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Gawron AJ, Horner B, Zurbuchen R, Boynton K, Fang JC. A comprehensive intervention to enhance inpatient colon preparation quality for colonoscopy. Minerva Gastroenterol (Torino) 2023; 69:351-358. [PMID: 33793164 DOI: 10.23736/s2724-5985.21.02766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adequate colon preparation is a critical component of high-quality colonoscopy especially for inpatients undergoing colonoscopy for acute indications. Inpatient colonoscopy has a high incidence of inadequate preparations. We report implementation of a multifaceted quality improvement intervention to improve inpatient colonoscopy preparations. METHODS Bowel preparation quality from inpatient colonoscopies performed for the 12 months prior to the comprehensive intervention were compared to colonoscopies performed for 12 months following the intervention. The intervention had multiple components including: 1) EMR-based colonoscopy preparation order set; 2) automated EMR alerts prompting nursing assessment of preparation progress; 3) standardized nursing charting processes for tracking preparation progress; and 4) standardized education for nursing staff and ordering providers on adequate colon preparation, assessment of colon preparation quality, and use of the above processes; and print and video patient education materials. RESULTS Two hundred thirty-eight inpatient colonoscopies were performed in the preintervention assessment period and 163 colonoscopies in the postintervention period. Median preintervention Boston Bowel Preparation Score (BBPS) was 6 and 26% of patients had inadequate colon preparation. Median postintervention BBPS was 8 with 16% inadequate colon preparation (P=0.016). The postintervention group had less ASA class I patients and used a lower dose of fentanyl than the preintervention group. There were no other significant differences between the pre- and postintervention groups. CONCLUSIONS Implementation of a comprehensive colon preparation quality intervention resulted in significantly improved inpatient colon preparation quality and decreased frequency of inadequate preparations. The intervention consisting of an EMR-based order-set, nursing alerts and charting process, and patient education materials is continually being refined.
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Affiliation(s)
- Andrew J Gawron
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brian Horner
- Cheyenne Regional Medical Center, Cheyenne, WY, USA
| | - Rudi Zurbuchen
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - John C Fang
- University of Utah School of Medicine, Salt Lake City, UT, USA -
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Losurdo G, Martino ML, De Bellis M, Celiberto F, Rizzi S, Principi M, Ierardi E, Iannone A, Di Leo A. Effect of Visual Booklets to Improve Bowel Preparation in Colonoscopy: Systematic Review with Meta-Analysis. J Clin Med 2023; 12:4377. [PMID: 37445412 DOI: 10.3390/jcm12134377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
An optimal bowel preparation for colonoscopy is essential to increasing the quality of the examination. Visual booklets have been proposed with conflicting results to enhance bowel preparation. A literature search was performed in March 2023 in the most important databases. Only RCTs were selected. We calculated odd ratios (OR) for dichotomous outcomes. Mean differences (MD) or standardized mean differences (SMD) were used for continuous outcomes. We estimated heterogeneity with the Chi2 and the I2 statistics. In cases of high heterogeneity, a random effect model was used. Six studies were selected, enrolling 1755 patients overall. Adequate bowel preparation was observed in 86.7% of the booklet group versus 77.5% of the control group, with an OR = 2.31 in favor of the booklet. In studies using a 4-L PEG-based preparation, no difference compared to controls was observed, while in non-PEG formulations, preparation with booklets was better than in controls (OR = 5.10, 95% CI 1.82-14.27, p = 0.002). Two studies were performed in an inpatient setting without any differences between booklets and controls, while outpatients receiving booklets had better results (OR = 7.13, 95% CI 5.39-9.45, p < 0.001). The adenoma detection rate was similar between the two groups. In conclusion, booklets are useful to improve bowel preparation. Outpatient settings and preparations not containing PEG could benefit more from booklets.
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Affiliation(s)
- Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Ludovica Martino
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Margherita De Bellis
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Precision Medicine Jonic Area, University "Aldo Moro" of Bari, 70124 Bari, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Mariabeatrice Principi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Andrea Iannone
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Shi L, Liao F, Liao W, Zhu Y, Chen Y, Shu X. Risk factors for inadequate bowel preparation before colonoscopy: a retrospective cohort study. BMC Gastroenterol 2023; 23:204. [PMID: 37312029 DOI: 10.1186/s12876-023-02796-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 05/03/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Colonoscopy is the standard and most effective screening tool for colonic diseases and the accuracy of colonoscopy depends on the quality of bowel preparation. The aim of this study was to analyze the risk factors for inadequate bowel preparation before colonoscopy. METHODS In this retrospective study, patients who underwent colonoscopy in 2018 and received 3 L of Polyethylene Glycol Electrolytes powder were included. They were instructed to drink 1.5 L the night before the colonoscopy and 1.5 L 4-6 h before the procedure given in doses of 250 ml every 10 min with 30 ml of simethicone given 4-6 h before the colonoscopy. Patient- and procedure-related parameters were recorded. An adequate bowel preparation was defined as all 3 segments rated 2 or 3 on the Boston Bowel Preparation scale. Risk factors for inadequate bowel preparation were identified using multivariate logistic regression analysis. RESULTS A total of 6720 patients were included in the present study. The mean age of these patients was 49.7 ± 13.0 years old. Inadequate bowel preparation was found in 233 (12.4%), 139 (6.4%), 131 (7%), 68 (8.6%) patients in spring, summer, autumn and winter respectively. On the multivariate analysis, male gender (OR: 1.295; 95% CI: 1.088-1.542; P = 0.005), inpatient status (OR: 1.377; 95% CI: 1.040-1.822; P = 0.025) and season (spring vs. winter, OR: 1.514; 95% CI: 1.139-2.012; P = 0.004) were the independent risk factors for inadequate bowel preparation. CONCLUSIONS Male gender, inpatient status and spring season were the independent risk factors for inadequate bowel preparation. For patients with risk factors for inadequate bowel preparation, enhanced bowel preparation and instructions may help to optimize the quality of bowel preparation.
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Affiliation(s)
- Liu Shi
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Gastroenterology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, 341000, Jiangxi, China
| | - Foqiang Liao
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Wangdi Liao
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
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Kabir C, Salazar Leon M, Ndiaye C, Flicker M. Effect of acuity level and patient characteristics on bowel preparation quality: a retrospective cohort study of inpatient colonoscopies. BMC Gastroenterol 2023; 23:126. [PMID: 37061688 PMCID: PMC10105396 DOI: 10.1186/s12876-023-02751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/28/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND AND AIMS Colonoscopy is the primary method to detect mucosal abnormalities in the colon, rectum, and terminal ileum. Inadequate bowel preparation is a common problem and can impede successful visualization during colonoscopy. Although studies identified hospitalization as a predictor of inadequate bowel preparation, acuity of care vary greatly within this patient population. The current study aims to examine the effect of patient characteristics and care level predictors on inadequate bowel preparation quality within the inpatient setting. METHODS This retrospective study was conducted in a single urban level 1 trauma medical center and included adult patients undergoing diagnostic colonoscopy while admitted in the hospital from January 1, 2015 to June 30, 2020. We examined the level of inpatient care between the General Medical Floor (GMF), Intensive Care Units (ICU) and Telemetry Unit (TU) and assessed this association with bowel preparation quality, adjusting for known and unknown predictors. RESULTS Of 538 patients undergoing colonoscopy, 47.4% were admitted into TU, 43.7% into GMF and 8.9% into ICU. For the entire sample, 72.7% of patients achieved good or excellent preparation and quality of bowel preparation differed by care level (P = 0.01). Patients from the critical care units were less likely to achieve adequate bowel preparation when compared to GMF (Odds Ratio [OR] 0.36; 95% Confidence Interval [CI] 0.17,0.77), after adjusting for patient characteristics, medications, physical status, and preparation regimen. No significant difference in Bowel Preparation Quality (BPQ) was identified between patients from GMF and TU (OR 0.96; 95%CI 0.61, 1.52). Furthermore, adequate BPQ was associated with withdrawal time and cecal intubation, but not higher adenoma detection rates. CONCLUSIONS Results suggest the ICU setting is an independent predictor for inadequate bowel preparation and patients with prior opioid and laxative use may be more likely to have inadequate bowel preparation in the hospital. Future interventions should prioritize preprocedural clinician meetings for critical care unit patients, including a more detailed readiness assessment and thorough medication history.
