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PubMed1980

Use of the AML scale to identify adjustment problems in fourth-, fifth-, and sixth-grade children.

This paper summarizes a series of studies of the technical merit of the AML scale when used to detect school maladaptation in a sample of 684 fourth, fifth, and sixth-grade children. Teachers, who did the rating, readily accepted this screening device. Preliminary norms are offered. Reliability and factor analytic studies show a reasonable degree of uniqueness and internal consistency among the three AML subscales. Relationships to other children's personality and behavioral indices (State-Trait Anxiety Inventory for Children and Cooper-smith's Self-Esteem Inventory) were found to be modest. The one-item L Scale correlated well (r = .65) with the California Achievement Test. First developed as a measure of school maladaptation in primary grade youngsters, the AML appears to be readily applicable at intermediate grade levels as well.

Age Factors↗

PubMed2001

Implications of using high contrast mammography X-ray film-screen combinations.

The objective of this study was to determine the implications of using Fuji AD-M and Kodak min-R 2000, two high contrast X-ray film types developed for mammography. Evaluation of the Fuji AD-M film was divided into two parts. The first part was a contralateral comparison between mammograms using Fuji AD-M and Fuji UM-MA HC film-screen combinations. Fuji AD-M contrast was about 25% higher than that of Fuji UM-MA HC. The effect of increased contrast on image quality was investigated by visually grading the quality of information in different parts of each mammogram. Fuji AD-M film was generally judged to be better for overall diagnosis. However, 2.3% of mammograms produced using Fuji AD-M film were not acceptable and might have led to a technical recall of the patient. In the second part of this study, sets of mammograms from women attending mobile screening units were reviewed. One unit used Fuji AD-M film and the other used Kodak min-R 2000 film. Both samples of mammograms were digitized and analysed. The average film gradients between an optical density (OD) of 0.25 and 2.00 above base plus fog were 4.38 for Fuji AD-M film and 3.77 for Kodak min-R 2000 film. The main breast regions of the mammograms were judged to be satisfactorily displayed when breast tissues were above ODs of approximately 0.6 for Fuji AD-M film and 0.8 for Kodak min-R 2000 film.

Adult↗

PubMed1997

Cervex brush versus vaginal-cervical-endocervical (VCE) triple smear techniques in cervical sampling.

Cervex brush sampling was compared with the conventional triple vaginal-cervical-endocervical (VCE) smear technique. Nine hundred and fifty-nine Cervex brush smears and 1064 VCE smears were studied. All smears with both methods were technically satisfactory for evaluation. Endocervical cells were found in 90.7% and metaplastic cells in 73.3% of Cervex brush samples and in 92.5% and 64.1% of VCE samples, respectively. There were significantly more metaplastic cells in smears from premenopausal women. Low grade squamous intraepithelial lesion (SIL) was found in three Cervex brush samples and in two VCE samples. High-grade SIL was found only in one Cervex brush sample. Benign cellular changes were found in 142 Cervex brush samples and in 144 VCE samples. Sampling with the Cervex brush is efficient, simple and fast and gives high quality cervical smears for cytological evaluation.

Adolescent↗

PubMed2003

Summary of historical beryllium uses and airborne concentration levels at Los Alamos National Laboratory.

