A National Survey and Needs Assessment on Choices of Therapeutic Agents for Chronic Idiopathic Constipation and Constipation Predominant Irritable Bowel Syndrome: A Canadian Perspective
Bibliographic record
Abstract
Introduction: Chronic Idiopathic Constipation (CIC) and constipation-predominant Irritable Bowel Syndrome (IBS-C) are common functional lower gastrointestinal disorders that impair patients' quality of life; despite this, therapies remain unsatisfactory to patients and treating physicians. In 2014, ACG and AGA published two clinical guidelines independently. In a national survey, we aim to evaluate: 1. Canadian gastroenterologists (GIs) practice patterns in the utilization of therapeutic agents listed in the two guidelines; 2. GIs satisfaction with these agents for their CIC and IBS-C patients; and 3. the usefulness of these new guidelines in their clinical practice. Methods: In February 2015, a 9-item questionnaire was sent to 350 Canadian GIs (Converge, Toronto, ON, Canada) to determine their practice demographic information and practice approaches to CIC and IBS-C management including stool softener, fibre supplement, stimulant and osmotic laxative, 5-HT4 agonist and guanylate cyclase-C (GCC) agonist therapies. The study closed in May 2015. Results: The response rate to the survey was 15% (n=52). Almost all (96%) responders follow a standard, stepwise approach for managing patients with CIC and IBS-C. However, they believe that only 23% of referring physicians follow the same approach. Reported first-line therapy (osmotic laxatives) was similar for IBS-C and CIC but second-line therapy differed for CIC (bulking agents) and IBS-C (GCC agonist). Nearly 80% of responders indicated that GCC agonists were the most satisfactory therapy for IBS-C and CIC; despite this, 61% of responders and 64% of referring physicians (reported by the responders) are reluctant to move from over-the-counter to prescription agents. Among the 68% of responders who are aware of the 2 published guidelines, only 51% found the guidelines helpful in prioritizing treatment choices, and 69% of responders indicated that a treatment algorithm, applicable to Canadian practice, would be valuable. Conclusion: This survey demonstrates a need for an education program to standardize and enhance the treatment of CIC and IBS-C. The majority of Canadian GIs would welcome a practical management algorithm to translate new published guidelines and the role of new therapeutic agents into clinical practice. Based on this needs assessment, a comprehensive treatment algorithm has been developed and will be evaluated for the management of IBS-C and CIC in Canadian practice.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.008 |
| Science and technology studies | 0.003 | 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) | 0.003 | 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".