Ileoscopy should only be attempted in situations in which the indication is warranted and that would alter management. It is not cost-effective to carry out ileoscopy on all patients.
SUMMARY
Background: The leaves of Khat are chewed for their central stimulant effect, but their use may cause anorexia and constipation.
Methods: Gastric emptying of a radio‐labelled semi‐solid meal was measured in 12 healthy volunteers on two occasions a week apart. Subjects chewed either Khat leaves (Catha edulis) or lettuce for 2 h before the study.
Results: Gastric emptying was significantly (P < 0.02 prolonged after chewing Khat compared with lettuce.
Conclusion: The sympathomimetic action of cathinonn in Khat may cause the observed delay in gastric emptying.
Objectives
To evaluate the use of colonoscopy in patients aged at least 85 years. Does the ideal of an ageism free service apply?
Design
A retrospective audit.
Setting
Department of gastroenterology that carries out about 1000 colonoscopies annually in a district general hospital serving a population of about 320 000.
Subjects
All patients aged at least 85 years who underwent colonoscopy over five years to 2003.
Main outcome measures
The indications for colonoscopy and its findings. The outcome of patients found to have colonic cancers.
Results
Colonoscopy was completed in 219 cases (69%). The main reasons for failure were poor bowel preparation and severe diverticular disease. Normal findings occurred in 65 (30%) of the 219 cases that had had a complete examination. Colonoscopy identified a problem that explained the patient’s symptoms in 116 (37%) cases. Polyps were found in 45 (14.2%) cases and malignancy in 28 (8.8%).
Conclusions
The absence of significant complications and comparatively high yield of colonic malignancies and polyps reinforces the value of colonoscopy as a diagnostic tool even after 85 years of age and despite the technical challenges of the procedure in this age group that limited completion. Increasing age alone should not preclude a patient from colonoscopy.
The use of clinical protocols allows health care providers to offer appropriate diagnostic treatment and care services to patients, variance reports to purchasers and quality training to clinical staff. Such protocols provide a locally agreed standard to which clinicians and the organization can work and against which they can be audited. By embedding protocols into patients' records and reporting by exception, the use of protocols may help to tackle a raft of other issues successfully such as the reduction in junior doctors' hours, and the facilitation of shared care. It may also bolster the medico-legal robustness of the health care delivered. If the protocols are sufficiently detailed, costing, coding and other resource usage information can flow directly from the clinical records. Such benefits may be maximized by using protocols within the framework of an electronic patient record system.
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