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Über dieses Buch

For the first time four crucial aspects of gastrointestinal endoscopy are combined in a single text. Drugs for sedation and monitoring of the patient are addressed with particular reference to safety issues and comfort and acceptability for the patient. Resource management and health economic techniques are applied to endoscopy to determine quality and outcome. Problems of negligence and informed consent form the basis of a medico-legal examination of endoscopic practices.

Inhaltsverzeichnis

Frontmatter

Drugs for Sedation

Frontmatter

Chapter 1. Drugs for Sedation

Abstract
Modern endoscopic techniques are being practised by a progressively wider spectrum of specialists for a greater range of both diagnostic and increasingly complex therapeutic procedures, particularly in the fields of gastroenterology, urology [1], gynaecology and cardiology, by orthopaedic and vascular surgeons, and interventional radiologists.
James Whitwam

Chapter 2. Report of Workshop on Drugs for Sedation

Abstract
In the American survey conducted by Keeffe [1] it was shown that most patients routinely receive intravenous sedation for endoscopic procedures. Likewise, in the United Kingdom, Bell [2] has shown that approximately 90% of endoscopists use intravenous benzodiazepines for sedating at least 75% of patients undergoing endoscopy. Overall, the Workshop concurred with this view although there were some marked national variations. The most extreme was Finland, where Dr. Janatuinen reported that they do not use sedation at all for endoscopy except for children under 6 years old.
Eran Geller

Procedural Safety

Frontmatter

Chapter 3. Endoscopic Procedural Safety

Abstract
In spite of the remarkable growth in the number and diversity of gastrointestinal endoscopic procedures performed over the past 30 years, endoscopy has maintained a remarkably good overall safety record. Large retrospective surveys of complication rates of specific endoscopic procedures confirm that endoscopy is safe [1–4]. On the basis of variable complication rates of different types of endoscopy, each individual procedure may have its own “inherent” complication rate. For example, diagnostic procedures are safer than therapeutic procedures as is shown for colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP) in Table 1. Complications may also be considered as procedure-related (e.g. bleeding, perforation) or more generic and most often sedation-related (e.g. miscellaneous cardiopulmonary adverse events).
Emmet Keeffe

Chapter 4. Report of Workshop on Procedural Safety

Abstract
Clinical competence and judgement are issues which must be resolved by adequate training before the procedure (see Chapter 3, pages 39–41). However, there are a variety of practices which can be undertaken before an endoscopy that may influence the safety of that procedure.
David Fleischer

Resource Management

Frontmatter

Chapter 5. Economic Aspects of Endoscopy

Abstract
Endoscopy, like many other activities in health care, is rarely evaluated from an economic perspective. The objective of economic analysis is to facilitate choice by identifying the value of what is given up when a procedure is provided (the opportunity cost) and what is gained, ultimately in enhancements in the length and quality of life (the outcome).
Alan Maynard

Chapter 6. Report of Resource Management Workshop

Abstract
The demand for medical interventions, diagnostic and therapeutic, exceeds their supply in many health care systems and therefore the “rationing” of resources is becoming more explicit. In some countries, e.g. France, Switzerland and Germany, these pressures are less obvious, although in these countries too resource managers are looking for data to contain cost inflation. The common problem, across all health care systems, public and private, is that data are few and choices are formulated in “data free” environments.
Alan Maynard

Medico-Legal Aspects

Frontmatter

Chapter 7. Medico-legal Issues in Endoscopy

Abstract
There are two main areas where endoscopists and their practice of endoscopy relate to the law, irrespective of whether the endoscopy is performed under sedation. Firstly, a doctor might be negligent in his treatment of the patient. Secondly, the endoscopist may fail to obtain informed consent.
Nicola Davies

Chapter 8. Report of Workshop on Medico-legal Issues

Abstract
The medico-legal sword of Damocles hangs over all our heads and the eternal hope of every practitioner when learning of a medico-legal incident is “There but for the grace of God go I”.
David Poswillo

Backmatter

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