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Kim J, Dai HD, Michaud T, Verma S, King KM, Ewing JW, Mabiala-Maye G, Estabrooks P. Leveraging Multi-Sectoral Partnership for Colorectal Cancer Education and Screening in the African American Community: A Protocol and Preliminary Results. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02506-w. [PMID: 39313626 DOI: 10.1007/s13187-024-02506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Abstract
Colorectal cancer (CRC) awareness and screening rates are still low in African Americans (AAs), especially for those who do not have regular access to health care. We established a multi-sector community partnership between academia, health system, cancer advocacy, and local county treasurer's office (CTO), to test a pilot CRC screening intervention using a tailored educational brochure and fecal immunochemical test (FIT). Participants were recruited at a local CTO in an urban midwestern region. Once eligible, participants were assigned to 2-by-2 intervention arms by educational strategy (brochure vs. no brochure) and FIT provision strategy (direct provision by onsite staff vs. indirect provision via phone/online request). We compared the effect of different strategies on FIT return rates. Of 1500 individuals approached, 212 were eligible for the study. The final sample consisted of 209 participants who were predominantly men (57%) and AAs (85%). No differences were found in the return rates by educational brochure (24% [brochure] vs. 23% [no brochure]; p = 0.82). In regard to FIT provision strategy, direct FIT provision yielded higher return rates than indirect provision (31% vs. 15%; p = 0.01). When the four groups were compared, direct provision with education brochure yielded the highest return rates (33.9%), followed by direct provision only (27.5%), indirect provision only (18%), and indirect provision with a brochure (12.2%). For community-based CRC screening intervention using stool-based test, the direct provision of FIT kits with educational brochure outperforms the other three strategies.
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Affiliation(s)
- Jungyoon Kim
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Hongying Daisy Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tzeyu Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sachi Verma
- Nebraska Hospital Association, Lincoln, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Grace Mabiala-Maye
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Paul Estabrooks
- Department of Health and Kinesiology, University of Utah College of Health, Salt Lake City, UT, USA
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Yang X, Xiao Y, Zhao Z, Yu S, Liu E, Xiao X, Ning S, Zheng S, Gong Y, Zhou L, Liu W, Lin H, Ji R, Zhang H, Bai J, Yang S. A novel strategy for improving bowel preparation based on social software-enhanced education: A prospective, multicenter, randomized controlled study. J Gastroenterol Hepatol 2024. [PMID: 39004797 DOI: 10.1111/jgh.16659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND AIM The compliance and timeliness of oral laxatives have always been the key factors restricting bowel preparation (BP). We have constructed a novel enhanced-educational content and process based on social software (SS) for BP to optimize these issues. METHODS A multicenter, prospective, randomized controlled study was conducted at 13 hospitals in China from December 2019 to December 2020. A total of 1774 enrollees received standard instructions for BP and were randomly assigned (1:1) to the SS group (SSG) that received a smartphone-based enhanced-education strategy starting 4 h before colonoscopy or the control group (CG). RESULTS A total of 3034 consecutive outpatient colonoscopy patients were assessed for eligibility, and 1774 were enrolled and randomly assigned. Ultimately, data from 1747 (SSG vs CG: 875 vs 872) enrollees were collected. The BP adequacy rate was 92.22% (95% CI: 90.46-93.98) in the SSG vs 88.05% (95% CI: 85.91-90.18) in the CG (P = 0.005), and the total Boston Bowel Preparation Scale scores (6.89 ± 1.15 vs 6.67 ± 1.15, P < 0.001) of those in the SSG were significantly higher than those in the CG. The average number of polyps detected in the SSG was considerably higher than that in the CG (0.84 ± 2.00 vs 0.53 ± 1.19, P = 0.037), and the average diameter of the polyps was significantly lower than that of the control group (4.0 ± 2.5 vs 4.9 ± 3.7, P < 0.001). CONCLUSIONS This SS-enhanced education strategy can improve the BP adequacy rate and increase the average number of polyps detected, especially those of small diameter.