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Affiliation(s)
- Christopher Kabir
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA.
| | - Mariani Salazar Leon
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
| | - Cindy Ndiaye
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
| | - Michael Flicker
- Advocate Illinois Masonic Medical Center, Advocate Aurora Research Institute, Advocate Aurora Health, Center for Education, 836 W Wellington Ave, #2025, Chicago, IL 60657, USA
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Horgan S, Hegarty J, Andrews E, Hooton C, Drennan J. Impact of a quality improvement intervention on the incidence of surgical site infection in patients undergoing colorectal surgery: Pre-test-post-test design. J Clin Nurs 2023. [PMID: 36924125 DOI: 10.1111/jocn.16690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/14/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to measure the impact of a complex quality improvement intervention on the incidence of SSI in patients undergoing elective colorectal surgery. BACKGROUND Surgical site infections are a major postoperative complication for patients undergoing colorectal surgery. Prevention of SSIs necessitates a complex intervention requiring many elements to be in place to ensure the successful implementation of prevention measures. DESIGN This study was a non-equivalent pre-test post-test design where consecutive patients undergoing colorectal surgery were surveyed for surgical site infections for 30 days postoperatively and is reported using the SQUIRE 2.0. METHODS A baseline cohort of patients was retrospectively reviewed in a single centre to ascertain the surgical site infection incidence rate in the first 6 months of 2018 (T0) and prospectively at two 6-month time periods in 2019 (T1, T2) following the introduction of a complex intervention. There were 311 patients included across three time periods. RESULTS There was a notable decrease in surgical site infection incidence rates from baseline over the course of the study. Univariate analysis identified Body Mass Index, a wound contamination classification of dirty or contaminated, duration of surgery >75th percentile and a National Healthcare Safety Network risk index score of 3 as factors that significantly increase the probability of developing a surgical site infection. Multivariate analysis identified duration of surgery and body mass index increased the probability of an SSI. The results of the logistical regression model found that there was a significant reduction in the probability of an SSI between T0 and T2. CONCLUSIONS The implementation of a complex intervention led to a reduction in the incidence of surgical site infections and improved implementation of evidence-based practices as part of a care bundle in relation to the prevention of surgical site infections in patients undergoing elective colorectal surgery. RELEVANCE TO CLINICAL PRACTICE A multicomponent multidisciplinary complex intervention as part of a quality improvement project can successfully reduce the incidence rates of surgical site infections in patients who require elective colorectal surgery. Normalisation Process Theory provides guidance and support in implementing complex interventions for the prevention of surgical site infection. PATIENT OR PUBLIC CONTRIBUTION Patients provided post-discharge information on their wound healing as part of the surveillance component of the intervention. Five patients reviewed and provided feedback on a patient information booklet which was developed from this quality improvement intervention. A multidisciplinary steering group guided all stages of the project.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and Midwifery, South/South West Hospital Group, Cork, Ireland
- Department of Surgery, Cork University Hospital/School of Medicine University College Cork, Cork, Ireland
| | - Josephine Hegarty
- Department of Nursing and Midwifery, South/South West Hospital Group, Cork, Ireland
| | - Emmet Andrews
- School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland
| | | | - Jonathan Drennan
- Department of Nursing and Midwifery, South/South West Hospital Group, Cork, Ireland
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6
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Iabichino G, Eusebi LH, Palamara MA, Luigiano C. Inpatients' bowel preparation: with teamwork we can win. Minerva Gastroenterol (Torino) 2023; 69:4-6. [PMID: 32623868 DOI: 10.23736/s2724-5985.20.02725-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
| | - Leonardo H Eusebi
- Department of Medical and Surgical Sciences, S. Orsola University Hospital, Bologna, Italy
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Sun CL, Li DK, Zenteno AC, Bravard MA, Carolan P, Daily B, Elamin S, Ha J, Moore A, Safavi K, Yun BJ, Dunn P, Levi R, Richter JM. Low-Volume Bowel Preparation Is Associated With Reduced Time to Colonoscopy in Hospitalized Patients: A Propensity-Matched Analysis. Clin Transl Gastroenterol 2022; 13:e00482. [PMID: 35347098 PMCID: PMC10476773 DOI: 10.14309/ctg.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/09/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Delays in inpatient colonoscopy are commonly caused by inadequate bowel preparation and result in increased hospital length of stay (LOS) and healthcare costs. Low-volume bowel preparation (LV-BP; sodium sulfate, potassium sulfate, and magnesium sulfate ) has been shown to improve outpatient bowel preparation quality compared with standard high-volume bowel preparations (HV-BP; polyethylene glycol ). However, its efficacy in hospitalized patients has not been well-studied. We assessed the impact of LV-BP on time to colonoscopy, hospital LOS, and bowel preparation quality among inpatients. METHODS We performed a propensity score-matched analysis of adult inpatients undergoing colonoscopy who received either LV-BP or HV-BP before colonoscopy at a quaternary academic medical center. Multivariate regression models with feature selection were developed to assess the association between LV-BP and study outcomes. RESULTS Among 1,807 inpatients included in this study, 293 and 1,514 patients received LV-BP and HV-BP, respectively. Among the propensity score-matched population, LV-BP was associated with a shorter time to colonoscopy (β: -0.43 [95% confidence interval: -0.56 to -0.30]) while having similar odds of adequate preparation (odds ratio: 1.02 [95% confidence interval: 0.71-1.46]; P = 0.92). LV-BP was also significantly associated with decreased hospital LOS among older patients (age ≥ 75 years), patients with chronic kidney disease, and patients who were hospitalized with gastrointestinal bleeding. DISCUSSION LV-BP is associated with decreased time to colonoscopy in hospitalized patients. Older inpatients, inpatients with chronic kidney disease, and inpatients with gastrointestinal bleeding may particularly benefit from LV-BP. Prospective studies are needed to further establish the role of LV-BP for inpatient colonoscopies.
