The "New Normal" Following the COVID-19 Pandemic: A Simple Infection-Prevention Measure Using a Surgical Mask during Transnasal Endoscopy.
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SUBMITTER: Higashimori A
PROVIDER: S-EPMC8357582 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
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The "New Normal" Following the COVID-19 Pandemic: A Simple Infection-Prevention Measure Using a Surgical Mask during Transnasal Endoscopy.
Higashimori Akira A Maruyama Hirotsugu H Nadatani Yuji Y Fujiwara Yasuhiro Y
Clinical endoscopy 20210303 4
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Project description:ObjectivesScreening in selected high risk populations for Barrett's oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.DesignPurposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.SettingA secondary care endoscopy unit, clinic room and interview room.ParticipantsPatients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.ResultsThe themes that arose from our analysis were: inclusivity in one's own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.ConclusionsMost patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. Trial registration number ISRCTNregistry identifier: 70595405; Pre-results.
| S-EPMC6924752 | biostudies-literature
Project description:Background & aimsScreening for Barrett's esophagus (BE) with conventional esophagogastroduodenoscopy (C-EGD) is expensive. We assessed the performance of a clinic-based, single use transnasal capsule endoscope (EG Scan II) for the detection of BE, compared to C-EGD as the reference standard.MethodsWe performed a prospective multicenter cohort study of patients with and without BE recruited from 3 referral centers (1 in the United States and 2 in the United Kingdom). Of 200 consenting participants, 178 (89%) completed both procedures (11% failed EG Scan due to the inability to intubate the nasopharynx). The mean age of participants was 57.9 years and 67% were male. The prevalence of BE was 53%. All subjects underwent the 2 procedures on the same day, performed by blinded endoscopists. Patients completed preference and validated tolerability (10-point visual analogue scale [VAS]) questionnaires within 14 days of the procedures.ResultsA higher proportion of patients preferred the EG Scan (54.2%) vs the C-EGD (16.7%) (P < .001) and the EG Scan had a higher VAS score (7.2) vs the C-EGD (6.4) (P = .0004). No serious adverse events occurred. The EG Scan identified any length BE with a sensitivity value of 0.90 (95% CI, 0.83-0.96) and a specificity value of 0.91 (95% CI, 0.82-0.96). The EG Scan identified long segment BE with a sensitivity value of 0.95 and short segment BE with a sensitivity values of 0.87.ConclusionsIn a prospective study, we found the EG Scan to be safe and to detect BE with higher than 90% sensitivity and specificity. A higher proportion of patients preferred the EG Scan to C-EGD. This device might be used as a clinic-based tool to screen populations at risk for BE. ISRCTN registry identifier: 70595405; ClinicalTrials.gov no: NCT02066233.
| S-EPMC6330075 | biostudies-literature
Project description:IntroductionIn the absence of specific treatment, preventive strategies are of paramount importance in management of coronavirus disease 2019(COVID-19) pandemic. We estimated cost-effectiveness of non-pharmacological interventions such as hand-hygiene, surgical-mask N-95 respirators and surgical mask in general population.MethodsWe performed a decision tree and markov-model based economic evaluation. We estimated total costs and outcomes from public payer's perspective, based on information available through systematic literature search on relative intervention effect during early pandemic phase. We estimated outcomes as number COVID-19 prevented and Quality Adjusted life year (QALY) over one-year time-horizon with one-day cycle-length. Incremental cost effectiveness ratios (ICER) was calculated multiple sensitivity analyses were applied to assess parameter uncertainty.ResultsUse of surgical mask with hand hygiene, fit tested N-95 respirator, surgical-mask, non-fit tested N-95 and hand-hygiene interventions prevented additional 1139, 1124, 1121, 1043 and 975 COVID-19 cases per-million as compared to using none. Additional costs incurred (in billion) were ₹29.78 ($0.40), ₹148.09 ($1.99), ₹72.51 ($0.98), ₹26.84 ($0.36) and ₹2.48 ($0.03) as well as additional QALYs gained were 357.4, 353.01, 327.95, 351.52 and 307.04 for surgical mask with hand hygiene, fit-tested N-95, non-fit-tested N-95, surgical mask and hand-hygiene respectively. ICERs with surgical with hand hygiene, hand-hygiene alone, surgical-mask alone, N-95 respirator fit and non-fit test were 83.32($1.12), 8.07($0.11), 76.36($1.03), 419.51($5.65) and 221.10 ($2.98) million ₹ ($)/QALY respectively. Results were robust on uncertainty analysis.DiscussionAmong the non-pharmacological interventions to be considered for preventing spread of COVID-19, hand hygiene was cost-effective and avoidance of use of surgical masks and respirators by the general public could save resources.
