2889 Upper and Lower Gastrointestinal Endoscopy and Concomitant Anesthesia in a Central Canadian Province: A Population-Based Study
Bibliographic record
Abstract
INTRODUCTION: There are limited data on upper and lower gastrointestinal endoscopy (GIE) and concomitant anesthesia in universal health care systems, despite their increasing use. All Canadian provinces advocate for fecal occult blood test based colorectal cancer screening, which theoretically should lead to less lower GIE use. We evaluated the time trends and variations in use of upper and lower GIE and concomitant anesthesia in the province of Manitoba between April 1, 1984 and March 31, 2017. METHODS: Physicians claims reimbursement data from the provincial health ministry were used to ascertain upper, lower GIE and anesthesia use. Provincial population in each year was determined from the registrants’ database. Hospitalization discharge database was used to identify procedures performed in hospitals. Generalized linear models with generalized estimating equations were used to test the linear trend over time and differences amongst age groups, health regions, income quintiles. Logistic regression analysis with generalized estimating equations was used to assess predictors of anesthesia use. RESULTS: 410, 685 individuals had at least one procedure between 1984-2017. Although approximately half of the procedures were performed outside the recommended CRC screening age group of 50-74 years (38% among those less than 50 years), the rate of increase stabilized among the > 75 years group over the last 5 years of the study (Figure 1). There were marked regional differences in the last ten years, with the slowest increase in the largest urban region (Figure 2). There were much more marked variation in anesthesia use, ranging from 1% in the largest region to 80% in a rural region (Figure 3). CONCLUSION: There are marked variations in GIE use and concomitant anesthesia use in a universal health care system. The potential good news is that the rate of GIE use is no longer increasing among the older individuals. We have identified several endoscopist factors which could lead to targeted information dissemination, individual provider review and feedback and continuing medical education initiatives.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.010 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".