A315 FREQUENCY AND PREDICTORS OF FASTING ORDERS IN INPATIENTS WITH ULCERATIVE COLITIS: THE AUDIT OF DIET ORDERS - ULCERATIVE COLITIS (ADORE-UC) STUDY
Bibliographic record
Abstract
Current clinical practice guidelines suggest that ulcerative colitis (UC) patients admitted due to a disease flare should be offered a normal diet or enteral nutrition unless such a diet is not tolerated. Despite this recommendation, concerns about iatrogenic malnutrition from unjustified NPO or clear liquid diet (CLD) orders exist. We aim to describe the frequency and audit the appropriateness of NPO and CLD orders among hospitalized UC patients and identify predictors of unjustified fasting. We conducted a retrospective cohort study of all UC patients who were admitted to the gastroenterology (GI) service or the general internal medicine (GIM) service at an academic hospital between January 2009 and December 2014. The frequency and duration of bowel rest orders and the number of meals missed because of these orders were assessed. Bowel rest orders were considered justified if the patient had intractable nausea or vomiting, pancreatitis, bowel obstruction, toxic megacolon or were awaiting endoscopy, or if alternative enteral or parenteral nutrition was provided. Patients with unjustified fasting orders were identified and the number of missed meal opportunities was measured. A logistic regression model was used to assess predictors of unjustified fasting in admitted UC patients. A total of 187 admissions in 158 UC patients were identified during the study period and included in the final analysis. The majority of the admissions were under the GI service (148/187, 79.1%). The mean age at admission was 35.0 years (standard deviation [SD] = 15) and 83/158 (52.5%) were female. The median length of stay was 8 days (interquartile range [IQR] = 4 – 12). Registered dietician consultation was obtained in only 32 admissions (17.1%), and admission weight was recorded in only 68 (36.4%) admissions. A total of 252 NPO or CF dietary orders were encountered in 142 admissions (75.9%). Of those, 112 orders were unjustified (44%). On average, patients with unjustified NPO or CF orders spent 3 days on an NPO or CF diet, which corresponded to a mean of 10 missed meals. Significant predictors of unjustified NPO or CF dietary orders were: NPO or CF diet ordered on admission [odds ratio, OR = 12.9, 95% confidence interval, 4.78–34.9]; admission to non-GI service [11.7, 95% CI 2.63–52.2], and lack of inpatient prednisone or biologics [3.4, 95% CI 1.4–11.6]. There is a high burden of prolonged bowel rest among hospitalized UC patients. Further studies are needed to assess the nutritional impact of prolonged bowel rest on UC patients. Our findings also suggest that targeted interventions are needed to decrease the frequency of inappropriate bowel rest among hospitalized UC patients. None
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".