Adequacy Of Preparation Research Articles

A novel hybrid approach based on CREAM and fuzzy ANP to evaluate human resource reliability in the urban railway

Nowadays, various factors such as the welfare of citizens as well as traffic and air pollution reduction demonstrate the necessity of the creation and development of urban rail transport systems. Despite the utilization of new technologies in transportation systems and their automation, humans continue to play an important role in different parts of design, operation, monitoring, and repair. All activities performed in these sectors are affected by special working conditions or workplaces. Therefore, in order to decrease human error and improve safety, it is essential to identify and evaluate operating conditions affecting the condition performance commons (CPCs) and determine the general action failure probability using a suitable method. One way to do so is by using the cognitive reliability and error analysis method (CREAM). So far, in studies based on CREAM, the effects of these factors have been assumed to be equal when evaluating the effects of CPCs. However, in real terms, the effect of these factors can vary regarding the workplace and employees. In the present study, the fuzzy analytic network process (FANP) has been employed to determine the weight of efficient parameters in order to investigate and evaluate the working conditions affecting employee performance as a theoretical contribution. Urban rail transport systems such as the subway, tram, and urban railway have multiple entities, all contributing to a safe and efficient transportation system. These systems are composed of multiple human actors (driver, traffic control, and communication and licensing operator) and signaling systems working in a synchronized procedure. Because of the importance of human resources in these systems, the application of this method has been shown in the Mashhad urban railway in Iran as a practical contribution. According to the results of the basic CREAM, six factors of CPCs reduce performance reliability, most notably the adequacy of the organization; adequacy of the man-machine-interface (MMI) and operational support;” and “adequacy of training and preparation,” which have more effects on performance reliability compared to other factors. Based on the results obtained from the extended CREAM, the highest amount of detected error belonged to execution failure (%85), observation failure (%11), and planning failure (%4).

Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation

Only scant data describe the practice of canceling colonoscopies before colonoscope insertion for presumed inadequate bowel preparation (PIBP). We sought to better understand the ramifications of such cancellations and to characterize the nationwide practice of cancellations for PIBP. We determined the frequency of colonoscopies canceled for PIBP at our institution, assessing practice variation and whether patients who were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. We also surveyed gastroenterology program directors to determine whether canceling colonoscopies for PIBP is commonly permitted and if such cancellations are included in calculations of bowel preparation adequacy rates. Three percent of patients were canceled because of PIBP at our institution, with significant provider practice variability in cancellation rates. Only 67% of patients whose cases were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. The ability of an endoscopist to cancel a colonoscopy for PIBP was reported by 97% of survey respondents. Such cases are frequently not included in calculations of bowel preparation adequacy rates. The ability to cancel colonoscopies because of PIBP is near ubiquitous, but such cases are not uniformly included in calculations of bowel preparation adequacy rates. Variation in provider practice, and resulting impact on patient care, suggests a need for standardized protocols. Colonoscopies canceled for PIBP should be included in calculations of bowel preparation adequacy rates.

Impact of a Citywide Benchmarking Intervention on Colonoscopy Quality Performance.

There is marked variability in colonoscopy quality, limiting its effectiveness in colorectal cancer prevention. Multiple indicators have been established as markers for colonoscopy quality; however, there are conflicting data on the effects of quality reporting programs on endoscopist performance. In this study, we investigate the impact of a multicenter quarterly report card initiative on colonoscopy quality metric performance. Data were collected from 194 endoscopists at 10 participating sites throughout New York City using a Qualified Clinical Data Registry from January 2013 to December 2014. Adenoma detection rate (ADR), cecal intubation rate, withdrawal time, bowel preparation quality and appropriate interval recommendations were tracked. Report cards were distributed to each site on a quarterly basis and technical assistance was provided as needed. Performance trends were analyzed using the Cochran-Armitage trend and analysis of variance tests. 37,258 screening colonoscopies were performed during the study period. There was a positive performance trend for ADR over time from the first quarter of 2013 to the last quarter of 2014 (15.6-25.7%; p < 0.001). There were also increases in cecal intubation rates (78.2-92.6%; p < 0.001), bowel preparation adequacy rates (77.5-92.8%; p < 0.001), and adherence to appropriate screening intervals (28.0-55.0%; p < 0.001). There was no clinically significant change in mean withdrawal time. The implementation of a quarterly report card initiative resulted in statistically significant improvements in adenoma detection, cecal intubation, bowel preparation adequacy rates, and appropriate recommended screening intervals.