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Affiliation(s)
- Xin Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yufeng Xiao
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhifeng Zhao
- Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shen Yang, China
| | - Shuang Yu
- Department of Gastroenterology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - En Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiao Xiao
- Department of Gastroenterology, Chongqing University Central Hospital, Chongqing, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Beijing, China
| | - Suyun Zheng
- Department of Gastroenterology, Qujing City First People's Hospital, Qujing, China
| | - Yanan Gong
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Lei Zhou
- Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hui Lin
- Department of Epidemiology, Army Medical University, Chongqing, China
| | - Rui Ji
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Heng Zhang
- Department of Gastroenterology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianying Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shiming Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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Chen HY, Tu MH, Chen MY. Effectiveness of a Mobile Health Application for Educating Outpatients about Bowel Preparation. Healthcare (Basel) 2024; 12:1374. [PMID: 39057517 PMCID: PMC11275862 DOI: 10.3390/healthcare12141374] [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: 04/30/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
Colonoscopy is an essential method for diagnosing and treating colorectal cancer, relying on effective bowel preparation to thoroughly examine the large intestinal mucosa. Traditional education involves printed instructions and verbal explanations but does not guarantee clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. A mobile medical model using Android devices for bowel preparation education was tested in a single-blind, randomized trial. This trial enrolled outpatients undergoing colonoscopy at the Endoscopy Center for Diagnostic and Treatment between 27 October 2021 and 31 December 2022. This study introduced the ColonClean app alongside traditional methods. After examination, endoscopists rated the preparation quality using the Aronchick scale. A data analysis was conducted using SPSS 25.0 to determine if there was a significant improvement in bowel preparation quality between the control group (traditional method) and the experimental group (traditional method plus the ColonClean app). Forty patients were recruited in each group. In the experimental group, all ratings were "fair", with 75% receiving an "excellent" or "good" rating, showing statistical significance (p = 0.016). The ColonClean app improves bowel preparation quality more effectively than traditional care instructions.
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Affiliation(s)
- Hui-Yu Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Ming-Hsiang Tu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
| | - Miao-Yen Chen
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan; (H.-Y.C.); (M.-Y.C.)
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Inaba A, Shinmura K, Matsuzaki H, Takeshita N, Wakabayashi M, Sunakawa H, Nakajo K, Murano T, Kadota T, Ikematsu H, Yano T. Smartphone application for artificial intelligence-based evaluation of stool state during bowel preparation before colonoscopy. Dig Endosc 2024. [PMID: 39031797 DOI: 10.1111/den.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/07/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVES Colonoscopy (CS) is an important screening method for the early detection and removal of precancerous lesions. The stool state during bowel preparation (BP) should be properly evaluated to perform CS with sufficient quality. This study aimed to develop a smartphone application (app) with an artificial intelligence (AI) model for stool state evaluation during BP and to investigate whether the use of the app could maintain an adequate quality of CS. METHODS First, stool images were collected in our hospital to develop the AI model and were categorized into grade 1 (solid or muddy stools), grade 2 (cloudy watery stools), and grade 3 (clear watery stools). The AI model for stool state evaluation (grades 1-3) was constructed and internally verified using the cross-validation method. Second, a prospective study was conducted on the quality of CS using the app in our hospital. The primary end-point was the proportion of patients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 among those who successfully used the app. RESULTS The AI model showed mean accuracy rates of 90.2%, 65.0%, and 89.3 for grades 1, 2, and 3, respectively. The prospective study enrolled 106 patients and revealed that 99.0% (95% confidence interval 95.3-99.9%) of patients achieved a BBPS ≥6. CONCLUSION The proportion of patients with BBPS ≥6 during CS using the developed app exceeded the set expected value. This app could contribute to the performance of high-quality CS in clinical practice.