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Affiliation(s)
- Christopher L.F. Sun
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Darrick K. Li
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ana Cecilia Zenteno
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marjory A. Bravard
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Carolan
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Daily
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sami Elamin
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasmine Ha
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Moore
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyan Safavi
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Brian J. Yun
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Dunn
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Retsef Levi
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James M. Richter
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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Li P, He X, Yang X, Du J, Wu W, Tu J. Patient education by smartphones for bowel preparation before colonoscopy. J Gastroenterol Hepatol 2022; 37:1349-1359. [PMID: 35384043 DOI: 10.1111/jgh.15849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM We aim to evaluate the effect of smartphone education on the bowel preparation quality of patients undergoing colonoscopy by meta-analysis. METHODS Randomized controlled trials using smartphones to educate patients on bowel preparation for colonoscopy were screened from the PubMed, Web of Science, Cochrane Library, and Embase databases from inception to August 31, 2021. After extracting the data, Review Manager software was used for meta-analysis. RESULTS A total of 12 randomized controlled trials with 4165 patients were included in the meta-analysis. There were 2060 patients in the smartphone group, including 1784 patients with adequate bowel preparation, with a rate of 86.6%, and 2105 patients in the control group, including 1614 patients with adequate bowel preparation, with a rate of 76.7%, and pooled risk ratio (RR) was 1.15 (95% confidence interval [CI]: 1.07-1.23, P < 0.01). Eight included studies reported the adenoma detection rate. The adenoma detection rate in the smartphone group was 26.2%, and the rate in the control group was 19.3%, with an RR of 1.29 (95% CI: 1.03-1.62, P < 0.05). CONCLUSION Using smartphones to educate patients on bowel preparation for colonoscopy improved the quality of bowel preparation and increased the adenoma detection rate.
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Affiliation(s)
- Peng Li
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xueqian He
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xufang Yang
- Department of General Medicine, Dinghai Central Hospital (Dinghai District of Zhejiang Provincial People's Hospital), Zhoushan, China
| | - Jing Du
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Weiquan Wu
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jiangfeng Tu
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Lam TY, Wu PI, Tang RS, Tse Y, Lau JY, Wu JC, Sung JJ. Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial. Int J Nurs Stud 2022; 133:104301. [DOI: 10.1016/j.ijnurstu.2022.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
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10
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Tian X, Yi LJ, Han Y, Chen H, Liu XL, Chen WQ, Jiménez-Herrera MF. Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials. J Med Internet Res 2021; 23:e19915. [PMID: 34694227 PMCID: PMC8576559 DOI: 10.2196/19915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 01/30/2023] Open
Abstract
Background Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. Objective We performed a network meta-analysis to determine the optimal instructions. Methods We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. Results We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). Conclusions Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/
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Affiliation(s)
- Xu Tian
- Nursing Department, Universitat Rovira i Virgili, Tarragona, Spain
| | - Li-Juan Yi
- Department of Nursing, Hunan Traditional Chinese Medical College, Zhuzhou, China
| | - Yang Han
- Chongqing University Cancer Hospital, Chongqing, China
| | - Hui Chen
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiao-Ling Liu
- Chongqing University Cancer Hospital, Chongqing, China
| | - Wei-Qing Chen
- Chongqing University Cancer Hospital, Chongqing, China
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Russell L, Mathura P, Lee A, Dhaliwal R, Kassam N, Kohansal A. Patient-centered approaches to targeting incomplete bowel preparations for inpatient colonoscopies. Ann Gastroenterol 2021; 34:547-551. [PMID: 34276194 PMCID: PMC8276365 DOI: 10.20524/aog.2021.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background A high-quality colonoscopy bowel prep is vital to completing the procedure. Adequate inpatient bowel preparation has been consistently difficult to achieve because of multiple factors. Incomplete bowel prep can lead to repeated colonoscopies, poor patient experience, increased costs, and prolonged hospitalization. This study aimed to develop patient-centered interventions to optimize bowel prep for inpatients undergoing colonoscopy. Methods The Model for Improvement and Donabedian frameworks guided this project. An interdisciplinary team compiled quality improvement tools that identified areas for improvement. Interventions development included a nursing tip sheet for troubleshooting symptoms, a standardized order label and a patient educational placemat. Plan-Do-Study-Act (PDSA) cycles were carried out to test and analyze the effects of the interventions. The project aim was a 30% reduction in incomplete inpatient colonoscopies from poor bowel prep. Process measures included the number of colonoscopy split prep order labels, and placemats used. The balancing measure was the number of repeat colonoscopies. Results Prior to the intervention, 44% (44/99) of inpatient colonoscopies had poor bowel prep resulting in 10 repeat procedures (10%). Post intervention, 60% (28/47) of the colonoscopies used the standardized label, 66% of physician orders used 2-L split prep, and 80% of patients were provided with the educational placemat. Of the 47 colonoscopies audited post intervention, there was a significant decrease in poor prep (27.7% [13/47], P=0.038) for colonoscopies. The percentage of repeated colonoscopies decreased to 4% (2/47). Conclusion Developing simple and easy-to-use patient-centered interventions can effectively improve colonoscopy preparation for hospitalized patients.
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Affiliation(s)
- Lindsey Russell
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal).,McMaster University, Hamilton ON (Lindsey Russell)
| | - Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal).,Alberta Health Services, Edmonton AB (Pamela Mathura, Narmin Kassam)
| | - Amanda Lee
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal)
| | - Raveena Dhaliwal
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal)
| | - Narmin Kassam
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal).,Alberta Health Services, Edmonton AB (Pamela Mathura, Narmin Kassam)
| | - Ali Kohansal
- Department of Medicine, University of Alberta, Edmonton AB (Lindsey Russell, Pamela Mathura, Amanda Lee, Raveena Dhaliwal, Narmin Kassam, Ali Kohansal).,Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Halifax NS (Ali Kohansal), Canada
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12
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Triantafyllou K, Gkolfakis P, Skamnelos A, Diamantopoulou G, Dagas A, Tziatzios G, Thomopoulos K, Potamianos S, Christodoulou D. Impact of simple, specific, verbal instructions on the quality of bowel preparation in hospitalized patients undergoing colonoscopy: a multicenter randomized controlled trial. Endosc Int Open 2021; 9:E378-E387. [PMID: 33655037 PMCID: PMC7895659 DOI: 10.1055/a-1339-0913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Bowel preparation for colonoscopy is frequently inadequate in hospitalized patients. We explored the impact of specific verbal instructions on the quality of inpatients bowel preparation and factors associated with preparation failure. Patients and methods Randomized (1:1), two strata (mobilized vs. bedridden; 3:2) trial of consecutive inpatients from four tertiary centers, who received either specific, verbal instructions or the standard of care (SOC) ward instructions about bowel preparation. The rate of adequate bowel preparation (Boston Bowel Preparation Score [BBPS] ≥ 6, no segment < 2) comprised the primary endpoint. Mean BBPS score, good (BBPS score ≥ 7, no segment score < 2) and excellent (BBPS = 9) were among secondary endpoints. Results We randomized 300 inpatients (180 mobile) aged 71.7 ± 15.1 years in the intervention (49.7 %) and SOC (50.3 %) groups, respectively. Overall, more patients in the intervention group achieved adequate bowel preparation, but this difference did not reach statistical significance neither in the intention-to-treat [90/149 (60.4 %) vs. 82/151 (54.3 %); P = 0.29] nor in the per-protocol analysis [90/129 (69.8 %) vs. 82/132 (62.1 %); P = 0.19]. Overall BBPS score did not differ statistical significantly in the two groups, but the provision of specific verbal instructions was associated with significant higher rates of good (58.1 % vs. 43.2 %; P = 0.02) and excellent (31.8 % vs. 16.7 %; P = 0.004) bowel preparation compared to the SOC group. Administration of same-day bowel preparation and patient American Society of Anesthesiologists score > 2 were identified as risk factors for inadequate bowel preparation. Conclusions Provision of specific verbal instructions did not increase the rate of adequate bowel preparation in a population of mobilized and bedridden hospitalized patients.