Evaluation of a low-residue diet for bowel preparation of colonoscopy

Objective To evaluate the clinical value of a commercial low-residue diet (LRD) for bowel preparation of colonoscopy. Methods This study was a prospective, endoscopist-blind, and randomized controlled trial. Participants were randomly assigned to two groups according to administration of LRD: the experimental group and the control group. Bowel preparation quality, compliance and tolerability of the two groups were compared. Results A total of 61 patients were enrolled, with 32 in the experimental group and 29 in the control group. The outcomes were as follows: Boston Bowel Preparation Scale (BBPS) (7.8±1.0 VS 7.1±1.3, P=0.037), the rate of bowel preparation adequacy (87.5% VS 79.3%, P=0.388), compliance rate of dietary restriction (78.1% VS 55.2%, P=0.057), preparation completion rate (93.8% VS 93.1%, P=0.919), cecal intubation rate (both were 100.0%) and cecum arrival time (9.1±2.9 min VS 9.8±3.7 min, P=0.417), incidence of adverse (3.1% VS 3.4%, P=0.944), and hunger rate before colonoscopy (34.4% VS 48.3%, P=0.102). Conclusion The LRD for bowel preparation of colonoscopy significantly improves BBPS, but its effect on improving the bowel preparation adequacy, patient compliance and tolerability needs to be confirmed by further larger-scale trials. Key words: Colonoscopy; Enteral nutrition; Food, formulated; Recommended dietary allowances; Bowel preparation

2845 Harm versus Benefit Ratio in Colonoscopy Preparation With Polyethylene Glycol: An Opportunity for Improvement

INTRODUCTION: Colonoscopy is the gold standard for colon cancer screening and has shown to decrease morbidity and mortality. However, the use of colonoscopy is limited by factors such as the patient's fear of the procedure and inadequate bowel preparation. The quality of bowel preparation is directly related to the endoscopist’s ability to detect adenomas. We carried out a retrospective descriptive analysis to assess the degree of preparation, and its effect on colonoscopy outcomes in a safety-net academic center. METHODS: We obtained data from the electronic medical record of a large, academic, safety-net hospital. Data for patients who underwent colonoscopy between January-June 2018 were reviewed. The data points extracted included: age, race, gender, indication for the colonoscopy, type of colonoscopy (screening, diagnostic or surveillance), procedure results, degree of the bowel preparation, and recommendations for a repeat colonoscopy. All the patients received polyethylene glycol (PEG). RESULTS: Our patient population was predominantly African American (98%). Of the 601 total colonoscopies performed, 454 (76%) were done for screening, 84 (14%) for diagnosis, and 59 (10%) for surveillance. Per documentation by the gastroenterologist, the adequacy of the bowel preparation was excellent in 1.1% (n = 7/601), good in 57% (n = 344), fair in 27% (n = 182) and poor in 10% (n = 66). More than 50% of colonoscopies were affected due to improper bowel preparation. 137 colonoscopies (23%) were canceled secondary to poor bowel preparation and were re-scheduled. 191 patients (32%) were advised to have repeat colonoscopy earlier than recommended guidelines due to inadequate preparation. The odds of a poor preparation versus good preparation having a canceled colonoscopy was 26.04, (CI 15.6-43.5, P =&lt; 0.00001). CONCLUSION: Our analysis revealed that in &gt;50% of patients who did not have good bowel preparation, the gastroenterologist’s ability to perform optimal colon cancer screening was negatively affected. This not only increases the risk of missing small polyps which carries the risk of malignant transformation but is also associated with increased cost burden and decreased patient satisfaction. Given that all our patients used PEG for bowel prep, we wonder whether the type, and/or amount of bowel preparation agent is contributory to poor preparation. Further prospective studies are needed to assess the adequacy of bowel preparation in our patient population using other formulas that have been approved by the FDA.