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Affiliation(s)
- Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | | | | | - Masashi Wakabayashi
- Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
- Division of Science and Technology for Endoscopy, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Chiba, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
- Medical Device Innovation Center, National Cancer Center Hospital East, Chiba, Japan
- Endoscopy Center, National Cancer Center Hospital East, Chiba, Japan
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Patel SV, Yu D, Taylor C, McKay J, Hookey L. Smartphone Application Versus Standard Instruction for Colonoscopic Preparation: A Randomized Controlled Trial. J Clin Gastroenterol 2024:00004836-990000000-00274. [PMID: 38489496 DOI: 10.1097/mcg.0000000000001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To compare smartphone application (Colonoscopic Preparation) instructions versus paper instructions for bowel preparation for colonoscopy. BACKGROUND Adhering to bowel preparation instructions is important to ensure a high-quality colonoscopy. PATIENTS AND METHODS This randomized controlled trial included individuals undergoing colonoscopy at a tertiary care hospital. Individuals were randomized (1:1) to receive instructions through a smartphone application or traditional paper instructions. The primary outcome was the quality of the bowel preparation as measured by the Boston Bowel Preparation Score. Secondary outcomes included cecal intubation and polyp detection. Patient satisfaction was assessed using a previously developed questionnaire. RESULTS A total of 238 individuals were randomized (n = 119 in each group), with 202 available for the intention-to-treat analysis (N = 97 in the app group and 105 in the paper group). The groups had similar demographics, indications for colonoscopy, and type of bowel preparation. The primary outcome (Boston Bowel Preparation Score) demonstrated no difference between groups (Colonoscopic Preparation app mean: 7.26 vs paper mean: 7.28, P = 0.91). There was no difference in cecal intubation (P = 0.37), at least one polyp detected (P = 0.43), or the mean number of polyps removed (P = 0.11). A higher proportion strongly agreed or agreed that they would use the smartphone app compared with paper instructions (89.4% vs 70.1%, P = 0.001). CONCLUSIONS Smartphone instructions performed similarly to traditional paper instructions for those willing to use the application. Local patient preferences need to be considered before making changes in the method of delivery of medical instructions.
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Affiliation(s)
| | - David Yu
- Department of Surgery, Peterborough Regional Health Centre, Peterborough, Canada
| | - Connie Taylor
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston
| | - Jackie McKay
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston
| | - Lawrence Hookey
- Department of Medicine, Division of Gastroenterology, Queen's University, Kingston
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Au M, Low P, Rennie M, Mohseni M, Song Y, Kim N, Baraty B, Mitrev N, He E, Ho V, Leong R, Kariyawasam V. Determining efficacy of dynamic multimedia bowel preparation instructions versus standard instructions on adenoma detection and patient reported measures (DIGICLEAN trial): a study protocol for a multicentre, colonoscopist-blinded, randomised controlled trial. BMJ Open 2023; 13:e073843. [PMID: 37479508 PMCID: PMC10364173 DOI: 10.1136/bmjopen-2023-073843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Colonoscopy plays important roles in bowel cancer screening and treatment. Poor bowel preparation occurs in 20-25% of colonoscopies. This negatively impacts adenoma and sessile serrated lesion detection rates, procedural time, requirement for repeat colonoscopies, healthcare costs and likelihood of patient withdrawal from screening programmes. It is unclear whether a combination of multimedia modalities can improve bowel preparation quality, adenoma detection rates and patient-reported measures in those undergoing colonoscopy assessment. METHODS The DIGICLEAN trial is a prospective, parallel, multicentre, colonoscopist-blinded, randomised controlled trial. The trial will enrol 1294 participants aged 45 years and older who are indicated for a colonoscopy as an outpatient with a positive faecal occult blood test, iron deficiency anaemia or rectal bleeding. Participants will be randomised into the interventional arm, where bowel preparation instructions are delivered via a web-based application which uses scheduled short messaging service, regular patient survey assessment, email and videos; or the control arm, where routine standard written, verbal or emailed instructions are administered. The web-based application will assess patient-reported bloating, constipation and dietary adherence leading up to the colonoscopy. Depending on patient responses, additional aperients may be encouraged digitally in the interventional arm with same instructions made available in written format for the control arm. Patient-reported measures will be collected in both arms the day after the procedure using the validated Newcastle ENDOPREM questionnaire. In some sites, participants will undergo digital pre-anaesthetic screening as well. The co-primary endpoints are the adenoma detection rates and patient-reported measures taken after the colonoscopy. ETHICS AND DISSEMINATION Ethics approval for this study was obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/ETH00059). Findings will be reported at national and international gastroenterology meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000747729.
