Referral for Colonoscopy in Patients With Streptococcus bovis Bacteremia and the Association With Colorectal Cancer and Adenomatous Polyps: A Quality Assurance Study
Bibliographic record
Abstract
Introduction: The association between Streptococcus bovis (S. bovis) bacteremia and colorectal cancer is well established. We aimed to review patients with S. bovis bacteremia in the Hamilton Regional Hospitals and determine the percentage of patients referred for colonoscopy. Methods: We searched the Hamilton Regional Laboratory Medicine Program database to identify S.bovis-positive blood cultures from January 2002 to December 2016. The records of patients with S. bovis bacteremia were reviewed and clinical data extracted. Clinical characteristics were analyzed using descriptive statistics. Univariate logistic regression analysis was performed to examine the association of clinical characteristics with a finding of adenocarcinoma or adenomatous polyps. Results: A total of 86 patients with S. bovis bacteremia were identified. From the 86 patients 14 were excluded (3 were made palliative, 6 had insufficient data, 4 were <18 years of age, and 1 was known to have CRC). The mean age of the 72 remaining patients was 74.5 (SD 13), 42/72 (58%) were male, 12/72 (17%) had infective endocarditis, and 19 (26%) died during admission. Of the 53 patients who survived, 37 (70%) were referred for colonoscopy or CT colonography, of which 30 had a colonoscopy. 3/30 (10%) cases showed adenocarcinoma and 11/30 (37%) cases showed adenomatous polyps. Using logistic regression, age, gender, or presence of infective endocarditis were not associated with a finding of adenocarcinoma or adenomatous polyps. Referral to gastroenterology was significantly associated with having a colonoscopy (p=0.001). Conclusion: In our local centers, only 70% of patients with S. bovis bacteremia were referred for colonoscopy or CT colonography, however, we did not have records from outside of our hospitals. Colonoscopy should be strongly considered as 10% of patients who had a colonoscopy were found to have adenocarcinoma with an additional 37% having adenomatous polyps.262 Figure 1. Flow diagram
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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 | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".