Beryllium operations and accompanying medical surveillance of workers at Los Alamos National Laboratory began in the 1940s. In 1999 a Former Workers Medical Surveillance Program that includes screening for chronic beryllium disease was initiated. As part of this program, historical beryllium exposure conditions were reconstructed from archived paper and electronic industrial hygiene data sources to improve understanding of past beryllium uses and airborne concentration levels. Archived industrial hygiene sampling reports indicated beryllium was principally used in technical areas-01 and -03, primarily being machined. Beryllium was also used at 15 other technical areas in activities that ranged from explosives detonation to the manufacture of X-ray windows. A total of 4528 personal breathing zone and area air samples for beryllium, combined for purposes of calculating summary statistics, were identified during the records review phase. The geometric mean airborne beryllium concentration for the period 1949-1989 for all technical areas was 0.04 microg Be/m(3) with 97 percent of all sample below the 2.0 microg Be/m(3) occupational exposure limit (OEL). Average beryllium concentrations per decade were less than 1 microg Be/m(3) and annual geometric mean concentrations in technical area-03, the largest user of beryllium, were generally below 0.1 microg Be/m(3), indicating exposure was generally well-controlled, that is, below the OEL. Typical of many retrospective exposure assessments, not all archived data could be extracted and summarized. Despite this, we report a reasonable summary of potential beryllium uses and airborne concentration levels a worker may have encountered from 1949-1989. These data can be used to more effectively identify former worker populations at potential risk for chronic beryllium disease and to offer these workers screening as part of the Former Worker Medical Surveillance Program, and in the event that a case is diagnosed, help to understand historical exposure conditions.

Air Pollutants, Occupational↗

PubMed1988

Intravenous urographic technique.

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.

Contrast Media↗

PubMed2000

Digital detectors in mammography. A technological overview.

At a first glance the future of digital mammography seems very bright considering the wealth of offerings for new detectors, made by companies on the market or in journals. However technically spoken, digital mammography is one of the most demanding applications in the spectrum of radiology along with a high degree of cost consciousness in the mammography screening programs. The functional requirements are so high for digital mammography that only the best and most expensive components are good enough to compete with the current screen-film systems. Next difficulties are the lack of quality standards for digital detectors, not at all existing in the past and still under discussion, and the non-existence or changing of approval procedures. This is discouraging the industries to enter the field and is slowing down the phase-in time. After these obstacles are removed, there will come the discussions on acceptance of digital mammography within the professional community, due to the 'look' of the images and also the need to gain confidence with these images.

Costs and Cost Analysis↗

PubMed1995

Ultrasound in the evaluation of osteoporosis: a comparison with bone mineral density at distal radius.

It is proven that, from a technical point of view, ultrasound transmission velocity (UTV) measurement can easily be taken at the distal end of the radius. The reproducibility of UTV is good (coefficient of variation 0.3% intraoperator and 0.5% interoperator). 248 normal and 65 osteoporotic women were then studied to establish the range of UTV values and to compare the ability of UTV and bone mineral density (BMD) measurement, taken at the same skeletal sites, to detect osteoporotic fragility. Osteoporosis was defined by the presence of atraumatic vertebral fractures on an X-ray of the spine. Ultrasound velocity averaged 1570.5 +/- 43.3 m s-1 in normal and 1519.2 +/- 15.2 m s-1 in osteoporotic women; the difference is also statistically significant (p < 0.01) for BMD. Both BMD and UTV decline after menopause and are significantly correlated with age. A weak correlation (r = 0.68) was found between UTV and BMD; this supports the thesis that ultrasound velocity measures bone mass as well as other fragility components of bone distinct from the decrease of mass. Receiver operating characteristic (ROC) curve analysis showed that UTV discriminates between normal and osteoporotic patients at least as well as radial BMD, indicating that UTV is a new available diagnostic modality which can be used to screen osteoporotic subjects.

Adult↗

PubMed1999

Confrontation of mammography systems in flanders with the European Guidelines for Quality Assurance in mammography screening. Analysis of initial results.

From May 1997 to April 98, 30 radiological centers made an agreement with the Leuvens Universitair Centrum voor Kankerpreventie (LUCK) for the work out of physical and technical quality control in mammography screening. A protocol was used based on the European Guidelines for Quality Assurance. The reports of all 30 acceptance tests were retrospectively reviewed. The following parts showed to be most critical: alignment of radiation field and film in the bucky, tube voltage precision, automatic exposure controller, average optical density of a standard exposure, dark room and its safe lights. The mean film gradient was in the majority of the centers higher than what is prescribed in the European document. This is acceptable and even desirable whenever daily quality control shows that the development system is sufficiently stable. Although it is difficult to compare the scores for the specific tests with results in other countries, there is evidence that the tendencies are very similar.