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Affiliation(s)
- Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Alexandros Skamnelos
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgia Diamantopoulou
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Athanasios Dagas
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens
| | - Konstantinos Thomopoulos
- Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
| | - Spyros Potamianos
- Department of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios Christodoulou
- Division of Gastroenterology, University Hospital & Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Strauss AT, Yeh J, Martinez DA, Yenokyan G, Yoder J, Nehra R, Feller T, Bull-Henry K, Stein E, Hsu LCH, Al-Grain H, Zabko C, Fain C. A patient-centered framework for health systems engineering in gastroenterology: improving inpatient colonoscopy bowel preparation. BMC Gastroenterol 2021; 21:89. [PMID: 33639850 PMCID: PMC7912514 DOI: 10.1186/s12876-021-01661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Inpatient colonoscopy bowel preparation (ICBP) is frequently inadequate and can lead to adverse events, delayed or repeated procedures, and negative patient outcomes. Guidelines to overcome the complex factors in this setting are not well established. Our aims were to use health systems engineering principles to comprehensively evaluate the ICBP process, create an ICBP protocol, increase adequate ICBP, and decrease length of stay. Our goal was to provide adaptable tools for other institutions and procedural specialties. Methods Patients admitted to our tertiary care academic hospital that underwent inpatient colonoscopy between July 3, 2017 to June 8, 2018 were included. Our multi-disciplinary team created a protocol employing health systems engineering techniques (i.e., process mapping, cause-effect diagrams, and plan-do-study-act cycles). We collected demographic and colonoscopy data. Our outcome measures were adequate preparation and length of stay. We compared pre-intervention (120 ICBP) vs. post-intervention (129 ICBP) outcomes using generalized linear regression models. Our new ICBP protocol included: split-dose 6-L polyethylene glycol-electrolyte solution, a gastroenterology electronic note template, and an education plan for patients, nurses, and physicians. Results The percent of adequate ICBPs significantly increased with the intervention from 61% pre-intervention to 74% post-intervention (adjusted odds ratio of 1.87, p value = 0.023). The median length of stay decreased by approximately 25%, from 4 days pre-intervention to 3 days post-intervention (p value = 0.11). Conclusions By addressing issues at patient, provider, and system levels with health systems engineering principles, we addressed patient safety and quality of care provided by improving rates of adequate ICBP. Supplementary information The online version contains supplementary material available at 10.1186/s12876-021-01661-4.
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Affiliation(s)
- Alexandra T Strauss
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA.
| | - Jennifer Yeh
- Department of Internal Medicine, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Diego A Martinez
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Janet Yoder
- Department of Medical Nursing, Johns Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Ravi Nehra
- Department of Pharmacy, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Tara Feller
- Department of Pharmacy, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Kathy Bull-Henry
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA
| | - Lawrence C H Hsu
- Operations Integration, Johns Hopkins Health System, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Haitham Al-Grain
- Department of Anesthesiology, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Candice Zabko
- Department of Medical Nursing, Johns Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Christopher Fain
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N Wolfe St. Blalock 465, Baltimore, MD, 21205, USA
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Factors That Affect Adequacy of Colon Cleansing for Colonoscopy in Hospitalized Patients. Clin Gastroenterol Hepatol 2021; 19:339-348.e7. [PMID: 32200083 DOI: 10.1016/j.cgh.2020.02.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Hospitalization is associated with inadequate colon cleansing before colonoscopy. We aimed to identify factors associated to inadequate colon cleansing among inpatients, and to derive and validate a model to identify inpatients with inadequate cleansing. METHODS We performed a prospective observational study at 12 hospitals in Italy. Consecutive adult inpatients scheduled for colonoscopy for any indication were enrolled from February through May 2019 (derivation cohort, n = 1016) and from June through August 2019 (validation cohort, n = 508). Inadequate cleansing was defined as Boston bowel preparation scale scores below 2 in any colon segment. We performed multivariate logistic regression to identify factors associated with inadequate cleansing. RESULTS In the combined cohorts, 1032 patients (68%) had adequate colon cleansing. Physicians' meetings to optimize bowel preparation (odds ratio [OR], 0.42; 95% CI, 0.27-0.65), written and oral instructions to patients (OR, 0.48; 95% CI, 0.36-0.65), admission to gastroenterology unit (OR, 0.71; 95% CI, 0.51-0.98), split-dose regimens (OR, 0.27; 95% CI, 0.20-0.35), a 1-liter polyethylene glycol-based bowel purge (OR, 0.39; 95% CI, 0.23-0.65), and 75% or more intake of bowel preparation (OR, 0.09; 95% CI, 0.05-0.15) significantly reduced odds of inadequate colon cleansing. Alternatively, bedridden status (OR, 2.14; 95% CI, 1.55-2.98), constipation (OR, 2.16; 95% CI, 1.55-3.0), diabetes mellitus (OR, 1.61; 95% CI, 1.18-2.20), use of anti-psychotic drugs (OR, 3.26; 95% CI, 1.62-6.56), and 7 or more days of hospitalization (OR, 1.02; 95% CI, 1.00-1.04) increased risk of inadequate colon cleansing. We developed a model to identify patients with inadequate cleaning using data from patients in the derivation cohort and tested it in the validation cohort. Calibration values were P = .218 for the discrimination cohort and P = .232 for the validation cohort. Discrimination values were c-statistic, 0.78 (95% CI, 0.74-0.81) for the discrimination cohort and c-statistic, 0.73 (95% CI, 0.69-0.78) for the validation cohort. We developed app for use by clinicians. CONCLUSIONS In a prospective observational study, we identified setting-, patient- and preparation-related factors that affect colon cleansing among inpatients. We derived and validated a model to identify patients with inadequate preparation and developed an app for clinicians. ClinicalTrials.gov no: NCT03925506.
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15
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Sullivan B, Zhang C, Wegermann K, Lee TH, Leiman DA. Standardizing inpatient colonoscopy preparations improves quality and provider satisfaction. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 32149482 DOI: 10.1108/ijhcqa-11-2019-0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes. DESIGN/METHODOLOGY/APPROACH Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers. FINDINGS There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent-6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent-1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001). PRACTICAL IMPLICATIONS The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools. ORIGINALITY/VALUE Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.
