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Michael Bretthauer

Publications and source records attributed to Michael Bretthauer.

16 recordsLinked to original sources
PubMed2006

The Norwegian Gastronet project: Continuous quality improvement of colonoscopy in 14 Norwegian centres.

OBJECTIVE: The burden on colonoscopy capacity is considerable and expected to increase further as colorectal cancer screening programmes gain a foothold in Europe. In this situation, it is particularly important to evaluate the quality of the service given. In this article we present our first year of experience with a quality network of endoscopy centres in Norway (Gastronet). MATERIAL AND METHODS: A questionnaire focusing on caecal intubation rate and pain was completed by the endoscopist (on site) and patient (on the day after the examination). Fourteen centres participated with registration of 7370 colonoscopies by 73 endoscopists. RESULTS: There was 100% endoscopist participation, 87% coverage of colonoscopies and an estimated 76% questionnaire coverage of the patient population. Overall caecal intubation rate was 91%, range 83% to 97% between centres (p < 0.001). Patients reporting severe pain during colonoscopy differed from 2 to 24% between centres (p < 0.001). Variations could only partly be explained by differences in procedure practice (sedation, CO2 insufflation). For individual endoscopists, improvement after feedback on performance was restricted to the group of endoscopists having contributed with only 50-99 registered colonoscopies. CONCLUSIONS: In quality assurance programmes we recommend a limited number of variables for registration in order to secure high compliance by endoscopists and patients. One year of experience with Gastronet disclosed a satisfactory overall caecal intubation rate, but considerable variation between centres in practice and ability to offer painless colonoscopy. This suggests a need for formal, centralized training of colonoscopists or the development of quality standards for colonoscopy training and practice.

Cecum↗
PubMed2005

[Presentation of statistical analysis in the Journal of the Norwegian Medical Association].

The present paper describes guidelines for the presentation of statistical analysis in manuscripts submitted to the Journal of the Norwegian Medical Association, in order to ensure a reasonable standard of statistic presentation in the journal. The paper is a supplement to the guidelines for authors in the journal and should not be used as replacement for statistics manuals.

Guidelines as Topic↗
PubMed2004

[Systematic quality control programme for colonoscopy in an endoscopy centre in Norway].

BACKGROUND: Colonoscopy is regarded as the gold standard for diagnosis of colorectal disease, and increasingly considered a primary screening approach for colorectal cancer. The quality of the procedure varies between centres and endoscopists. The aim of the present study was to describe a quality control programme for colonoscopy performance in a secondary care centre. MATERIAL AND METHODS: Starting in 2001, we established a systematic quality control programme. All patients received a questionnaire on their satisfaction with and pain during and after examination. The questionnaire was to be filled in the next day and mailed back to the centre. Pain and discomfort during and after colonoscopy and caecum intubation rate were registered as indicators of quality. RESULTS: During the study period of 15 month, 1354 colonoscopies were performed by 16 endoscopists. 94% of examinations were performed without any sedation. 1054 (78%) of patients responded to the questionnaire, 99% of whom were generally satisfied. The caecum intubation rate was 82%. While 23% of patients scored for moderate pain during the examination and 16% complained of severe pain, 61% had no or only light pain. Significant differences between endoscopists regarding pain and caecum intubation rate were found in a multiple logistic regression model. INTERPRETATION: A satisfactory feedback from patients was observed, with a high response rate to the questionnaire survey and high overall satisfaction, in spite of the fact that about one third of patients experienced moderate or severe pain. There were significant variations in performance between endoscopists.

Adolescent↗
PubMed2003

Quality control in colorectal cancer screening: systematic microbiological investigation of endoscopes used in the NORCCAP (Norwegian Colorectal Cancer Prevention) trial.

