelos de regresión también se encontró una disminución de las tasas de incidencia tanto en el modelo crudo (RTI: 0,34 IC95%: 0,24-0,49), como en el modelo ajustado con diferencia estadística significativa entre los sometidos y no sometidos a SL (RTI: 0,12 IC95%: 0,08-0,18), por las variables asociadas con el resangrado (RTI: 0,21 IC95%: 0,15-0,30) y por las variables que cumplían los criterios clásicos de confusión (RTI: 0,12 IC95%: 0,08-0,18). Conclusiones: El SL es efectivo en la prevención de resangrado intrahospitalario en pacientes adultos con HDA en un hospital de referencia nacional. / Background: Upper gastrointestinal bleeding (UGIB) is one of the most common medical emergencies. Part of its approach includes performing a second endoscopy, known as second look (SL). However, its indications and usefulness are controversial. Objectives: To evaluate the effectiveness of SL in preventing nosocomial rebleeding in adult patients with non-variceal upper gastrointestinal bleeding. Methods: A retrospective cohort of 1144 patients diagnosed with UGIB admitted at a Digestive Bleeding Unit of a reference center for Social Security in Lima, Peru was performed; during the years 2012 and 2014. The response variable was rebleeding and the exposure variable was programmed SL. Besides hemoglobin on admission, comorbidities, blood transfusion and endoscopic variables were measured. The cumulative incidence, relative risk (RR) and effectiveness were calculated, and using a generalized linear model of the Poisson family link log with robust standard errors, incidence rate ratios (IRR) were estimated. Results: The cumulative incidence rebleeding overall was 24.48% (n = 280). Significant difference between the cumulative incidences (IA) between the SL group and the control group (11.7% vs 29.0%, respectively, p <0.01) was found. The RR was 0.40 (95% CI 0.29 - 0.56) .The calculated effectiveness was 59.81% (95% CI: 44.17 - 71.08). The regression models also found a decrease in incidence in both crude model (IRR: 0.34 95% CI 0.24 to 0.49) and in the adjusted models. The first model was adjusted for variables with statistically significant differences between exposed and unexposed (IRR: 0.12 95% CI 1.8 to 0.18), the second was adjusted for variables that were significantly associated with rebleeding (IRR 0.21 95% CI 0.15-0.30). The third model was adjusted for variables that met classical criteria of confusion (IRR: 0.12 95% CI 0.08 to 0.18). / Tesis

Objectives: Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods: The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results: The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (

Für eine optimale Prävention und die Beurteilung verschiedener Krankheitsverläufe ist eine regelmäßige, ambulant durchgeführte Gastroskopie erforderlich. Diese wird am Universitätsklinikum Leipzig (UKL) als orale Gastroskopie angeboten. Dabei können die Patienten, sofern keine medizinische Kontraindikation besteht, gemäß der Leitlinie zwischen einer Untersuchung mit oder ohne Sedierung wählen. Eine weitere Wahlmöglichkeit für die Patienten, um eine Sedierung und die damit einhergehenden Risiken zu vermeiden, stellt das Angebot der nasalen Gastroskopie dar. Von September 2016 bis März 2017 führten wir die prospektive klinische Studie „Besteht die Notwendigkeit der Verfügbarkeit nasaler Gastroskopie in der Routinediagnostik“ in der interdisziplinären zentralen Endoskopie am UKL durch. Konkret hatte diese Studie das Ziel, Aufschluss über den möglichen Patientenwunsch einer Wahloption der nasalen Methode unter den ambulanten Patienten des UKLs zu geben. Darüber hinaus sollte mit der Studie ermittelt werden, welche Gründe die Patienten für ihre Entscheidung angeben, ob bereits Vorerfahrungen bestehen, wie sich ggf. bestehende Vorerfahrungen auf die Entscheidung auswirken und ob die dann durchgeführte Untersuchung die Präferenz für eine zukünftige Untersuchung verändern würde. Die nasale Gastroskopie hat sich in der durchgeführten Untersuchung als eine sichere und von Patienten gut tolerierte Alternative zur oralen Gastroskopie herausgestellt. Mit der Möglichkeit der Verminderung sedierungsassoziierter Risiken, der Senkung der anfallenden Kosten sowie der Ermöglichung einer gastroskopischen Untersuchung bei Patienten, bei denen die Durchführung der oralen Gastroskopie nicht möglich ist, könnte die nasale Gastroskopie einen großen Gewinn für die Endoskopie darstellen.:Inhaltsverzeichnis I Abkürzungsverzeichnis 1 Bibliographische Beschreibung . 2 Einleitung 2.1 Hintergrund 2.2 Historische Entwicklung und Erscheinungsformen der Gastroskopie 2.2.1 Orale Gastroskopie 2.2.2 Nasale Gastroskopie 2.2.3 Sedierung während der Gastroskopie 2.2.4 Aktuelle Studienlage 2.3 Fragestellung der Studie 3 Publikation 4 Zusammenfassung der Arbeit 5 Literaturverzeichnis 6 Anlage 1 – Fragebogen an die Patienten und Patientinnen 7 Anlage 2 – Fragebogen an die behandelnden Ärzte II Darstellung des eigenen Beitrags III Erklärung über die Eigenständigkeit der Arbeit IV Verzeichnis der wissenschaftlichen Veröffentlichungen und Vorträge