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Affiliation(s)
- Brian Sullivan
- Duke University Medical Center, Durham, North Carolina, USA
| | - Cecelia Zhang
- Duke University Medical Center, Durham, North Carolina, USA
| | - Kara Wegermann
- Duke University Medical Center, Durham, North Carolina, USA
| | - Tzu-Hao Lee
- Duke University Medical Center, Durham, North Carolina, USA
| | - David A Leiman
- Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
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16
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Determination of the Effectiveness of Informing With the Guidance of an Education Booklet in Patients Undergoing Colonoscopy-A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:502-507. [PMID: 32451203 DOI: 10.1016/j.jopan.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/09/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of precolonoscopy information with the guidance of an education booklet on anxiety and bowel preparation adequacy in patients undergoing colonoscopy. DESIGN A randomized controlled study. METHODS The education group was informed face to face by the researcher with the guidance of the colonoscopy education booklet and provided the education booklet. The control group received usual care. FINDINGS The mean state and trait anxiety scores of the patients in the education group were found to be significantly lower than the control group. In the education group, the bowel preparation adequacy was determined to be higher compared with the control group. CONCLUSIONS Informing patients with the guidance of the education booklet before the colonoscopy decreased patients' state and trait anxiety levels and increased their bowel preparation adequacy.
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Guo X, Li X, Wang Z, Zhai J, Liu Q, Ding K, Pan Y. Reinforced education improves the quality of bowel preparation for colonoscopy: An updated meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0231888. [PMID: 32343708 PMCID: PMC7188205 DOI: 10.1371/journal.pone.0231888] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background and aims Inadequate bowel preparation (BP) is an unfavorable factor that influence the success of colonoscopy. Although standard education (SE) given to patients are proved useful to avoid inadequate BP. Studies concerning the effects of reinforced education (RE) on the quality of BP were inconsistent. The aim of this updated meta-analysis of randomized controlled trial was to compare the quality of BP between patients receiving RE in addition to SE and those receiving SE alone. Methods MEDLINE, EMBASE, Web of Science and the Cochrane Library were systemically searched to identify the relevant studies published through April 2019. The primary outcome was the rate of adequate BP. Subgroup analyses were conducted. Secondary outcomes included BP score, adenoma detection rate (ADR), polyp detection rate (PDR), insertion time, withdrawal time, adverse events, >80% purgative intake and diet compliance. Dichotomous variables were reported as odds ratio (OR) with 95% confidence interval (CI). Continuous data were reported as mean difference (MD) with 95%CI. Pooled estimates of OR or MD were calculated using a random-effects model. Statistical heterogeneity was accessed by calculating the I2 value. A P value less than 0.05 was considered significant. Results A total of 18 randomized controlled trails (N = 6536) were included in this meta-analysis. Patients who received RE had a better BP quality than those only receiving SE (OR 2.59, 95%CI: 2.09–3.19; P<0.001). A higher ADR (OR 1.35; 95%CI: 1.06–1.72; P = 0.020) and PDR (OR 1.24, 95%CI: 1.02–1.50; P = 0.030), shorter insertion (MD -0.76; 95%CI: -1.48-(-0.04); P = 0.040) and withdrawal time (MD -0.83; 95%CI: -1.83-(-0.28); P = 0.003), less nausea/vomiting (OR 0.78; 95%CI: 0.64–0.97; P = 0.020) and abdominal distension (OR 0.72; 95%CI: 0.68–0.92; P = 0.020) were achieved in the RE group. More patients had >80% purgative intake (OR 2.17; 95%CI, 1.09–4.32; P = 0.030) and were compliant with diet restriction (OR 2.38; 95%CI: 1.79–3.17; P<0.001) in the RE group. Conclusion RE significantly improved BP quality, increased ADR and PDR, decreased insertion and withdrawal time and adverse events.
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Affiliation(s)
- Xiaoyang Guo
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
- Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
| | - Xin Li
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Junli Zhai
- Department of Pneumology, The Second Medical Center of PLA General Hospital, Beijing, China
| | - Qiang Liu
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
| | - Kang Ding
- Department of Ultrasound, The 305 Hospital of PLA, Bejing, China
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi’an, China
- * E-mail:
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18
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Zhang C, Li Q, Li F, Zhang Y, Tang Y, Hou J, Yang R. Post-Arthroscopic Rotator Cuff Repair Rehabilitation Booklet: A Patient-Based Evaluation. Patient Prefer Adherence 2020; 14:1493-1500. [PMID: 32943847 PMCID: PMC7478374 DOI: 10.2147/ppa.s263645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lack of physical therapists has led to increment of self-managed rehabilitations in post-arthroscopic rotator cuff repair (ARCR) in the forms of booklets or leaflets. PURPOSE The aim of study is to investigate 1) the acceptance of post-ARCR patients towards an education booklet, and 2) whether it could be a timesaving and laborsaving tool to physical therapists. METHODS An education booklet was established through a systematic review. Patients who underwent ARCR in our hospital were included and randomly assigned to the intervention or control group (27 women, 21 men, mean age=57.06 years old). Patients in the intervention group received educational booklets, and an evaluation was also obtained after they finished reading. Patients' understanding of the booklet was determined by asking patients to re-enact training presented in the booklet. Then, a therapist blinded to allocations would personally demonstrate training to patients until patients fully understood the protocol. For the control group, the same therapist coached patients until the whole protocol was clearly understood. The coaching time for patients in both groups was recorded. RESULTS Out of 48 patients, 24 (50%) were randomly assigned to the intervention group, and 21 (87.50%) completed their questionnaire. Out of these 21 patients, 20 (95.24%) rated the booklet as "excellent and easy to read", and 17 (80.95%) felt that the booklet was helpful. The re-enaction accuracy was for strengthening training and specific training (71.43% and 61.90%, respectively). As compared to the control group, the time of coaching for the patients to fully master the protocol in the intervention group was significantly less (P<0.01). CONCLUSION Patients highly applauded this booklet, and they cherished the information and support it contained. Nevertheless, the re-enaction accuracy was not high, suggesting that the high level of acceptance does not guarantee full understanding of information sent to patients.
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Affiliation(s)
- Congda Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qingyue Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Fangqi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yuanhao Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yiyong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Correspondence: Rui Yang; Jingyi Hou Tel +86 13694200667; +86 18102769380Fax +86 81332199 Email ;
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Guo B, Zuo X, Li Z, Liu J, Xu N, Li X, Zhu A. Improving the quality of bowel preparation through an app for inpatients undergoing colonoscopy: A randomized controlled trial. J Adv Nurs 2019; 76:1037-1045. [PMID: 31840286 DOI: 10.1111/jan.14295] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 01/14/2023]
Abstract
AIMS To explore whether educational information delivered via a medical smartphone app in conjunction with verbal and written instructions, compared with traditional booklet-based and verbal instructions, could improve the quality of bowel preparation for hospitalized patients undergoing colonoscopy. DESIGN A prospective, single-blinded, randomized controlled trial. METHODS We performed a prospective, endoscopist-blinded, randomized, controlled trial at Qilu Hospital of Shandong University in China between October 2017-March 2018. Inpatients who are eligible, based on the inclusion criteria, were randomized into two groups. Both groups received oral and written instructions for bowel preparation. In addition, the smartphone app group received instructions through a medical smartphone app. The primary outcome was the rate of adequate bowel preparation according to the Boston bowel preparation scale score. The secondary outcomes included patient compliance with instructions on how to take laxatives, side effects and rates of adenoma detection. RESULTS A total of 293 patients were enrolled in this study. Demographic characteristics were comparable between the two groups. The χ2 test showed that the medical smartphone app group showed significant improvement in the rate of adequate bowel preparation compared with the control group (77.2% vs. 56.8%, p < .001). The adenoma detection rate (ADR) was significantly higher in the smartphone app group than in the control group (21.4% vs. 12.8%, p = .029) based on the χ2 test. The rates of incomplete compliance with instructions were 15.17% in the smartphone app group and 33.11% in the control group (p < .001) based on the χ2 test. The overall adverse events were 23.45% and 37.84% in the smartphone app and control groups, respectively (p = .008), based on the χ2 test. CONCLUSION Instructions provided via a mobile social media app in conjunction with traditional verbal and written methods could improve the quality of bowel preparation, increase the ADR and decrease adverse effects. App instructions could be an effective addition to oral and written instructions for inpatients undergoing colonoscopy. IMPACT This study suggested that clinical personnel could deliver information via smartphone as a powerful addition to traditional educational methods that could improve work efficiency and help patients increase the success rate of bowel preparation. TRIAL REGISTRATION Chinese clinical trial registration number: ChiCTR1900024666.
