Reviewer's report
Title:Maximizing the general success of cecal intubation during propofol
sedation in a multi-endoscopist academic centre
Version: 1Date:12 August 2010
Reviewer: Russell Heigh
Reviewer's report:
This is an interesting retrospective review of a large number of colonoscopies
performed under propofol sedation. The most important finding notes in the
Results is that "having a colonoscopy by a less experienced endoscopist
coincided with a 5 fold increased risk of an incomplete procedure by comparison
with colonoscopies handled by a highly experienced specialist; this risk dropped
to a 2 fold increase if the test was performed by a more experienced non
specialist." Unfortunately the authors do not talk about direct remediation of the
underlying quality problem they identified, or of the ethical decision making
involved in allowing unqualified colonoscopists to perform the procedure at all.
Instead, the authors talk about shunting patients who are easier to the least
qualified colonoscopist. Until the core issue is addressed, perhaps with
comparison to other studies where quality outliers are dealt with, the study is not
publishable. Revising the Discussion and Conclusions would merit re review.
Minor points include no mention of: dates when study was conducted, institution
IRB approval, and total number of colonoscopies (instudy and out of study)during
study period In the Discussion"technical machismo" should be substituted for a
more appropriate term, perhaps technical ability.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Reviewer's report
Title:Maximizing the general success of cecal intubation during propofol
sedation in a multi-endoscopist academic centre
Version: 1Date:12 August 2010
Reviewer: Russell Heigh
Reviewer's report:
This is an interesting retrospective review of a large number of colonoscopies
performed under propofol sedation. The most important finding notes in the
Results is that "having a colonoscopy by a less experienced endoscopist
coincided with a 5 fold increased risk of an incomplete procedure by comparison
with colonoscopies handled by a highly experienced specialist; this risk dropped
to a 2 fold increase if the test was performed by a more experienced non
specialist." Unfortunately the authors do not talk about direct remediation of the
underlying quality problem they identified, or of the ethical decision making
involved in allowing unqualified colonoscopists to perform the procedure at all.
Instead, the authors talk about shunting patients who are easier to the least
qualified colonoscopist. Until the core issue is addressed, perhaps with
comparison to other studies where quality outliers are dealt with, the study is not
publishable. Revising the Discussion and Conclusions would merit re review.
Minor points include no mention of: dates when study was conducted, institution
IRB approval, and total number of colonoscopies (instudy and out of study)during
study period In the Discussion"technical machismo" should be substituted for a
more appropriate term, perhaps technical ability.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Please review this paper.
user
Reviewer's report
Title:Maximizing the general success of cecal intubation during propofol
sedation in a multi-endoscopist academic centre
Version: 1Date:12 August 2010
Reviewer: Russell Heigh
Reviewer's report:
This is an interesting retrospective review of a large number of colonoscopies
performed under propofol sedation. The most important finding notes in the
Results is that "having a colonoscopy by a less experienced endoscopist
coincided with a 5 fold increased risk of an incomplete procedure by comparison
with colonoscopies handled by a highly experienced specialist; this risk dropped
to a 2 fold increase if the test was performed by a more experienced non
specialist." Unfortunately the authors do not talk about direct remediation of the
underlying quality problem they identified, or of the ethical decision making
involved in allowing unqualified colonoscopists to perform the procedure at all.
Instead, the authors talk about shunting patients who are easier to the least
qualified colonoscopist. Until the core issue is addressed, perhaps with
comparison to other studies where quality outliers are dealt with, the study is not
publishable. Revising the Discussion and Conclusions would merit re review.
Minor points include no mention of: dates when study was conducted, institution
IRB approval, and total number of colonoscopies (instudy and out of study)during
study period In the Discussion"technical machismo" should be substituted for a
more appropriate term, perhaps technical ability.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
assistant