An Audit of Fecal Occult Blood Testing in Hospital Inpatients
Bibliographic record
Abstract
Purpose: The fecal occult blood test (FOBT) is a community-based screening tool for the early detection of colorectal cancer. Although not validated for use in inpatients, it is often used by hospital physicians for reasons other than asymptomatic screening. The purpose of this study was to profile its use in hospital and assess its impact on patient care. Methods: Patient charts were retrospectively reviewed for all FOBTs conducted over a three month period in 2011 by the central laboratory supporting the three acute care campuses of Hamilton Health Sciences (Hamilton ON). Results: A total of 229 patients had 351 tests performed. 52% were female and the mean age was 49 (range 1-104). A total of 80 (34.9%) patients had at least one positive test. The most common indications for testing were anemia (51.0%) and overt gastrointestinal bleeding (19.2%). Only one patient had testing performed for asymptomatic colorectal cancer screening. In only 20 cases (8.7%) were medications modified prior to testing and in only 21 cases (9.2%) was diet modified. Most patients (85.2%) were taking one or more medications that could result in a false positive result. Only 18 (7.9%) patients had digital rectal exams documented, of which 7 were positive. All patients with a positive digital rectal exam had endoscopic procedures that revealed a source of bleeding. Among 44 patients with overt gastrointestinal bleeding, 12 (27.3%) had endoscopic investigations delayed to await results of the FOBT. Five of these were still referred despite a negative FOBT. Conclusion: The FOBT is often used inappropriately in the hospital setting. Confounding issues such as diet and medication use that may lead to false positives are often ignored. Use of FOBT in-hospital may lead to inappropriate management of patients, increased length of stay and increased direct medical costs. Use of the FOBT should be limited to validated indications only.
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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 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| 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) | 0.001 | 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".