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Affiliation(s)
- Bingmei Guo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Jun Liu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Na Xu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiaohui Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Aifang Zhu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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Guardiola-Arévalo A, Granja Navacerrada A, García-Alonso FJ, Bernal Checa P, Piqué Becerra R, Guerra I, Algaba A, de Andrés Esteban E, Bermejo F. Randomized clinical trial evaluating the effect of a visual educational leaflet on the preparation of colonoscopies in hospitalized patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:946-952. [PMID: 31755280 DOI: 10.17235/reed.2019.6317/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the safety and diagnostic accuracy of colonoscopies depends on the quality of colon cleansing. Several factors have been reported that affect the quality of bowel cleansing, hospitalization being one of them. AIMS the aim of the study was to investigate whether a visual educational leaflet improved the level of cleanliness achieved in hospitalized patients undergoing a colonoscopy and to identify predictors of a poor bowel preparation. METHODS a prospective, single-center, endoscopist-blinded, randomized controlled trial was performed. The intervention group was given a visual educational leaflet and both groups received four liters of polyethylene glycol solution. Demographic data, personal history, reason for admission and indication for colonoscopy, work shift during which the procedure was performed and endoscopy findings were collected. The Boston Bowel Preparation Scale (BBPS) was used to assess the bowel preparation. RESULTS one hundred and thirty-six patients were included in the study; 51.5% were male, with a mean age of 64.3 ± 17.6 years. The educational leaflet did not result in a difference in the total BBPS obtained between the standard group and the intervention group (7 [6-9] vs 6 [5.7-9]; p = 0.17). According to the multivariable analysis, the only factors associated with a poor bowel cleansing were heart disease (OR 3.37 [1.34-8.46]; p = 0.010) and colorectal cancer (OR 3.82 [1.26-11.61]; p = 0.018). CONCLUSION the use of a visual educational leaflet for the preparation of colonoscopies did not provide a significant improvement in hospitalized patients in our health area. Heart disease was identified as the only predictor of poor preparation for colonoscopy.
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Affiliation(s)
| | | | | | - Pilar Bernal Checa
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, España
| | - Rubén Piqué Becerra
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada, España
| | - Ivan Guerra
- Department of Gastroenterology.IdiPAZ, Hospital Universitario de Fuenlabrada, España
| | - Alicia Algaba
- Department of Gastroenterology. IdiPAZ, Hospital Universitario de Fuenlabrada, España
| | | | - Fernando Bermejo
- Department of Gastroenterology. IdiPAZ, Hospital Universitario de Fuenlabrada, España
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Hernández G, Gimeno-García AZ, Quintero E. Strategies to Improve Inadequate Bowel Preparation for Colonoscopy. Front Med (Lausanne) 2019; 6:245. [PMID: 31781565 PMCID: PMC6857107 DOI: 10.3389/fmed.2019.00245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
Bowel cleansing is one of the most important parameters included in the evaluation of colonoscopy quality. The available evidence suggests that inadequate bowel preparation reduces the diagnostic yield of colorectal neoplasia and increases post-colonoscopy colorectal cancer risk. Nowadays, up to 30% of patients referred for colonoscopy have a poor bowel cleansing. Recently, several studies have analyzed the risk factors for inadequate bowel cleansing as well as the strategies to optimize bowel preparation. In this review, we have focused on summarizing the available evidence in this field.
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Affiliation(s)
- Goretti Hernández
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Antonio Z Gimeno-García
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Enrique Quintero
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain.,Departamento de Medicina Interna, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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22
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Trasolini R, Nap-Hill E, Suzuki M, Galorport C, Yonge J, Amar J, Bressler B, Ko HH, Lam ECS, Ramji A, Rosenfeld G, Telford JJ, Whittaker S, Enns RA. Internet-Based Patient Education Prior to Colonoscopy: Prospective, Observational Study of a Single Center’s Implementation, with Objective Assessment of Bowel Preparation Quality and Patient Satisfaction. J Can Assoc Gastroenterol 2019; 3:274-278. [PMID: 33241180 PMCID: PMC7678736 DOI: 10.1093/jcag/gwz026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Nonpharmacologic factors, including patient education, affect bowel preparation for colonoscopy. Optimal cleansing increases quality and reduces repeat procedures. This study prospectively analyzes use of an individualized online patient education module in place of traditional patient education. Aims To determine the effectiveness of online education for patients, measured by the proportion achieving sufficient bowel preparation. Secondary measures include assessment of patient satisfaction. Methods Prospective, single-center, observational study. Adults aged 19 years and over, with an e-mail account, scheduled for nonurgent colonoscopy, with English proficiency (or someone who could translate for them) were recruited. Demographics and objective bowel preparation quality were collected. Patient satisfaction was assessed via survey to assess clarity and usefulness of the module. Results Nine hundred consecutive patients completed the study. 84.6% of patients achieved adequate bowel preparation as measured by Boston bowel preparation score ≥ 6 and 90.1% scored adequately using Ottawa bowel preparation score ≤7. 94.2% and 92.1% of patients rated the web-education module as ‘very useful’ and ‘very clear’, respectively (≥8/10 on respective scales). Conclusions Our analysis suggests that internet-based patient education prior to colonoscopy is a viable option and achieves adequate bowel preparation. Preparation quality is comparable to previously published trials. Included patients found the process clear and useful. Pragmatic benefits of a web-based protocol such as time and cost savings were not formally assessed but may contribute to greater satisfaction for endoscopists and patients.
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Affiliation(s)
- Roberto Trasolini
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Estello Nap-Hill
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Matthew Suzuki
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Cherry Galorport
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Jordan Yonge
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Jack Amar
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Brian Bressler
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Hin Hin Ko
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Eric C S Lam
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Alnoor Ramji
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Gregory Rosenfeld
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Jennifer J Telford
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Scott Whittaker
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Robert A Enns
- Division of Gastroenterology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia
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Strategies to Improve Inpatients' Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2019; 2019:5147208. [PMID: 31191646 PMCID: PMC6525904 DOI: 10.1155/2019/5147208] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background and Aims Inpatients' bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the efficacy of various interventions to improve inpatients' colon preparation quality. Methods We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients' colon preparation until June, 2018. Significant heterogeneity—measured with I2—was detected at the level of P < 0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR). Results Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I2 = 97%; P < 0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR (95%CI) = 3.49 (1.67-7.28), P = 0.0009; I2 = 74%; P = 0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients. Conclusions Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients' bowel preparation quality.