Absorptiometry, Photon↗

PubMed1997

Field evaluation of rapid HIV serologic tests for screening and confirming HIV-1 infection in Honduras.

OBJECTIVE: To determine the ability of simple, rapid tests to identify HIV-1 antibody-positive specimens in field settings using the World Health Organization's (WHO) alternative testing strategies. DESIGN: Three-phase evaluation of simple, rapid assays using banked specimens and prospectively collected serum specimens at regional hospitals and rural clinics. METHODS: Seven test (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were evaluated and results compared with standard enzyme immunoassay (EIA) and Western blot results (phase 1). Further evaluation consisted of prospective testing of routine specimens at regional (phase 2; n = 900) and rural, peripheral laboratories (phase 3; n = 1266) throughout Honduras with selected assays. RESULTS: Sensitivity and specificity were calculated for each assay and combination of assays for each phase to evaluate the effectiveness of the WHO alternative testing strategies. All tests in all phases were > 99% sensitive after correcting for technical errors, with two exceptions (SUDS, phase 1; HIVCHEK, phase 3). In phase 3, where the testing algorithm was diagnostic, several combinations of assays were 100% sensitive and specific using WHO strategy II or III. For the Honduras Ministry of Health, the combination of Retrocell and Genie was found to be equally sensitive, more specific (no indeterminate results), and less expensive than EIA/Western blot. CONCLUSION: Combinations of rapid, simple HIV antibody assays provide sensitivity and specificity performance comparable to EIA/Western blot. Application of these combinations in the WHO alternative testing strategies provides an inexpensive and effective method of determining HIV status. Assay combinations using these strategies can be easily performed in small, rural laboratories and have been implemented in routine HIV screening in Honduras.

AIDS Serodiagnosis↗

PubMed2005

[Cancer screening].

The purpose of cancer screening is to widen the difference between morbidity and mortality of the target cancer. Since 1983 cancer screening has been supported by the Japanese government. Initially it covered gastric and cervical cancer with lung, breast and endometrial cancers supported from 1987 and colorectal cancer in 1992. Since 1998 support for cancer screening has been transferred to local government. It is generally accepted that the uptake of screening services is too low. Estimates for Japan suggest that at best 30% of the eligible population accept the services. In other parts of the world screening is more widely accepted, for example, 67% for breast cancer and 79% for cervical screening in the USA. Barriers within Japan for increasing screening are complex and include, legal, ethical, financial, technical infrastructure, data related matters and the level of understanding and education of the general public. In 2000 the MHLW conducted an evaluation of cancer screening in terms of usefulness and effectiveness. It concluded that fair or better evidence for reduction in mortality existed for cervical cancer (cytology), breast cancer (mammography with clinical examination for women aged > or = 50 years), colorectal cancer (faecal occult blood test), gastric cancer, lung cancer and liver cancer. As a step towards improving screening services and their uptake by the general public a new Research Centre for Cancer Prevention and Screening was established at the National Cancer Centre in October 2003. This and other initiatives will build on the progress of the past 20 years but it is generally agreed that there is still have a long way to go.