Die vorliegende Bachelorarbeit stellt die Implementierung einer umfassenden Koordination in einer universitären Endoskopie dar und untersucht die Beeinflussung der Koordination auf Untersuchungszahlen, Mehrarbeitszeiten des nicht-ärztlichen Personals, Verteilung dieser Mehrarbeitszeiten zwischen Voll- und Teilzeitarbeitnehmern, als auch Wartezeiten der Patienten vor Ort. Die Ergebnisse bestätigen den positiven Einfluss der Koordination so dass bei kontinuierlicher Leistungssteigerung die Kapazitäten für einzelne Untersuchungsformen erhöht, die Patientenwartezeit deutlich verringert und die Mehrarbeitszeiten des nicht-ärztlichen Personals mit einem ausgewogenem Verhältnis dieser zwischen Voll- und Teilzeitarbeitnehmern vermindert werden konnten. / This bachelor thesis presents the implementation of a comprehensive coordination in a university endoscopy and examines the influence of the coordination on examination numbers, overtime hours of the non-physician staff, distribution of these overtime hours between full- and part-time employees, as well as waiting times of the patients on site. The results confirm the positive influence of the coordination so that with continuous performance improvement the capacities for individual examination forms could be increased, the patient waiting time could be significantly reduced and the overtime of the non-physician staff could be decreased with a balanced ratio of these between full- and part-time employees.

Contamination is a prevalent issue with reprocessed levered endoscopes. The number of infections caused by resistant enterobacteriaceae in patients due to contaminated endoscopes increased to the point that the United States Food and Drug Administration released a safety alert to health care facilities that perform endoscopic retrograde cholangiopancreatography (ERCP). The purpose of this descriptive project was to evaluate if levered endoscopes used in ERCP procedures met high level disinfection criteria, were properly processed, and were germ free after reprocessing. The project was supported by 2 theories: the middle range theory of patient advocacy and the germ theory. Data (counts and percentages) were collected from testing 150 endoscopes at each of 4 facilities within an organization regarding the effectiveness of the reprocessing of the levered endoscopes. According to the project findings, there was a 7% average germ-free failure rate across the sites after the initial reprocessing. The cleaning process of the levered endoscopes allowed bacteria to remain on the scopes after the manufacturer-recommended cleaning was completed at the sites. Standardization of the organization's cleaning process and improvement in the national protocols were recommended. The project supported protecting the safety of endoscopy patients by identifying that the cleaning process could be improved to prevent introduction of infectious bacteria through a procedure. The results will be informative for laboratory staff who clean levered endoscopes, physicians who use the scopes in patient procedures, patients who undergo the procedures, and nurses who are tasked with improving patient safety in perioperative environments.