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Sengupta N. The role of colonoscopy and endotherapy in the management of lower gastrointestinal bleeding. Best Pract Res Clin Gastroenterol 2019; 42-43:101615. [PMID: 31785729 DOI: 10.1016/j.bpg.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/23/2019] [Indexed: 01/31/2023]
Abstract
Colonoscopy is an integral diagnostic and therapeutic tool in the management of patients with lower gastrointestinal bleeding (LGIB). After resuscitation, reversal of coagulopathy, and exclusion of a proximal source of bleeding, colonoscopy should be performed in most patients with LGIB. Bowel preparation, typically with polyethylene glycol based solutions, is needed to closely inspect the colonic mucosa for bleeding sources. Colonoscopy within 24 h is recommended for high-risk patients with ongoing bleeding, although there is limited evidence that this strategy improves clinical outcomes. When active or stigmata of bleeding is detected, endoscopic intervention is indicated and can reduce future rebleeding. The most common options for endoscopic intervention include clipping, endoscopic band ligation, and coagulation, however rigorous head-to-head comparisons of different endoscopic tools are unavailable. Future research is needed to determine the optimal timing of colonoscopy, appropriate reversal strategies for patients on antithrombotics, and the most effective endoscopic hemostatic therapy.
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Affiliation(s)
- Neil Sengupta
- Section of Gastroenterology, University of Chicago Medical Center 5841 S Maryland Avenue, MC 4076, Chicago, IL, 60637, USA.
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25
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Strategies to optimise the quality of bowel cleansing. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 42:326-338. [PMID: 31027972 DOI: 10.1016/j.gastrohep.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022]
Abstract
Colonoscopy is the gold standard procedure for detecting neoplastic lesions of the colon and its efficiency is closely linked to the quality of the procedure. Adequate bowel preparation is a crucial factor in achieving the recommended quality indicators, but poor preparation has been reported in up to 30% of outpatients referred for colonoscopy. Consequently, over recent years, a number of studies have developed strategies to optimise bowel cleansing by improving adherence and tolerance to and the efficacy of the bowel preparation. Moreover, the identification of risk factors for inadequate bowel cleansing has led to tailored bowel preparation strategies being designed, with promising results. We aimed to review studies that assessed risk factors for inadequate bowel preparation and strategies to optimise bowel cleansing in patients at high risk of having poor preparation.
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26
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Martel M, Ménard C, Restellini S, Kherad O, Almadi M, Bouchard M, Barkun AN. Which Patient-Related Factors Determine Optimal Bowel Preparation? ACTA ACUST UNITED AC 2018; 16:406-416. [PMID: 30390208 DOI: 10.1007/s11938-018-0208-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Adequate bowel cleansing before colonoscopy is a simple concept but the high rate of inadequate or incomplete bowel cleanliness and its consequences have been the subject of many studies, guidelines, and meta-analysis. The complexity resides in all the factors surrounding preparation intake such as type and regimen of bowel preparation, diets, compliance, and also patient-related factors that all influence quality of the bowel preparation. The purpose of this review is to focus specifically on patient-related factors and their challenges. Patients with lower GI bleeding are excluded from this review. RECENT FINDINGS Patient factors that may be associated with a poor bowel preparation were searched for in the literature. With regard to patient's characteristics, higher age, male gender, and socio-economic status (lower income, Medicaid, and lower education) were all associated with higher rates of inadequate bowel preparation. Comorbidities such as inflammatory bowel disease (IBD), in-patients, body mass index (BMI), cirrhosis, constipation, and neurological condition as well as some pharmacotherapy were also associated with inadequate bowel preparation. Studies identifying predictive patient factors as well as those studying these patients in particular showed variability in the strength of the patient factor associations. Patients taking tricyclic antidepressant, narcotics, and those with neurological conditions were identified to have a stronger association with worse bowel cleanliness. Those can be implemented with the current recommendations of split-dosing. Identifying individual factors that can impact the quality of bowel cleanliness can be challenging. Some have been well-studied in the literature such as age, in-patient status, or constipation and others such as male gender or higher BMI have required more studies to clearly conclude on any possible association. In many studies, simple recommendations like walking 30 min during the preparation, and additional instructions or support have also been added to instructions to improve motility and compliance.
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Affiliation(s)
- Myriam Martel
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
| | | | - Sophie Restellini
- Department of Specialties of Internal Medicine, Division of Gastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - Omar Kherad
- Internal Medicine, La Tour Hospital, University of Geneva, Geneva, Switzerland
| | - Majid Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Maïté Bouchard
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Canada.
- Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, 1650 Cedar Avenue, D7.346, Montréal, Québec, H3G1A4, Canada.
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Jeon SC, Kim JH, Kim SJ, Kwon HJ, Choi YJ, Jung K, Kim SE, Moon W, Park MI, Park SJ. Effect of Sending Educational Video Clips via Smartphone Mobile Messenger on Bowel Preparation before Colonoscopy. Clin Endosc 2018; 52:53-58. [PMID: 30153724 PMCID: PMC6370934 DOI: 10.5946/ce.2018.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/02/2018] [Indexed: 02/07/2023] Open
Abstract
Background/Aim We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy.
Methods This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale.
Results Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034).
Conclusions We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.
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Affiliation(s)
- Sung Chan Jeon
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Jae Hyun Kim
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Sun Jung Kim
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Hye Jung Kwon
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Youn Jung Choi
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Kyoungwon Jung
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Sung Eun Kim
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Won Moon
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Moo In Park
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Gastroenterology, Kosin University College of Medicine, Busan, Korea
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Back SY, Kim HG, Ahn EM, Park S, Jeon SR, Im HH, Kim JO, Ko BM, Lee JS, Lee TH, Cho JH. Impact of patient audiovisual re-education via a smartphone on the quality of bowel preparation before colonoscopy: a single-blinded randomized study. Gastrointest Endosc 2018; 87:789-799.e4. [PMID: 28939500 DOI: 10.1016/j.gie.2017.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Education on preparation is essential for successful colonoscopy. This study aimed to evaluate the impact of audiovisual (AV) re-education via a smartphone on bowel preparation quality before colonoscopy. METHODS A prospective, endoscopist-blinded, randomized, controlled study was performed. Patients who underwent colonoscopy with 3 purgatives, including 4 L of polyethylene glycol (4-L PEG), 2 L of PEG with ascorbic acid (2-L PEG/Asc), and sodium picosulfate with magnesium citrate (SPMC), were enrolled and randomized into the AV re-education via smartphone group (AV group, n = 160) and a control group (n = 160). The primary outcome was the quality of the bowel preparation according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included instruction adherence using adherence score (AS) and patient satisfaction with education using a visual analog scale (VAS). RESULTS A total of 283 patients (AV group, n = 139; control group, n = 144) were analyzed per protocol. The mean BBPS (7.53 vs 6.29, P < .001) and the proportion with adequate preparation were higher in the AV group. The mean BBPS of the AV group was significantly higher than that of the control group for the 2-L PEG/Asc and SPMC preparations, but not for the 4-L PEG preparation. The mean AS and the mean VAS score were all significantly higher in the AV group. Among the 3 purgatives, the mean AS was lowest in the 4-L PEG group (P = .041). CONCLUSIONS AV re-education via smartphone was easy and convenient, and enhanced preparation quality, patient adherence to instructions, and patient satisfaction.