Adult↗

PubMedDate not supplied

Computerized screening devices and performance assessment: development of a policy towards automation. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: The extension of automation to the diagnostic assessment of clinical materials raises issues of professional responsibility, on the part of both the medical professional and designer of the device. The International Academy of Cytology (IAC) and other professional cytology societies should develop a policy towards automation in the diagnostic assessment of clinical cytologic materials. CONSENSUS POSITION: The following summarizes the discussion of the initial position statement at the International Expert Conference on Diagnostic Cytology Towards the 21st Century, Hawaii, June 1997. 1. The professional in charge of a clinical cytopathology laboratory continues to bear the ultimate medical responsibility for diagnostic decisions made at the facility, whether automated devices are involved or not. 2. The introduction of automated procedures into clinical cytology should under no circumstances lead to a lowering of standards of performance. A prime objective of any guidelines should be to ensure that an automated procedure, in principle, does not expose any patient to new risks, nor should it increase already-existing, inherent risks. 3. Automated devices should provide capabilities for the medical professional to conduct periodic tests of the appropriate performance of the device. 4. Supervisory personnel should continue visual quality control screening of a certain percentage of slides dismissed at primary screening as within normal limits (WNL), even when automated procedures are employed in the laboratory. 5. Specifications for the design of primary screening devices for the detection of cervical cancer issued by the IAC in 1984 were reaffirmed. 6. The setting of numeric performance criteria is the proper charge of regulatory agencies, which also have the power of enforcement. 7. Human expert verification of results represents the "gold standard" at this time. Performance characteristics of computerized cytology devices should be determined by adherence to defined and well-considered protocols. Manufacturers should not claim a new standard of care; this is the responsibility of the medical community and professional groups. 8. Cytology professionals should support the development of procedures that bring about an improvement in diagnostic decision making. Advances in technology should be adopted if they can help solve problems in clinical cytology. The introduction of automated procedures into diagnostic decision making should take place strictly under the supervision and with the active participation and critical evaluation by the professional cytology community. ONGOING ISSUES: Guidelines should be developed for the communication of technical information about the performance of automated screening devices by the IAC to governmental agencies and national societies. Also, guidelines are necessary for the official communication of IAC concerns to industry, medicolegal entities and the media. Procedures and guidelines for the evaluation of studies pertaining to the performance of automated devices, performance metrics and definitions for evaluation criteria should be established.

Automation↗

PubMed1993

[The decision making process in tuberculosis control programme].

The main purpose of this paper is to demonstrate relevance of the medical technology assessment (MTA) approach in the decision making process in the tuberculosis control programme. Recently MTA has progressed remarkably under the pressure of limited medical resources and necessity for rational utilization of those resources. This approach has also been assisted by the development in related technologies, such as statistics and the managerial sciences. The author demonstrates the feasibility of the MTA approach in tuberculosis control programmes, with special emphasis on the applicability of the mathematical model in risk-effectiveness analysis, citing several examples from his recent works. A critical analysis of the screening chest radiophotography (Mass Miniature Radiophotography, MMR) is a good sample of risk-effectiveness analysis, where benefit from early detection of tuberculosis is quantified and compared with the possible risk due to radiation exposure. A mathematical model is used to simulate the fate of tuberculosis patients with or without treatment. The benefit is computed in terms of lives saved, life-years extended, and treatment costs saved with or without the MMR programme. In Japan, it is concluded that MMR cannot be rationalized as a life-saving intervention in young age-groups, nor being economically cost-effective for wider age ranges. Based on the estimated trend of risk of infection of Japan now and in the near future, the infection status of a cohort born around 1990 can be calculated. Applying risk of clinical breakdown of tuberculosis to the above infection status and the assumed level of protective efficacy of BCG vaccination, assessment of the BCG vaccination programme can be made, under various hypothetical modes of vaccination, whether vaccinated to the newborn or to school entrants, whether revaccinated or not, and when, etc. The analysis revealed that the revaccination has very limited effectiveness, which in turn emphasizes the importance of the primary vaccination with optimum technical level. Under the very low prevalence conditions of tuberculous infection as in Japan of present (annual risk of infection estimated at ca. 0.05%), the determination of a cut-off point for selecting those eligible for chemoprophylaxis with isoniazid is a good example of a clinical decision problem which has a narrow spectrum of positive risk benefit ratio. Using the ROC analysis of the tuberculin testing, risk of excessive tuberculosis deaths and that of fatal hepatitis cases are compared under varying cut-offs, which leads to a conclusion that for the presumably very low-risk population chemoprophylaxis should be given to those with 20mm diameter or more of erythema.(ABSTRACT TRUNCATED AT 400 WORDS)

BCG Vaccine↗

PubMed2005

[Value of ultrasound and doppler sonography in chronic hepatitis and liver cirrhosis].

