In most proposed systems of assessment, a key differentiator is not accounted for, namely whether the papillae were virgin or otherwise prior to commencement.
The alternative approach of dealing with all cases on an intention-to-treat basis, and ignoring case mix, is undoubtedly simpler, but less precise. Once cannulated, the therapeutic intent will be realised partially or fully, but separating the two elements of the procedure, as far as benchmarking is concerned, allows a clearer understanding of exactly what is occurring at each ERCP centre. The intent of this paper is to define a straightforward and readily reproducible measure of successful cannulation of a virgin papilla, an interpretation of JAG's definition of ‘initial attempt’, where subsequent therapeutic or diagnostic success is treated as a separate category.
These guidelines echo the statement made in their previous endoscopy guidelines of 2007, 2 which advise that completion of the intended therapeutic procedure should be achieved in at least 80% of cases.ĭue to caseload differences between endoscopy units, direct comparison of success rates requires standardising, with a wide variation nationally and internationally in both grading systems and success rates. The Joint Advisory Group (JAG) on Gastrointestinal Endoscopy published guidelines for the use of a Global Rating Scale in 2009, 1 which promotes the frequent audit of quality and safety of each mode of endoscopy. The caseload is shared between three consultants, one of whom works for another Trust where he also performs ERCP. St Thomas’ Hospital was the first centre performing ERCP in the UK in the early 1970s and now serves as a tertiary referral centre performing a moderately high volume of procedures per year. Measuring success of the procedure against an agreed benchmark is an evolving and debated topic, and one which is essential in providing a basis for assessing performance of both trainees and established practitioners. And when you’re not gaming, the GPU has quieter or even idleĪnd emits less heat, which we can all appreciate on hot summer days.Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most challenging endoscopic techniques indicated in a range of pancreatic and biliary diseases. And of course, with increased performance efficiency comes better overall performance-per-watt, giving you more frames for every watt of power.Īltogether, this means you get a faster GPU that operates at lower temperatures, enabling quieter fan speeds, ensuring your gaming isn’t drowned out by fan noise. In the case of GeForce RTX graphics cards, numerous industry-firsts enable unprecedented performance efficiency on a 12nm process node, that is still to date more efficient than any other architecture. Power efficiency comes from all aspects of a graphics card’s design, not just the size of the process node it was built on. With better power efficiency you generate less heat, which means the GPU can be cranked up to higher levels, resulting in higher clock speeds, and giving the GPU’s designers the thermal and power capacity to add more Ray Tracing Cores and other doodads to the chip.
Power efficiency is of critical importance in the world of GPUs.
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