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Affiliation(s)
- Su Young Back
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Eu Mi Ahn
- Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Suyeon Park
- Biostatistical Consulting Unit, Soonchunhynag University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Hee Hyuk Im
- Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Jin-Oh Kim
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Bong Min Ko
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
| | - Jun-Hyung Cho
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea; Digestive Disease Center, Soonchuhyang University Hospital, Seoul, Korea
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Pontone S, Palma R, Panetta C, Eberspacher C, Angelini R, Pironi D, Filippini A, Pontone P. Polyethylene glycol-based bowel preparation before colonoscopy for selected inpatients: A pilot study. J Dig Dis 2018; 19:40-47. [PMID: 29266839 DOI: 10.1111/1751-2980.12571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of a new same-day, low-dose 1-L polyethylene glycol-based (1-L PEG) bowel preparation on the diagnostic rating of selected hospitalized patients and its tolerability, with risk factors for inadequate bowel preparation. METHODS A single-center prospective pilot study was conducted with hospitalized patients scheduled for colonoscopy, presenting risk factors for poor bowel preparation, such as bleeding or subocclusive symptoms. The included patients were randomly divided in two groups, which received either a same-day 1-L PEG (group A) or a split-dose 4-L PEG (group B), and performed a colonoscopy within 4 h of the last dose. RESULTS In all, 44 inpatients [27 males; mean age 63.5 years (range 20-94 years)] were enrolled. Optimal bowel cleansing was reached in 64% and 55% (P = 0.64) of patients in groups A and B, respectively. The adenoma detection rate was 14% (group A) and 18% (group B) (P = 0.34). A valid diagnosis was reached in 38 (86%) of 44 patients (21 in group A and 17 in group B) after a mean hospitalization of 3 days for group A and 6 days for group B (P = 0.04). CONCLUSIONS Our data support the conclusion that the schedule protocol proposed in this study enables a clear diagnosis in most of the inpatients at high risk of poor bowel preparation and no statistical differences were found between the two groups in terms of successful bowel cleansing achieved. Therefore, the same-day, low-dose 1-L PEG bowel preparation could be introduced for selected inpatients.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Rita Angelini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Cho J, Lee S, Shin JA, Kim JH, Lee HS. The Impact of Patient Education with a Smartphone Application on the Quality of Bowel Preparation for Screening Colonoscopy. Clin Endosc 2017; 50:479-485. [PMID: 28669148 PMCID: PMC5642069 DOI: 10.5946/ce.2017.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/14/2017] [Accepted: 04/02/2017] [Indexed: 12/21/2022] Open
Abstract
Background/Aims Few studies have evaluated the use of a smartphone application (app) for educating people undergoing colonoscopy and optimizing bowel preparation. Therefore, this study was designed to develop a smartphone app for people to use as a preparation guide and to evaluate the efficacy of this app when used prior to colonoscopy. Methods In total, 142 patients (male:female=84:58, mean age=43.5±9.3 years), who were scheduled to undergo a colonoscopy at Myongji Hospital, were enrolled in this study. Seventy-one patients were asked to use a smartphone app that we had recently developed to prepare for the colonoscopy, while the 71 patients of the sex and age-matched control group were educated via written and verbal instructions. Results The quality of bowel cleansing, evaluated using the Boston Bowel Preparation Scale, was significantly higher in the smartphone app group than in the control group (7.70±1.1 vs. 7.24±0.8, respectively, p=0.007 by t-test). No significant differences were found between the two groups regarding work-up time and the number of patients with polyps. Conclusions In this study, targeting young adults (≤50 years), the bowel preparation achieved by patients using the smartphone app showed significantly better quality than that of the control group.
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Affiliation(s)
- JeongHyeon Cho
- Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
| | - SeungHee Lee
- Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
| | - Jung A Shin
- Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
| | - Jeong Ho Kim
- Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
| | - Hong Sub Lee
- Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea
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31
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Liu Z, Zhang MM, Li YY, Li LX, Li YQ. Enhanced education for bowel preparation before colonoscopy: A state-of-the-art review. J Dig Dis 2017; 18:84-91. [PMID: 28067463 DOI: 10.1111/1751-2980.12446] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/27/2016] [Accepted: 01/04/2017] [Indexed: 12/11/2022]
Abstract
Colonoscopy remains the mainstay in diagnosing and monitoring colorectal cancer and other colorectal lesions. The diagnostic efficiency of colonoscopy greatly depends on the quality of bowel preparation, which is closely associated with the patient's compliance with the preparation instructions. In addition, the procedural requirements of bowel preparation are often complex and difficult for patients to comprehend and memorize, especially those with lower health literacy and motivation. Therefore, in recent years, many educational methods have been developed, such as educational booklets, cartoon visual aids, educational videos, short message service, telephone, social media and smart phone applications. These educational methods have significantly improved compliance with the instructions for bowel preparation and ultimately promoted the visualization of the colon in patients undergoing colonoscopy.
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Affiliation(s)
- Zhu Liu
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Ming Ming Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yue Yue Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Li Xiang Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
| | - Yan Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, Jinan, Shandong Province, China
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Video on Diet Before Outpatient Colonoscopy Does Not Improve Quality of Bowel Preparation: A Prospective, Randomized, Controlled Trial. Am J Gastroenterol 2016; 111:1564-1571. [PMID: 27753434 DOI: 10.1038/ajg.2016.450] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Successful outpatient colonoscopy (CLS) depends on many factors including the quality of a patient's bowel preparation. Although education on consumption of the pre-CLS purgative can improve bowel preparation quality, no study has evaluated dietary education alone. We have created an educational video on pre-CLS dietary instructions to determine whether dietary education would improve outpatient bowel preparation quality. METHODS A prospective randomized, blinded, controlled study of patients undergoing outpatient CLS was performed. All patients received a 4 l polyethylene glycol-based split-dose bowel preparation and standard institutional pre-procedure instructions. Patients were then randomly assigned to an intervention arm or to a no intervention arm. A 4-min educational video detailing clear liquid diet restriction was made available to patients in the intervention arm, whereas those randomized to no intervention did not have access to the video. Patients randomized to the video were provided with the YouTube video link 48-72 h before CLS. An attending endoscopist blinded to randomization performed the CLS. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS). Adequate preparation was defined as a BBPS total score of ≥6 with all segment scores ≥2. Wilcoxon rank-sum and Pearson's χ2-tests were performed to assess differences between groups. RESULTS Ninety-two patients were randomized (video: n=42; control: n=50) with 47 total video views being tallied. There were no demographic differences between groups. There was no statistically significant difference in adequate preparation between groups (video=74%; control=68%; P=0.54). CONCLUSIONS The availability of a supplementary patient educational video on clear liquid diet alone was insufficient to improve bowel preparation quality when compared with standard pre-procedure instruction at our institution.
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