| S-EPMC7859732 | biostudies-literature
Project description:BACKGROUND : Transnasal endoscopy presents a technical difficulty when inserting the flexible endoscope. It is unclear whether a particular breathing method is useful for transnasal endoscopy. Therefore, we conducted a prospective randomized controlled trial to compare endoscopic operability and patient tolerance between patients assigned to nasal breathing or oral breathing groups. METHODS : 198 eligible patients were randomly assigned to undergo transnasal endoscopy with nasal breathing or with oral breathing. Endoscopists and patients answered questionnaires on the endoscopic operability and patient tolerance using a 100-mm visual analog scale ranging from 0 (non-existent) to 100 (most difficult/unbearable). The visibility of the upper-middle pharynx was recorded. RESULTS : Patient characteristics did not differ significantly between the groups. Nasal breathing showed a higher rate of good visibility of the upper-middle pharynx than oral breathing (91.9 % vs. 27.6 %; P < 0.001). Nasal breathing showed lower mean [SD] scores than oral breathing in terms of overall technical difficulty (21.0 [11.4] vs. 35.4 [15.0]; P < 0.001). Regarding patient tolerance, nasal breathing showed lower scores than oral breathing for overall discomfort (22.1 [18.8] vs. 30.5 [20.9]; P = 0.004) and other symptoms, including nasal and throat pain, choking, suffocating, gagging, belching, and bloating (all P < 0.05). The pharyngeal bleeding rate was lower in the nasal breathing group than in the oral breathing group (0 % vs. 9.2 %; P = 0.002). CONCLUSIONS : Nasal breathing is superior to oral breathing for those performing and undergoing transnasal endoscopy. Nasal breathing led to good visibility of the upper-middle pharynx, improved endoscopic operability, and better patient tolerance, and was safer owing to decreased pharyngeal bleeding.
| S-EPMC9974334 | biostudies-literature
Project description:Study objectivesPositive airway pressure (PAP) adherence data are a routine aspect of clinical care for obstructive sleep apnea (OSA), but not uniformly available. We hypothesized that mask refills are a measure of PAP adherence.MethodsWe measured PAP use over the first 90 days of treatment in 123 patients with OSA. The number and timing of mask refills was assessed over 18 months. Demographic and medical information was obtained from the electronic medical record.ResultsAverage PAP use in the first week of more than 4 h/d was a predictor of adherence over the first 90 days (P < .0001). PAP use over 90 days was greater in datacard-derived data dependent on patients presenting a datacard to the clinic compared to modem-derived data (P = .0006). A mask refill within the first 30 days of treatment was associated with a 1.3 h/d lower PAP usage in the first 90 days (P = .0044). Conversely, the number of mask refills between 30 days and 18 months was associated with higher PAP adherence during the first 90 days, with an additional 0.61 h/d of use for each additional refill (P = .0015).ConclusionsIn a retrospective cohort of veterans with OSA, first week PAP use was a strong predictor of 90-day use. Use of autonomously transmitted modem data avoided potential selection bias in adherence estimates. Mask refills in the first month were associated with less 90-day PAP use, whereas more mask refills after 30 days were associated with greater PAP use.