Ultrasound is unquestionably of great importance in the diagnosis of liver diseases due to the technical improvements of the last years. Indications for an ultrasound examination are the primary diagnosis of chronic liver disease and the screening for hepatocellular carcinoma. Apart from the diagnosis of portal hypertension in liver cirrhosis a portal vein thrombosis should be detected or excluded in cases of new or refractory ascites. The Budd-Chiari syndrome is another rare but important indication. There is a considerable improvement in the differential diagnosis of focal liver lesions especially due to contrast-enhanced sonography. Using phase-inversion harmonic sonography it is possible to detect tumor vascularity in a very sensitive manner. The accuracy of contrast-enhanced sonography is comparable with helical-CT or MRT, and contrast-enhanced sonography is very useful in the evaluation of response to ablation therapy of hepatocellular carcinoma.

Budd-Chiari Syndrome↗

PubMed2002

[Optical density of phantom images of different mammography equipment using various exposure conditions].

The requirements for the target value of the mean optical density (o.d.) including proper tolerances of mammograms are determined in the "European Protocol for the Quality of the Physical and Technical Aspects of Mammography Screening (EPMS)". These requirements are not only applicable to screening mammography. 22 mammography devices were tested with exposures of test phantoms using different kV and thickness of PMMA and with sensitometric step wedges to check the processing conditions. Only five of 22 devices fulfill all requirements of EPMS to the opt. density. These results are caused by three reasons: first, wrong locking of optical density under standard exposure conditions; second, wrong compensation of the optical density by the automatic exposure control due to varing tube voltage (kV) and PMMA thickness and third, an inadequate back coupling to the processing conditions. All tested devices are not conspicuous in respect to the results of constancy tests according DIN 6868-2 [2] and DIN 6868-7 [3]. It is obvious, that the claimed devices are not properly adjusted in the acceptance test according DIN 6868-52 (1990-12) [4]. Respectively the tolerances, used do not fulfill the requirements to proper density in mammograms.

Equipment Design↗

PubMedDate not supplied

[Screening for breast cancer in females at the level of regional (territorial, republican) clinical hospitals: organizational and methodological aspects].

The paper deals with a special screening for breast cancer in female visitors of the consultative-and-diagnostic units (CDU) of regional (territorial, republican) clinical hospitals in the Russian Federation. The study was conducted in the CDU of the Moscow Regional Clinical Research Institute that in addition to its clinical researches acts as a regional clinical hospital for the Moscow Region. The basic idea of this screening is firstly that specialists of such-level CDU attended by many women requiring various consultations obligatorily give multifaceted counseling. Secondly, such polyclinic complexes have a required set of technical devices, such as as radiomammographs, ultrasound apparatuses, etc. In other words, there are prerequisites for providing a present-day screening, without spending any extra money. This screening has been made at the Institute since 2002. A total of 2724 risk-group females and 4222 female patients with the clinical signs of breast space-occupying lesions were examined. Its procedure including the formation of risk groups has been developed by means of a specially designed questionnaire. A comparative analysis of the results of these examinations gives preference to the screening diagnosis of this pathology. This all makes the author recommend this screening for its use in all 89 regions of the Russian Federation, by understanding that this can partially solve the problem of a screening for breast cancer in women in general outpatient care health facilities at the municipal level. Moreover, any attempts to mage a screening diagnosis of tumorous lesions at this level of today's health care become particularly relevant in the light of the governmental program to be implemented, which focuses on municipal public health that is one of its main goals.

Breast Neoplasms↗

PubMed2006

Peptaibiomics: an advanced, rapid and selective analysis of peptaibiotics/peptaibols by SPE/LC-ES-MS.

