Frequency and Predictors of Fasting Orders in Inpatients with Ulcerative Colitis: The Audit of Diet Orders - Ulcerative Colitis (ADORE-UC) Study
Bibliographic record
Abstract
Introduction: Studies have demonstrated that physicians may contribute to malnutrition by ordering bowel rest inappropriately. Practice guidelines recommend that patients hospitalized with UC be offered a normal diet or enteral nutrition unless such a diet is not tolerated. There are no published studies assessing compliance with this recommendation. This study aims to assess the frequency of unnecessary bowel rest in hospitalized UC patients and to identify predictors of prolonged bowel rest. Methods: We conducted a retrospective cohort study of ulcerative colitis 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, with a length of stay of 2 or more and 30 or fewer days. 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 necessary if the patient had intractable nausea or vomiting, pancreatitis, bowel obstruction, toxic megacolon or were awaiting endoscopy. Prolonged bowel rest was defined as being NPO (nil per os) or on a CFD (clear fluids diet) for over 25% of the duration of the admission, and absence of an appropriate indication. Predictors of prolonged bowel rest were assessed using logistic regression. Results: A total of 187 admissions in 158 UC patients were identified during the study period. The median length of stay was 8 days ([IQR] = 4 - 12). Prolonged bowel rest orders were encountered in 82 (43.9%) admissions. The mean duration of prolonged bowel rest was 2.27 days (SD = 1.2) or 36% of admission length (SD = 26). Prolonged bowel rest was encountered in 52 (27.8%) admissions. Significant (p< 0.05) predictors of prolonged bowel rest in the final model were: NPO or CFD diet ordered at admission, odds ratio [OR] 19.5 (95% confidence interval [CI] 7.75 - 49.0); more than one admission during the study period, 8.86 (95% CI 2.16 - 36.27); biologic therapy initiation during admission, 4.25 (95% CI 1.40 - 12.85); and admission to non-GI service 2.64 (1.30 - 6.72). Conclusion: There is a high burden of prolonged bowel rest among hospitalized UC patients. Our findings also suggest that targeted interventions, possibly directed early in admission, are needed to decrease the frequency of inappropriate bowel rest among hospitalized UC patients. Further studies are needed to assess the nutritional impact of prolonged bowel rest on UC patients.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| 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".