| S-EPMC5656483 | biostudies-literature
Project description:BACKGROUND AND STUDY AIMS:?Screening for esophageal and gastric varices is indicated for patients with portal hypertension or cirrhosis. Typically, conventional endoscopy is used; however, the need for sedation increases the costs and risks, especially in cirrhotic patients. Use of transnasal endoscopy with an ultrathin endoscope enables study of the upper gastrointestinal tract without the need for sedation. The objective of this study is to evaluate the feasibility of transnasal endoscopy in screening for esophageal and gastric varices in patients with chronic liver disease. PATIENTS AND METHODS?:This was a prospective study in which transnasal endoscopy was carried out in patients with cirrhosis or portal hypertension who had indications for screening of esophageal and gastric varices. The following variables were evaluated: demographical data, duration of procedure, patient tolerance and acceptance, adverse events (AEs), endoscopic findings and interobserver agreement related to portal hypertension alterations ( kappa index). RESULTS?:A total of 50 patients entered the study. The most common cause of liver disease was chronic viral hepatitis (66?%). Among the cirrhotic patients, most of the patients were Child-Pugh A (74?%). In 5 patients (10?%), nasal intubation was not possible. Two patients (4?%) experienced minor epistaxis. Tolerance was excellent or good in 92?% according with a visual analogic scale. In 16 patients (32?%), esophageal varices were detected and in 2 patients (4?%) gastric varices were detected. The mean duration of the procedure was 7 minutes. CONCLUSIONS?:Transnasal endoscopy is feasible, effective and well tolerated for screening of esophageal and gastric varices in patients with chronic liver disease. It can be performed in outpatient clinics safely and without the use of sedation.
| S-EPMC5500113 | biostudies-literature
Project description:16S sequencing data from skin microbiota samples derived from female volunteers
| PRJEB45035 | ENA
Project description:BackgroundDuring the Covid-19 pandemic, the negative effects of wearing a mouth-nose cover (MNC) on interpersonal functioning have been discussed in public media but empirical studies on how wearing MNCs affect social judgements are sparse. In the present study, we investigated the effects of MNCs on trustworthiness appraisals, the influence of changes due to MNCs in evaluating joy, and the relationship between a social-cognitive appraisal bias and a participant's characteristics.MethodsAll participants (N = 165) judged the intensity of happiness and trustworthiness in calm facial stimuli presented with and without a surgical mask covering part of the face. We analysed the relationship of changes in judgements evoked by MNCs to participants' evaluations of MNCs as protective tools and explored their associations with the burden experienced by wearing MNCs, compliance to behaviour recommendations, their risk associated with the pandemic, and their levels of psychological distress.ResultsOverall, calm facial stimuli covered with MNCs were evaluated as less trustworthy and, to an even stronger extent, less happy than uncovered facial stimuli. However, participants varied in whether they showed a negative or positive evaluation of faces with MNCs; the negative bias was stronger in those participants who attributed lower protective potential to MNCs, experienced a higher burden while wearing MNCs, wore MNCs less often, and experienced a higher level of psychological distress.ConclusionsA negative bias in trustworthiness appraisals of faces with a positive emotional expression covered by MNCs is linked to a participant's evaluation of MNCs as inefficient and burdening and their experience of high psychological distress.
| S-EPMC8130962 | biostudies-literature
Project description: Not available
| S-EPMC7224167 | biostudies-literature
Project description:PurposeThe detection and segmentation of surgical instruments has been a vital step for many applications in minimally invasive surgical robotics. Previously, the problem was tackled from a semantic segmentation perspective, yet these methods fail to provide good segmentation maps of instrument types and do not contain any information on the instance affiliation of each pixel. We propose to overcome this limitation by using a novel instance segmentation method which first masks instruments and then classifies them into their respective type.MethodsWe introduce a novel method for instance segmentation where a pixel-wise mask of each instance is found prior to classification. An encoder-decoder network is used to extract instrument instances, which are then separately classified using the features of the previous stages. Furthermore, we present a method to incorporate instrument priors from surgical robots.ResultsExperiments are performed on the robotic instrument segmentation dataset of the 2017 endoscopic vision challenge. We perform a fourfold cross-validation and show an improvement of over 18% to the previous state-of-the-art. Furthermore, we perform an ablation study which highlights the importance of certain design choices and observe an increase of 10% over semantic segmentation methods.ConclusionsWe have presented a novel instance segmentation method for surgical instruments which outperforms previous semantic segmentation-based methods. Our method further provides a more informative output of instance level information, while retaining a precise segmentation mask. Finally, we have shown that robotic instrument priors can be used to further increase the performance.
| S-EPMC8260538 | biostudies-literature