A PROSPECTIVE STUDY OF QUALITY OF PREPARATION FOR COLONOSCOPY IN A LARGE TERTIARY REFERRAL CENTER
Bibliographic record
Abstract
Purpose: Although we acknowledge that poor quality of preparation (poor prep) interferes with the quality of colonoscopic examination, there is very little information in the published literature on the incidence of poor prep and the factors influencing it in clinical practice. Aim: To report the results of a one year prospective study on the incidence of poor prep and the factors influencing it at our center. Methods: Based on the lecture of Peter Cotton at the NIH ERCP conference in 2002, we have developed an “Endoscopic QA Sheet” in February 2002 to monitor the quality of care provided at our center for every single patient undergoing endoscopy. Using the “Endoscopy QA Sheet,” data from every single patient scheduled to undergo a procedure was entered into a computer data-base daily. After obtaining approval from the IRB for this study, data from January through December 2003 was reviewed to assess the incidence of poor prep and the factors influencing it. Statistics: Chi-square was used for comparison. Results: Between January & December 2003, 3923 colonoscopies were performed at our center (mean age: 58.9 ± 13.3 years, Males: females: 2:1.9). I. Incidence of Poor Quality of Prep: 9%. II. Factors Influencing the incidence of “Poor Quality Prep”: i. Seasonal variation: 1st quarter of the year: 12%, 2nd quarter: 12%, 3rd quarter: 7%, 4th quarter: 8%. ii. Diurnal variation: Colonoscopy schedule before Noon: 9%, & colonoscopy scheduled in the afternoon: 10%. iii. Effect of Age: <60 years: 10% and >60 years: 9%. iv. Effect of Gender: Males: 11%, Females: 8% (p <0.01). v. Effect of Origin of Patients: Inpatients: 21%, Inmates: 17%, Outpatients: 7%(p <0.001). vi. Effect of type, dosing, and timing of purgative intake: PM Phosphosoda: 6%, Split dose (PM & AM) Phosphosoda: 7%, and PM Golytely: 18% (p <0.001). III. Findings on Repeat Colonoscopy: Cancer 1.5%, Advanced adenoma 2.1%, Tubular adenoma: 15%. Conclusions: The incidence of poor prep for colonoscopy is worse in in-patients (21%) and inmates (17%) undergoing colonoscopy, which would translate into a higher number of repeat procedures, increased morbidity from repeat preparation and procedures, and higher cost of care from prolonged hospital stay. Measures to decrease the poor prep in hospitalized patients i.e., development of a dedicated colon prep protocol for hospitalized patients and education of the hospital nurses in assessing the quality of stool output before sending the patients to endoscopy are being investigated at our center.
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".