Sonnenberg Amnon
The Portland VA Medical Center and the Division of Gastroenterology/Hepatology, Oregon Health & Science University, Portland, Oregon, USA.
Endosc Int Open. 2017 Jul;5(7):E627-E629. doi: 10.1055/s-0043-111791. Epub 2017 Jul 6.
Over the last decades, the length of time required for endoscopic procedures has greatly expanded. The aim of the present decision analysis is to study the interactions amongst various factors that have caused such delays and to compare the relative magnitude of their influences.
Performance of gastrointestinal endoscopy is influenced by the interaction of five domains, that is, (1) patient discomfort and fear; (2) injury, disorder, and disruption; (3) rituals to reduce fear, prevent disruption, and maintain order; (4) administrators or various health providers carrying out a ritual; (5) information, knowledge, and science, which influence fear, prevent disruption, and curtail unnecessary ritualistic behavior. A Markov chain model is used to describe the interaction among the five domains.
Overall, science exerts the strongest influence, followed by fear and ritual as distant second and third most relevant influences, respectively. Disruption and administrator exert only a minor influence on the system of mutual interactions.
Studying patterns of ritualistic behavior during endoscopy and subjecting them to means of scientific research could help eliminate redundancy, cutting unnecessary rituals, and thus making gastrointestinal endoscopy overall more efficient.
在过去几十年中，内镜检查所需的时间大幅延长。本决策分析的目的是研究导致此类延迟的各种因素之间的相互作用，并比较它们影响的相对大小。
胃肠内镜检查的操作受五个领域相互作用的影响，即：（1）患者的不适与恐惧；（2）损伤、紊乱和干扰；（3）减轻恐惧、防止干扰和维持秩序的程序；（4）执行程序的管理人员或各类医疗服务提供者；（5）影响恐惧、防止干扰并减少不必要程序行为的信息、知识和科学。采用马尔可夫链模型描述这五个领域之间的相互作用。
总体而言，科学的影响最为强烈，其次是恐惧和程序，分别为第二和第三大相关影响因素。干扰和管理人员对相互作用系统的影响较小。
研究内镜检查期间的程序行为模式并对其进行科学研究，有助于消除冗余，减少不必要的程序，从而提高胃肠内镜检查的整体效率。