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Affiliation(s)
- Michael Au
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
| | - Patrick Low
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
| | - Michael Rennie
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Marriam Mohseni
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Yang Song
- Clinical Research Support Unit, Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Narae Kim
- Clinical Research Support Unit, Research and Education Network, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Brandon Baraty
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Nikola Mitrev
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
| | - Emily He
- Department of Gastroenterology and Hepatology, Sydney Local Health District, Concord, New South Wales, Australia
- The Daffodil Centre, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Rupert Leong
- Department of Gastroenterology and Hepatology, Sydney Local Health District, Concord, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Viraj Kariyawasam
- Department of Gastroenterology and Hepatology, Western Sydney Local Health District, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia
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Guan Y, Song Y, Li X, Zhang A, Li R. Impact of WeChat guidance on bowel preparation for colonoscopy: a quasi-experiment study. Sci Rep 2023; 13:11553. [PMID: 37463959 DOI: 10.1038/s41598-023-37435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
Colonoscopy is a standard procedure for screening, monitoring, and treating colorectal lesions. To explore the impact of WeChat guidance on bowel preparation before colonoscopy. This quasi-experiment study included patients who underwent colonoscopy at Qingdao Endoscopy Center between March 2016 and September 2016. The primary outcome was bowel preparation quality (Ottawa score), the secondary outcomes were intubation time, withdrawal time, adenoma detection rate (ADR), and adverse reactions. Finally, 588 patients were included and divided into the WeChat guide (n = 295) and the non-WeChat guide (n = 293) groups, they were comparable in baseline characteristics. The Ottawa score (1.59 ± 1.07 vs. 6.62 ± 3.07, P < 0.001), intubation time (6.47 ± 1.81 vs. 11.61 ± 3.34, P < 0.001), withdrawal time (13.15 ± 3.93 vs. 14.99 ± 6.77, P < 0.001), and occurrence rate of adverse reactions (2.0% vs. 5.5%, P = 0.029) were significantly lower in the WeChat guide group than those in the non-WeChat guide group. ADR was significantly higher in the WeChat guide than that in the non-WeChat guide group (1.47 ± 2.30 vs. 0.84 ± 1.66, P < 0.001). WeChat guidance might improve the quality of bowel preparation and adenoma detection rate, shorten the time of colonoscopy, and reduce adverse reactions in bowel preparation.
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Affiliation(s)
- Yifang Guan
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Yanjun Song
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiaona Li
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Aijun Zhang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Ruyuan Li
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
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Wonggom P, Rattanakanokchai S, Suebkinorn O. Effectiveness of bowel preparation innovative technology instructions (BPITIs) on clinical outcomes among patients undergoing colonoscopy: a systematic review and meta-analysis. Sci Rep 2023; 13:10783. [PMID: 37402823 DOI: 10.1038/s41598-023-37044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
To evaluate the effectiveness of bowel preparation innovative technology instructions (BPITIs) among patients undergoing colonoscopy. We searched PubMed, MEDLINE, CINAHL, CENTRAL, Scopus, Web of Science, LILACS, ClinicalTrials.gov, and Google Scholar for randomised controlled trials (RCTs) and cluster-RCTs from inception to February 28, 2022. The Cochrane risk of bias (RoB) tool and GRADE were used to assess RoB and certainty of evidence, respectively. Meta-analyses with random-effects model were used for analysis. This review included 47 RCTs (84 records). Seven BPITIs were found among included studies: (1) mobile apps, (2) VDO stream from personal devices, (3) VDO stream from a hospital device, (4) SMS re-education, (5) telephone re-education, (6) computer-based education, and (7) web-based education. The findings demonstrate that BPITIs have a slight impact on adherence to overall instructions (RR 1.20, 95% CI 1.13-1.28; moderate-certainty evidence), adequate bowel preparation (RR 1.10, 95% CI 1.07-1.13; low-certainty evidence), and quality of bowel preparation score (SMD 0.42, 95% CI 0.33-0.52; low-certainty evidence) compared to routine care. BPITIs may enhance the clinical outcomes. Due to the low-certainty evidence and heterogeneity of the included studies, the findings should be interpreted cautiously. Well-designed and reported RCTs are required to confirm the findings.PROSPERO registration number: CRD42021217846.
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Affiliation(s)
- Parichat Wonggom
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Orathai Suebkinorn
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, 40002, Thailand.
