PMC:4596361 / 11020-14974
Annnotations
{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/4596361","sourcedb":"PMC","sourceid":"4596361","source_url":"https://www.ncbi.nlm.nih.gov/pmc/4596361","text":"A total of 37 doctors performed most of the endoscopies (31 physicians, 5 surgeons and 1 paediatrician) and their records could be easily recognised. There were a few others included simply as ‘guest doctor’. Thirteen of the 37 doctors contributed over 500 procedures each, and five contributed over one thousand each. Many of these span several years, with one contributing over two decades (Fig. 1). With respect to inter-observer variation there is clear evidence that doctors differed with respect to diagnosis (Table 2). There was also variation by medical specialty. Surgical endoscopists were more likely to diagnose oesophageal cancer (3.9 % vs 3.2 % by physicians; P = 0.048), and less likely to diagnose duodenal ulcer (7.1 % vs 9.2 %; P \u003c 0.0001), oesophageal varices (3.3 % vs 5.4 % respectively; P = 0.0001) or normal findings (34 % vs 66 %; P = \u003c0.0001). The single paediatrician, who carries out procedures on both adults and children, was nevertheless less likely to diagnose cancer (doctor 10 in Table 2). However, the frequent diagnosis of oesophageal candidiasis by doctors 9 and 11, and lack of such by doctors 1, 2, 3 and 5, actually reflects the period over which they worked (Fig. 1), as HIV-related disorders were virtually unknown before about 1984.\nFig. 1 Contributions of individual endoscopists over the period 1977–2014. Only those endoscopists who contributed over 500 procedures are shown, except where they were the only doctors performing endoscopy at that time. The other 23 doctors are not shown, for clarity, but contributed 2656 records to the total. The bars at the bottom indicate the equipment in use over the whole period, beginning with non-immersible endoscopes (a) from 1977 to 1991, then immersible fibre-optic Olympus endoscopes (b) from 1991 to 2003, then fibre-optic Pentax endoscopes with camera viewing system (c) from 2003 to 2010, and lastly Pentax high-definition video endscopes (d) from 2010 to date\nTable 2 Principal endoscopists over time and diagnostic variation\nDoctor Period n Children Candida Varices Reflux OCA GU GCA DU KS Normal\n1 1977–1980 78 0 0 1 (1) 6 (8) 0 8 (10) 0 12 (16) 0 9 (12)\n2 1980–1983 520 9 0 25 (5) 10 (2) 12 (2) 35 (7) 15 (3) 87 (16) 0 63 (13)\n3 1980–1985 445 6 6 (1) 14 (3) 2 13 (3) 13 (3) 6 (1) 47 (11) 2 215 (52)\n5 1983–1985 347 5 3 (1) 22 (6) 0 15 (4) 44 (13) 5 (1) 15 (4) 0 68 (28)\n6 1985–1990 532 7 1 (0.2) 31 (6) 7 (1) 17 (3) 23 (5) 12 (2) 77 (15) 1 183 (38)\n7 1988–1998 819 18 51 (6) 22 (3) 86 (11) 10 (1) 29 (4) 8 (1) 62 (8) 3 256 (33)\n8 1993–2014 3499 101 202 (6) 220 (7) 63 (2) 115 (3) 210 (6) 110 (3) 398 (12) 24 1502 (50)\n9 1995–2010 1199 14 123 (10) 34 (3) 21 (2) 26 (2) 83 (7) 35 (3) 139 (12) 5 353 (31)\n10 1997–2014 776 238 48 (6) 46 (6) 29 (4) 12 (2) 29 (4) 8 (1) 62 (8) 1 319 (46)\n11 2001–2004 501 8 38 (8) 10 (2) 21 (4) 15 (3) 49 (10) 19 (4) 48 (10) 1 120 (26)\n12 2003–2014 1244 33 112 (9) 37 (3) 75 (6) 61 (5) 83 (7) 65 (5) 43 (4) 8 342 (32)\n13 2007–2014 2587 50 83 (3) 176 (7) 2 60 (2) 212 (9) 49 (2) 170 (7) 1 1333 (59)\n14 2006–2014 730 4 46 (3) 23 (3) 31 (4) 45 (6) 73 (11) 16 (2) 36 (5) 1 246 (41)\n15 2011–2014 1107 6 35 (3) 41 (4) 13 (1) 87 (8) 117 (12) 36 (3) 65 (6) 6 519 (56)\n16 2011–2012 701 9 54 (8) 17 (3) 0 20 (3) 70 (10) 20 (3) 59 (8) 0 365 (57)\nPercentages are shown in brackets, where % ≥1.0. Endoscopies performed by doctors who carried out less than 500 are not shown unless they were the sole endoscopists over a period of one or more years (see Fig. 1). Findings differed by endoscopist for all disorders (P \u003c 0.0001 for all, except for KS where P = 0.003). Variation in the length of time contributed reflects the contributions made by some volunteers on short term contracts, some recent trainees who now contribute to the service regularly, and two deaths among endoscopists in the 1990s. Trainees’ reports are always signed by the supervising doctor and are not reflected in this table until deemed ready for independent 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