"Proteomics" and "peptidomics" are used as technical terms to define the analysis and study of all proteins and peptides expressed in an organism or tissue. In analogy we propose the name peptaibiomics for the analysis of a group of fungal peptide antibiotics (peptaibiotics) containing the characteristic amino acid Aib (alpha-aminoisobutyric acid). In analogy to the peptidome the complete expression of peptaibiotics by fungal multienzyme complexes should be named the peptaibiome. Peptaibiotics are defined as peptides containing Aib and exerting a variety of bioactivities. They comprise the sub-groups of N-acetylated peptaibols, characterized also by a C-terminal amide-linked 2-amino alcohol, and lipopeptaibols having in place of an acetyl group a lipophilic fatty acid acyl group. Furthermore, lipoaminopeptides are also known with long-chain fatty acid on the N-termini, a lipoamino acid in position three and a strongly basic secondary or tertiary amine form a subgroup of mixed forms which could not be integrated in one of these three previously mentioned groups. Here we present a specific and rapid screening method on the peptaibiome applicable directly onto filamentous fungi cultured in a single Petri dish. The method comprises solid-phase extraction (SPE) of peptaibiotics followed by on-line reversed-phase HPLC coupled to an ion trap electrospray tandem mass spectrometer (ES-MS). The presence of these peptides is indicated by characteristic mass differences of Deltam = 85.1 Da representing Aib-residues which can be observed in the b-series of acylium fragment ions resulting from ES-MS. Partial sequences can be deduced from the data and compared with structures compiled in electronic peptaibol data bases. The judgement is possible whether or not structures are novel, already known or related to known structures. Suitability of the method is demonstrated with the analysis of strains of Trichoderma and its teleomorph Hypocrea. New sequences of peptaibiotics are presented and those being related to established 10- to 18-residue peptaibols trichovirin, trichogin and trichotoxin, which have been described in the literature.

Anti-Bacterial Agents↗

PubMed2001

Is duplex scanning the best screening test for renal artery stenosis?

Screening for renal artery stenosis is indicated in patients with suspected renovascular hypertension or ischemic nephropathy to identify those who could benefit from renal artery interventions. The critical requirements for a clinically useful screening test include safety, low cost, and a high sensitivity or low false-negative rate. Arteriography remains the "gold standard" for the anatomic diagnosis of renal artery disease, but it is unsuitable for screening because of its high cost and invasive nature. Although renal duplex scanning technically is difficult, experienced laboratories have been able to achieve sensitivities and specificities in the range of 93% to 98% for identification of stenoses in the main renal arteries. Renal duplex scanning also provides a method for assessing the renal parenchyma and predicting the clinical outcome of renal revascularization. The principal limitation of renal duplex scanning is failure to identify accessory renal arteries. The finding of one or more widely patent main renal arteries makes ischemic nephropathy unlikely, because this condition results from "total" renal ischemia. However, renovascular hypertension can be present with normal main renal arteries when there are isolated stenoses involving accessory renal arteries, so further testing may be indicated in selected hypertensive patients with normal main renal arteries by duplex scanning. Currently, duplex scanning in a qualified vascular laboratory arguably is the best screening test for renal artery stenosis. Other methods for assessing the renal arteries, particularly spiral computed tomography and magnetic resonance angiography, are evolving rapidly and also may play a role in screening of selected patients.

Humans↗

PubMed2005

Quality in the technical performance of screening flexible sigmoidoscopy: recommendations of an international multi-society task group.

BACKGROUND: Flexible sigmoidoscopy (FS) is a complex technical procedure performed in a variety of settings, by examiners with diverse professional backgrounds, training, and experience. Potential variation in technical quality may have a profound impact on the effectiveness of FS on the early detection and prevention of colorectal cancer. AIM: We propose a set of consensus and evidence based recommendations to assist the development of continuous quality improvement programmes around the delivery of FS for colorectal cancer screening. RECOMMENDATIONS: These recommendations address the intervals between FS examinations, documentation of results, training of endoscopists, decision making around referral for colonoscopy, policies for antibiotic prophylaxis and management of anticoagulation, insertion of the FS endoscope, bowel preparation, complications, the use of non-physicians as FS endoscopists, and FS endoscope reprocessing. For each of these areas, continuous quality improvement targets are recommended, and research questions are proposed.

Antibiotic Prophylaxis↗