Littérature scientifique sur le sujet « Painless colonoscopy »

Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.

Objective Currently, the best method for CRC screening is colonoscopy, which ideally (where possible) is performed under partial or deep sedation. This study aims to evaluate the efficacy of the Endotics System, a new robotic device composed of a workstation and a disposable probe, in performing accurate and well-tolerated colonoscopies. This new system could also be considered a precursor of other innovating vectors for atraumatic locomotion through natural orifices such as the bowel. The flexible probe adapts its shape to the complex contours of the colon, thereby exerting low strenuous forces during its movement. These novel characteristics allow for a painless and safe colonoscopy, thus eliminating all major associated risks such as infection, cardiopulmonary complications and colon perforation. Methods An experimental study was devised to investigate stress pattern differences between traditional and robotic colonoscopy, in which 40 enrolled patients underwent both robotic and standard colonoscopy within the same day. Results The stress pattern related to robotic colonoscopy was 90% lower than that of standard colonoscopy. Additionally, the robotic colonoscopy demonstrated a higher diagnostic accuracy, since, due to the lower insufflation rate, it was able to visualize small polyps and angiodysplasias not seen during the standard colonoscopy. All patients rated the robotic colonoscopy as virtually painless com-pared to the standard colonoscopy, ranking pain and discomfort as 0.9 and 1.1 respectively, on a scale of 0 to 10, versus 6.9 and 6.8 respectively for the standard device. Conclusions The new Endotics System demonstrates efficacy in the diagnosis of colonic pathologies using a procedure nearly completely devoid of pain. Therefore, this system can also be looked upon as the first step toward developing and implementing colonoscopy with atraumatic locomotion through the bowel while maintaining a high level of diagnostic accuracy.

碩士
國立臺灣大學
商學組
104
The major obstacle of National Health Insurance （NHI） is the aggregate insurance premium is not able to meet the rapid growth of medical demands in Taiwan. Without increasing the rate of NHI premium, NHI Bureau can only reduce the costs and expenses （i.e. control the growth rate of medical expenditure）, and hence it is very challenge for NHI Bureau to breakeven. Taiwan''s NHI is a single payer system. No matter whether the scales of medical institutes and hospitals are large or small, the pricing strategies of all medical services should aim to be self-sufficient in order to make medical institutes and hospitals sustainable. One of the possible solutions is for NHI Bureau to provide certain flexibilities for medical institutes and hospitals to offer medical services to be paid out of pockets of patients. At the moment, most expenses of the medical services are primarily covered by NHI and only minor percentage is paid by patients. Patients will be benefited from having choice（s） to pay extra for certain health services on-demand, which may not be covered by NHI. To date, there are still a lot of constraints regulated by NHI Bureau for the health services under self-expenditure of patients. It would be optimal for NHI Bureau, medical institutes and hospitals, and patients to have reasonable cost - pricing formulas. Among all, the direct cost of medical personnel of health services is the most important element, which is substantially under-estimated by the current cost - pricing formula utilized by NHI Bureau. Only when the cost of medical personnel is fairly reflected in the pricing formula, the correlation between the payment and the actual costs and expenses involved will make sense. The current cost – pricing formulas neither reflect the costs involved of the respective health services nor take into account the risk provisions. The purposes of the thesis are: To provide information for the NHI Bureau, medical institutes and hospitals to better price health services To break-down the cost of health personnel for various items of health services in order to better price the self-expenditure services on-demand To re-gain medical personnel by properly pricing health services and to move the healthcare industry into the right track To educate patients with proper attitude and concepts for taking medical treatments To provide the calculation basis for government to subsidize those people with low income and those remote villages without sufficient medical resources The thesis utilizes Activity Based Costing （ABC） to analyze the costs involved for Painless Colonoscopy in order to break down each item of medical services, especially the direct cost of medical personnel. Thereafter, the thesis modified the cost – pricing formula of Painless Colonoscopy and applied into the Spinal Anesthesia for Cesarean Section and Incubated General Anesthesia. The thesis concluded that Activity Based Costing analysis is helpful for properly pricing medical procedures and medical services. The result is a useful reference for NHI system to better allocate resources and for medical institutes and hospitals to operate with long term plans.