Examination of Physiciansʼ Perception of the Indications of Colorectal Stents in the Management of Malignant Large Bowel Obstruction: A Provincial Survey
Bibliographic record
Abstract
Introduction: Data are conflicting when assessing the indications of colorectal self-expandable metallic stents (SEMS) in the management of acute malignant large bowel obstruction (MLO). In November 2014, the European and American Societies of Gastrointestinal Endoscopy published guidelines to aid in understanding which patients might benefit from colorectal stenting. Yet there remain marked disparities in clinical practice. Methods: A web-based survey was sent to Gastroenterologists and Surgical specialists across Quebec to assess physicians' knowledge and adherence to the indications for colonic SEMS placement in the management of MLO using eight targeted clinical scenarios. Descriptive statistics were performed. Results: Out of 124 respondents, 74.1% (95% confidence interval (CI) 66.0- 82.2%) preferred surgical intervention in young, healthy individuals with MLO, in keeping with guidelines. Advanced age and comorbidities motivated 56.3% (95% CI 47.1-65.5%) of participants to opt for SEMS placement. In palliative settings of patients undergoing chemotherapy including bevacizumab, a minority of respondents followed guidelines 12.5% (95% CI 6.4-18.6%) for young patients, 25.0% for elderly patients (95% CI 17.0-33.0%). The pooled overall adherence to guidelines was 50.4% (95% CI 40.7-59.3%).Table 1: Baseline characteristics of survey respondents (n = 112)Figure 1Figure 2Conclusion: The current evidence suggests that SEMS are an acceptable therapeutic option in selected cases of MLO. (1) This survey suggests that guidelines recommendations are not being implemented by at least half of specialists involved in the care of patients with MLO. Future studies should attempt to identify possible knowledge gaps and barriers responsible for this impaired knowledge translation, and tailored educational initiatives planned accordingly.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".