BACKGROUND: Endoscopic colorectal cancer (CRC) screening is currently implemented in many countries. Since endoscopes cannot be sterilised, the transmission of infectious agents through endoscopes has been a matter of concern. We report on a continuous quality control programme in a large-scale randomised controlled trial on flexible sigmoidoscopy screening of an average-risk population. Continuously, throughout a two-year screening period, series of microbiological samples were taken from cleaned ready-to-use endoscopes and cultured for bacterial growth. RESULTS: 8573 endoscopies were performed during the trial period. Altogether, 178 microbiological samples (2%) were taken from the biopsy channels and surfaces from the endoscopes. One sample (0.5%) showed faecal contamination (Enterobacter cloacae), and 25 samples (14%) showed growth of environmental bacteria. CONCLUSIONS: Growth of bacteria occurs in a clinical significant number of samples from ready-to-use endoscopes. Pathogenic bacteria, however, were found only in one sample. Improvement of equipment design and cleaning procedures are desirable and continuous microbiological surveillance of endoscopes used in CRC screening is recommended.

Bacteria↗
PubMed2003

Air and carbon dioxide volumes insufflated during colonoscopy.

BACKGROUND: During colonoscopy, air or carbon dioxide is insufflated to secure adequate visualization of the colon, and endoscopy trainees are reminded to use as little gas as possible to avoid patient discomfort. However, the volume of gas insufflated by endoscopists during colonoscopy is unknown. The aim of the present study was to measure volumes of carbon dioxide and air insufflated during colonoscopy. METHODS: A total 249 consecutive patients participating in a colorectal cancer screening program were randomized to undergo colonoscopy with either carbon dioxide or air insufflation. Gas volumes insufflated during the procedure were measured with a mass-flowmeter. Four experienced endoscopists performed all of the examinations. RESULTS: Gas volumes were successfully measured in 218 (87%) patients. A mean of 8.3 L of carbon dioxide (range 1.2-19.8 L) and 8.2 L of air (range 1.8-18 L) were insufflated (p = 0.9). Mean volumes insufflated per minute were estimated to be 0.26 L and 0.24 L, respectively, in the carbon dioxide and air groups (p = 0.5). Statistically significant differences in the volumes of gas insufflated per minute were observed among some of the endoscopists. CONCLUSIONS: The volumes of carbon dioxide and air used during colonoscopy can be estimated. Differences in volumes of gas used by experienced endoscopists were detected.

Air↗
PubMedDate not supplied

Sensitivity of pain rating scales in an endoscopy trial.

OBJECTIVE: The purpose of this study was to compare the sensitivity of two commonly used pain-rating scales, the Visual Analog Scale and the 4-point verbal rating scale. Both are considered reliable and valid, but previous studies regarding sensitivity of rating scales have lead to different conclusions, and there is no firm agreement as to the best scale to choose. METHODS: The sensitivity of the Visual Analog Scale and the 4-point verbal rating scale was compared by stochastic simulation. In the simulation model, we used 168 pairs of pain ratings on the Visual Analog Scale and the 4-point verbal rating scale from individuals undergoing a lower gastrointestinal endoscopy, maintaining the true relation between ratings from the same individual. We created empirical distributions mimicking 2 independent groups of pain ratings. Random samples from the 2 groups were compared by the Wilcoxon-Mann-Whitney U test in 10,000 repetitions of a computer algorithm. By increasing the proportion of individuals with a high level of pain in one group, we increased the true difference between pain ratings and estimated a statistical power function. RESULTS: In the present pain model with pain ratings from healthy individuals undergoing endoscopy, the Visual Analog Scale is consistently more sensitive than the four-point verbal rating scale. DISCUSSION: Because each individual provided one Visual Analog Scale and one 4-point verbal rating scale rating for the same pain experience, the ability of the two scales to detect differences between groups of pain ratings could be compared. The use of a simulation model enabled estimation of a power function and reduced the probability of basing the conclusion on a chance finding.

Colonoscopy↗
PubMedDate not supplied

[Screening for colorectal cancer. Collaboration among politicians and scientists is necessary].

Colorectal cancer is one of the most common cancers in the western world. It is especially common in the Nordic countries. In many of the European countries and in the United States colonoscopy is recommended as a screening procedure for CRC. However, there are no randomized studies of the effects of the method on incidence, mortality, possible complications or negative effects on the population. Public pressure to have screening for CRC with colonoscopy will probably increase heavily in the next years to come. We fear that colonoscopy will be introduced as a screening method without proper scientific support. Therefore we want to argue for a common Nordic randomized study on population screening with colonoscopy.

Colonoscopy↗