A237 COLONOSCOPY PREPARATION OPTIMIZATION FOR INPATIENTS (COIN STUDY). A RANDOMIZED CONTROLLED TRIAL COMPARING 4L PEGLYTE TO REGULAR DOSE PICO SALAX AND SPLIT DOSE PICO SALAX FOR COLONOSCOPY BOWEL PREPARATION IN HOSPITALIZED PATIENTS.
Bibliographic record
Abstract
Colonoscopy is routinely performed in hospitalized patients (HP) for investigation and treatment. Being a HP is a risk factor for a poor bowel preparation but there are limited studies examining bowel cleansing in this population. Our goal was to determine whether a low volume prep (PicoSalax) taken the day before or as a split prep is superior to a 4L of PegLyte taken the day before colonoscopy. This single-centre, endoscopist-blinded, three armed randomized controlled trial compared 4L PEG-Lyte to regular dose Pico Salax and to split dose Pico-Salax for colonoscopy preparation in HP’s. In addition, all patients were given Bisacodyl before starting the preparation. Inclusion criteria: Adult in-patients requiring colonoscopy. Exclusion criteria: renal insufficiency, severe congestive heart failure, recent myocardial infarction, ileus, ascites, severe colitis, megacolon, gastrointestinal obstruction, presence feeding tube, bowel resection, pregnancy, or allergy to study drugs. The primary outcome was overall cleansing efficacy using the Ottawa Bowel Preparation Scale (OBPS) as determined by the endoscopist. Secondary outcomes were components of the OBPS, canceled or repeated procedure due to poor cleansing, and safety and tolerability. The study sample size was calculated to be 126 patients. From October 2012 to November 2016, 44 patients were recruited and randomized. One patient refused to take the preparation. One patient’s procedure was canceled, and one patient was un-blinded due to poor response. The average patient age was 65.7 year’s with 22 females (50%). Indications for colonoscopy include investigation of bleeding (18), anemia (13), change in bowels (6), and abnormal imaging (2). There were 16 patients in the Pico Salax day before group, with mean OBPS of 6.5 (standard deviation (SD) 3.4), 13 patients in the Pico Salax split dose group, with mean OBPS of 4.3 (SD 2.6), and 15 patients in the PEGLyte group, with mean OBPS of 4.9 (SD 2.9) with ANOVA showing no difference between groups (p=0.15). Four patients reported severe adverse effects while taking the prep. Bowel preparation did not result in any cancelation or repeat procedure. The study was terminated early due to poor recruitment. Preparing hospitalized patients for colonoscopy is a challenging task. The optimal bowel preparation for these patients remains unknown. This study did not show any meaningful difference between groups taking PicoSalax the day before colonoscopy, or Pico Salax as a split preparation, or PEG Lyte the day before colonoscopy but was limited in power because of poor recruitment. Further research is needed in this population. Resident Research Grant, Department of Medicine, McMaster University.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".