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INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants. MATERIALS AND METHODS: The analysis included 6384 patients aged 40–65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I – patients examined by residents, group II - patients examined by board-certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for both groups (p = 0.994). There was no statistically significant difference in adenoma detection rate: 29.30% among residents and 27.66% among consultants (p = 0.203). Patient tolerance of the examination was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p < 0.001). CONCLUSION: In a proper learning environment general surgery residents are able to perform high-quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of a consultant.
Content available remote Perioperative Antibiotic Prophylaxis in Clinical
The aim of the study was to determine the efficiency of perioperative antibiotic prophylaxis in surgical patients.Material and methods. During the period between January and December, 2005, eight surgical Departments were subject to investigation, considering surgical wound infections following selected procedures: 3 orthopedic departments, 3 general surgery departments, and two vascular surgery departments. Based on obtained results the following parameters concerning perioperative antibiotic prophylaxis were evaluated: was the procedure performed with antibiotic prophylaxis?; type of chemotherapeutic agent used, and duration of prophylaxis.Results. Inguinal hernia repair procedures were most often performed without antibiotic (33% of procedures). The statistically significant higher incidence index of surgical wound infections was confirmed in case of cholecystectomy without (18.8 vs 2%). In case of vascular procedures cefuroxime was used in 8 doses. In case of hip or knee joint endoprosthesis surgery cefazolin was administered in five doses. In 70% of cholecystectomy and hernial repair procedures one dose of cefazolin was used. Considering colorectal operations the following antibiotics were used: 6 doses of cefazolin in 36% of cases, and 8 doses of amoxicillin with clavulanic acid. Twenty-five percent of colorectal procedures required the administration of amoxicillin with clavulanic acid and metronidazolConclusions. Analysis demonstrated that in spite of the many guidelines elaborated by scientific associations concerning perioperative antibiotic prophylaxis, the above-mentioned are rarely administered according to clinical practice.
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