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Kong Q, Li Y, Li R, Li Z, Zheng X, Wang Z, Song K, Zhang X, Liu J, Han Z, Duan M, Ding Y, Zhang W, Lin M, Wang J, Wan M, Lin B, Wang S, Zuo X, Li Y. Low compliance to post-screening recommendations in a family-based Helicobacter pylori screening and treatment program: A prospective cohort study. Helicobacter 2022; 27:e12912. [PMID: 35816511 DOI: 10.1111/hel.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Intra-family transmission is an important Helicobacter pylori (H. pylori) infection route. Family-based screening and treatment of H. pylori is a promising strategy. However, limited data are available on patient compliance with post-screening recommendations for such a strategy. MATERIALS AND METHODS A prospective cohort study of families from six regions in Shandong, China, from July 2021 to February 2022 was conducted. Demographic characteristics, prior testing, and treatment for H. pylori, prior gastroscopy, symptoms, and family history were collected. Infection status of participants was determined using the 13 C-urea breath test. Infected participants were recommended to undergo eradication treatment, confirmation testing, and gastroscopy per expert consensus. Participants were monitored for 6 months to record recommendation compliance in a real-world setting. Logistic regression models were used to analyze the factors influencing compliance with the recommendations. RESULTS The study included 1173 individuals from 386 families with the overall infection rate of 36.7%. The recommendation compliance for eradication treatment, confirmation testing, and gastroscopy was 69.3% (271/391), 32.5% (88/271), and 6.1% (19/309), respectively. Factors that increased the risk of lower compliance were male sex (odds ratio [OR], 1.917, 95% confidence interval [CI], 1.233-2.981), and living in a non-urban area (OR, 1.954, 95% CI, 1.241-3.074), for treatment recommendations; having more than one infected family member (OR, 2.138, 95% CI, 1.237-3.698), and a lower family income (¥100,000-¥300,000 per year, OR, 7.247, 95% CI, 1.788-29.363; or <¥100,000 per year, OR, 7.294, 95% CI, 1.832-29.042), for confirmation testing recommendations; and being asymptomatic (OR, 3.009, 95% CI, 1.105-8.196), for gastroscopy recommendations. CONCLUSIONS Post-screening recommendation compliance for this family-based H. pylori screening and treatment program was unsatisfactory. Further studies focusing on pre-screening education are warranted to improve compliance.
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Affiliation(s)
- Qingzhou Kong
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yueyue Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ruili Li
- Department of Gastroenterology, Taierzhuang District People's Hospital, Zaozhuang, China
| | - Zhiyuan Li
- Department of Gastroenterology, Caoxian County Hospital, Heze, China
| | - Xueting Zheng
- Department of Gastroenterology, Yangxin County People's Hospital, Binzhou, China
| | - Zhi Wang
- Department of Internal Medicine, Maternity and Child Care Cencer of Dezhou, Dezhou, China
| | - Kun Song
- Department of Gastroenterology, Zichuan District Chinese Medicine Hospital, Zibo, China
| | - Xia Zhang
- Department of Gastroenterology, Zoucheng People's Hospital, Jining, China
| | - Jing Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhongxue Han
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Miao Duan
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuming Ding
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenlin Zhang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Minjuan Lin
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Juan Wang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meng Wan
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Boshen Lin
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shaotong Wang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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10
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Walter B. Reply. Clin Gastroenterol Hepatol 2022; 20:2414-2415. [PMID: 34971809 DOI: 10.1016/j.cgh.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Benjamin Walter
- Interdisciplinary Endoscopy Unit, Clinic of Internal Medicine I, Gastroenterology, University Hospital of Ulm, Ulm, Germany
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11
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Phan T, Peterson A, Le S. Digital Health Interventions for Colorectal Polyp Detection: Are We Ready for Prime Time? Clin Gastroenterol Hepatol 2022; 20:2413-2414. [PMID: 33524591 DOI: 10.1016/j.cgh.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Timothy Phan
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia
| | - Adam Peterson
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Clayton, Victoria, Australia; School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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12
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Aksan F, Tanriverdi LH, Figueredo CJ, Barrera LC, Hasham A, Jariwala SP. The impact of smartphone applications on bowel preparation, compliance with appointments, cost-effectiveness, and patients' quality of life for the colonoscopy process: A scoping review. Saudi J Gastroenterol 2022; 29:71-87. [PMID: 36073572 DOI: 10.4103/sjg.sjg_207_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this scoping review is to evaluate the impact of smartphone application (SPA) technology in patients undergoing elective colonoscopy to measure compliance with appointments, cost-effectiveness, bowel preparation, and quality of life. The scoping review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Ovid Medline, Web of Science, Science Direct, Scopus, Cochrane Library, and PubMed were screened up to Oct 14, 2020, and bibliographies of the retrieved articles were included. Based on pre-specified inclusion and exclusion criteria, 8 primary studies were included in the final analysis from a total of 3,979 non-duplicate articles. Seven out of eight studies measured the bowel preparation quality. In six of these studies, patients in the smartphone group had a successful bowel preparation when compared with the control arm; on the other hand, one study did not find any differences between groups. Adherence to colonoscopy screening was assessed by one study. Patients in the digital intervention arm were significantly more likely to complete a screening test. Patient satisfaction during the periprocedural period of colonoscopy was assessed by five studies which reported significantly higher patient satisfaction in the intervention arm compared to the control arm. None of the studies measured cost-effectiveness. We came to the conclusion that a well-designed, user-friendly SPA can help and guide patients undergoing colonoscopy through the process of following up on their appointments, adhering to bowel preparation, and better understanding their disease condition. Future trials investigating SPAs should include cost-effectiveness and adherence to appointments as an endpoint.
