A214 ADHERENCE TO COLONOSCOPY SURVEILLANCE GUIDELINES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Notice bibliographique
Résumé
Colorectal cancer (CRC) is a major worldwide cause for cancer related mortality. Colonoscopy-based population screening programs based on guideline recommended surveillance intervals have been put in place to reduce the morbidity and mortality associated with CRC. To evaluate clinical practice adherence to surveillance colonoscopies guideline recommendations, the potential extent of early repeat colonoscopies, and causes for non-adherence to guideline recommendations. MEDLINE, EMBASE, EBM Reviews, and CINAHL databases were searched up to January 2018 for articles reporting on guideline adherence for surveillance colonoscopies. Original clinical studies reporting patient outcomes were included if they excluded inflammatory bowel disease and hereditary CRC syndrome cohorts. Eligibility was assessed by two different researchers and conflicts were resolved through a third researcher. Primary outcome was correct surveillance interval assignment in patients undergoing screening or surveillance colonoscopy. Groups were assessed for adherence according to their respective guideline recommendations (North American or European). Eighteen studies were included in the analysis. The mean colonoscopy surveillance interval adherence rate was 48.8% (95% CI, 37.3–60.4). Adherence to clinical indications for performing colonoscopies was 66.5% (95% CI, 52.7–79.0). For North American guidelines, surveillance interval assignments after detection of low-risk lesions were adherent to recommendations in 44.7% (95% CI, 24.2–66.3) of patients; shorter in 52.4% (95% CI, 31.5–72.8); longer in 1.4% (95% CI, 0.00–5.82). After detection of high-risk lesions, 54.6% (95% CI, 41.4–67.4) of surveillance intervals were adherent to recommendations; 30.8% (95% CI, 22.7–39.5) were shorter; 14.7% (95% CI, 4.0–30.0) were longer. For European guidelines, surveillance interval assignments after detection of low-risk lesions were adherent to recommendations in 24.4% (95% CI, 1.1–63.4) of patients; shorter in 61.2% (95% CI, 43.8–77.2); longer in 0.7% (95% CI, 0.0–4.1). After detection of high-risk lesions, 73.6% (95% CI, 35.5–98.8) of surveillance intervals were adherent to recommendations; 0% (95% CI, 0.0–0.4) were shorter; 16.1 (95% CI, 2.4–36.5) were longer. The worldwide adherence to surveillance colonoscopy guidelines is low with more than 50% of patients undergoing too early or too late repeat colonoscopies. Early repeat colonoscopies occur with the highest frequency in patients in whom only hyperplastic polyps or low-risk adenomas are found. Reasons cited for non-adherence included disagreement with the guidelines, endoscopist concern for missed polyps, poor bowel preparation, malpractice concerns, and reimbursement reasons. Percentage of adherence to surveillance intervals None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,039 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,015 | 0,038 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».