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Affiliation(s)
- Feyzullah Aksan
- Department of Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Lokman H Tanriverdi
- Department of Medical Pharmacology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Carlos Jose Figueredo
- Department of Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Alia Hasham
- Department of Gastroenterology and Liver Diseases, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Sunit P Jariwala
- Montefiore Einstein Innovation Biodesign Training Program; Clinical and Research Innovation, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center; Department of Allergy and Immunology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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13
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Face-to-Face Instruction and Personalized Regimens Improve the Quality of Inpatient Bowel Preparation for Colonoscopy. Dig Dis Sci 2022; 67:3592-3600. [PMID: 34705157 DOI: 10.1007/s10620-021-07290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Poor bowel preparation is commonly observed in inpatients undergoing colonoscopy, particularly those with higher risks for inadequate bowel preparation. AIMS The objective of this study was to determine whether personalized bowel preparation regimens combined with face-to-face instruction (FFI) could improve the quality of bowel preparation for inpatient. METHODS In this endoscopist-blinded, randomized controlled trial, 320 inpatients were enrolled and randomly allocated (1:1) to the control and intervention groups. The intervention group received FFI and personalized bowel preparation regimens, while the control group received the routine bowel preparation regimen and education. The primary outcome was adequate bowel preparation rate. Secondary outcomes included rates of procedure-related adverse events, incorrect diet restriction and laxative intake, etc. RESULTS: The adequate bowel preparation rate in the intervention group was significantly higher compared to control group [intention-to-treat (ITT) analysis: 70.0% vs 51.3%, P < 0.001; per-protocol (PP) analysis: 79.4% vs 58.6%, P < 0.001]. Bowel cleanliness was significantly improved in high-risk inpatients (ITT analysis: 65% vs 44.6%, P = 0.004; PP analysis: 73.0% vs 51.7%, P = 0.004) and in low-risk inpatients (ITT analysis: 80% vs 62.7%, P = 0.037; PP analysis: 92.3% vs 69.8%, P = 0.003). There were no significant differences between two groups regarding procedure-related adverse events. CONCLUSIONS Personalized bowel preparation regimens combined with FFI improve the rate of adequate bowel preparation, especially for patients with high-risk factors. As such, inpatients could benefit from this novel approach for better bowel preparation to ultimately improve the quality of colonoscopies.
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14
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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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15
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Li P, He X, Chen S. Impact of Patient Education via WeChat on Bowel Preparation for Colonoscopy: A Meta-analysis of Randomized Controlled Trials. Comput Inform Nurs 2022; 41:00024665-900000000-99173. [PMID: 35266903 DOI: 10.1097/cin.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the impact of education via WeChat on the quality of bowel preparation in patients undergoing colonoscopy through a meta-analysis of randomized controlled trials. Randomized controlled trials of bowel preparation education provided via WeChat for patients undergoing colonoscopy were screened from databases such as PubMed, Web of Science, Cochrane Library, and Embase. Papers published from the date of database construction to May 1, 2021, were extracted, and a meta-analysis was performed using Review Manager software. A total of four randomized controlled trials were included in the meta-analysis. The results showed that for patients undergoing colonoscopy, education via WeChat significantly improves the quality of bowel preparation for colonoscopy, reduces the insertion time, and increases the adenoma detection rate and the patient's compliance and willingness to repeat bowel preparation. In conclusion, education via WeChat before colonoscopy can significantly improve the quality of bowel preparation.
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Affiliation(s)
- Peng Li
- Author Affiliations: Department of Gastroenterology (Dr Li) and Laboratory Medicine Center, Department of Laboratory Medicine (Dr He and Dr Chen), Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
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16
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Solonowicz O, Stier M, Kim K, Kupfer S, Tapper E, Sengupta N. Digital Navigation Improves No-Show Rates and Bowel Preparation Quality for Patients Undergoing Colonoscopy: A Randomized Controlled Quality Improvement Study. J Clin Gastroenterol 2022; 56:166-172. [PMID: 33471486 PMCID: PMC10065085 DOI: 10.1097/mcg.0000000000001497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Because of high historical no-show rates and poor bowel preparation quality in our unit, we sought to evaluate whether text message navigation for patients scheduled for colonoscopy would reduce no-show rates and improve bowel preparation quality compared with usual care. METHODS We performed a randomized controlled quality improvement study from April to August 2019 in an urban academic endoscopy unit. All patients scheduled for colonoscopy were randomly assigned to a control group that received usual care (paper instructions/nursing precalls) or to the intervention group that received usual care plus the text message program [short message service (SMS)]. The program provided timed-release instructions on dietary modifications and bowel preparation before colonoscopy. The primary outcome was no-shows. Secondary outcomes were no-show/same-day cancellations, no-show/cancellations within 7 days of the procedure, and bowel preparation quality. RESULTS A total of 1625 patients were randomized (SMS=833, control=792). No-show rates were significantly lower in the SMS group compared with the control group (8% vs. 14%; P<0.0001). Similar results were found for no-show/same-day cancellations (10% vs. 16%; P=0.0003), and no-show/cancellations within 7 days (18% vs. 26%; P=0.0008). There was no difference in adequate bowel preparation for all colonoscopies between the groups (89% vs. 87%; P=0.47). However, rates of adequate bowel preparation for screening/surveillance colonoscopies were significantly higher in SMS versus control groups (93% vs. 88%; P=0.04). CONCLUSIONS Text message navigation for patients scheduled for colonoscopy improved the quality of colorectal cancer screening by decreasing no-show rates and increasing adequate bowel preparation rates in patients undergoing screening colonoscopy compared with usual care.
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Affiliation(s)
- Olga Solonowicz
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Matt Stier
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Karen Kim
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Sonia Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Elliot Tapper
- Section of Gastroenterology, Department of Medicine, University of Michigan Medicine, Ann Arbor, MI 48109
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
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17
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Chen G, Zhao Y, Xie F, Shi W, Yang Y, Yang A, Wu D. Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2135576. [PMID: 34807255 PMCID: PMC8609410 DOI: 10.1001/jamanetworkopen.2021.35576] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy. OBJECTIVE To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach. EXPOSURES Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos. MAIN OUTCOMES AND MEASURES The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy. RESULTS A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation. CONCLUSIONS AND RELEVANCE Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03667911.
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Affiliation(s)
- Guorong Chen
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Zhao
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Wen Shi
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingyun Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Wu
- Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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18
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van der Zander QEW, Reumkens A, van de Valk B, Winkens B, Masclee AAM, de Ridder RJJ. Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26703. [PMID: 34420924 PMCID: PMC8414298 DOI: 10.2196/26703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 06/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background Adequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18% to 35%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs. Objective The aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure. Methods Eligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18. Results A total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32). Conclusions Our personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions. Trial Registration ClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050
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Affiliation(s)
- Quirine E W van der Zander
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Ankie Reumkens
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Bas van de Valk
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
| | - Ad A M Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands.,NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Rogier J J de Ridder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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19
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Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology 2021; 161:701-711. [PMID: 34334168 DOI: 10.1053/j.gastro.2021.05.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this American Gastroenterological Association Institute Clinical Practice Update was to review the available evidence and provide best practice advice regarding strategies to improve the quality of screening and surveillance colonoscopy. This review is framed around 15 best practice advice statements regarding colonoscopy quality that were agreed upon by the authors, based on a review of the available evidence and published guidelines. This is not a formal systematic review and thus no formal rating of the quality of evidence or strength of recommendation has been carried out.
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Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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20
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Colonoscopy Bowel Preparation-Is There an App for That? Clin Gastroenterol Hepatol 2021; 19:235-237. [PMID: 32447018 PMCID: PMC7897467 DOI: 10.1016/j.cgh.2020.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
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