2887 Bowel Preparation Adequacy in a Direct Access Screening Program

INTRODUCTION: Direct access colonoscopy (DAC) pathways facilitate access to colon cancer screening. However, the absence of a pre-procedure office visit may increase the risk for inadequate colon cleansing, particularly in patients (pts) already at high risk for this. The aim of this pilot study was to establish non-inferiority of preparation (prep) adequacy for high-risk patients receiving high-dose (HD) purgative versus average-risk patients receiving standard-dose (SD) prep. METHODS: This was a retrospective single academic center study. HD assignment for DAC was based on any of the following criteria: chronic constipation (&lt;3 BM/week), medications (narcotics, tricyclics, or calcium channel blockers), diabetes mellitus (DM) on medication, stroke, BMI &gt;35, or prior inadequate prep. All pts received a PEG based prep. HD was defined as &gt;2L PEG-ELS/vitamin C (MoviPrep®), &gt;4L of PEG-ELS, or &gt;2L PEG 3350-sports drink. Prep adequacy (BBPS of ≥2 per segment) was compared between the HD and SD groups, with a 12% relative margin of non-inferiority (relative risk = 0.88). Assuming an overall 85% adequacy rate, 140 patients per group would give the study 80% power. Secondary outcomes were comparison of inadequate prep risk factors between study groups. RESULTS: We identified 1,522 pts who received DAC over 11 months. 156 pts were excluded due to no electronic prep order or non-PEG prep use. These interim analyses are based on all 59 HD pts and a subset of 140 of the 1307 SD pts. The adequacy rates were 92% for HD (54/59) versus 99% for SD (139/140), failing to establish non-inferiority (P-value = 0.17). Predictably, HD pts were more likely than SD pts to have prior inadequate preparation (19% vs. 0%), to be obese (68% vs. 39%), to have chronic constipation (15% vs. 6%), to have DM on medication (32% vs. 16%), and to be using narcotics (10% vs. 5%) or tricyclics (5% vs. 1%). CONCLUSION: Despite miss-assignment of many pts high risk for inadequate prep to SD, we found high rates of adequate cleansing in all DAC pts. Improper prep assignment and retrospective design allowing examination of only electronic (and not telephone) orders likely contributed to fewer pts than expected in the HD arm. This interim analysis does not establish non-inferiority of the HD prep for pts high risk for prep failure. Future efforts will focus on analyzing and correcting the cause for pt miss-assignment and prospectively evaluating prep adequacy in these two groups.

195 Adequacy Rates of Magnesium Citrate Bowel Preparation in a Large Retrospective Cohort

INTRODUCTION: Magnesium Citrate (MC) is not FDA approved as a colonoscopy preparation, but has been used widely in Europe. Advantages include low cost and small volume Few studies have evaluated MC as a bowel preparation. A large prospective trial by Gu, where MC (n = 53) had better tolerability and bowel cleansing compared to GoLYTELY but was statistically insignificant likely due to small sample size. Arora found PEG to be superior to MC We evaluated bowel preparations used in an endoscopy center of a Gastroenterology practice. Sample size is the largest for any similar studies (n = 19173). METHODS: Electronic Medical Records were queried for colonoscopies between 2010–2016. Bowel prep used, indication for colonoscopy (screening vs other) and preparation adequacy were all documented prospectively but queried for analysis retrospectively. Cases where the prep type was not recorded were excluded. Adequacy was based on numeric grade (0 = excellent, 1 = good, 2 = fair, and 3 = poor), where 0–2 were considered adequate and 3 not. An adequate prep resulted in following guidelines for next interval colonoscopy. Adequacy rates were calculated and compared. Data were analyzed using SAS software. RESULTS: A total of 19,173 cases (MC 2 bottles plus 2 Dulcolax (n = 9315), MC 3 bottles (n = 4682), Golytely 4 L (n = 137), Golytely 2 L (n = 72), Miralax (n = 193), Moviprep (n = 153), Nulytely 4 L (n = 145), Halflytely (n = 104), Osmoprep (n = 42), Suprep (n = 208), Combo prep which was a combination of GoLytely or Nulytely with MC (n = 3960), miscellaneous (n = 162)). We divided all into two major groups (Screening colonoscopies and non-screening colonoscopies) and looked at adequacy rate of each preparation used (Table 1). We compared MC 2 bottles and 3 to the rest of the major groups (Table 2). CONCLUSION: Our study included a large number of MC (n = 13,997), and we observed an excellent adequacy rate for both 2 bottles and 3 bottles, for both screening and non-screening colonoscopies (all &gt; 90%). This is the largest study evaluating MC as a bowel preparation. Two bottles with Dulcolax were better than 3 bottles, which could be due to better tolerability, combination with Dulcolax or other. We failed to detect a difference between screening and non-screening groups. MC demonstrated better results than GoLYTELY, nonetheless, the sample size for the later was smaller. In conclusion; MC as bowel preparation is an adequate, well tolerated, and inexpensive. In a large retrospective analysis, it compares favorably to other preparations.

Poor Health Literacy and Medication Burden Are Significant Predictors for Inadequate Bowel Preparation in an Urban Tertiary Care Setting.

The goal of this study was to identify factors impacting the quality of bowel preparation in an urban tertiary care setting. Inadequate bowel preparation is encountered in 17% to 32% of colonoscopies performed in the United States. Suboptimal colonic visualization reduces the yield of screening colonoscopies and increases healthcare costs because of longer procedure times and aborted procedures. We performed a cross-sectional survey in patients undergoing outpatient colonoscopy within the Johns Hopkins Health System. A Boston Bowel Preparation Score (BBPS) score of <5 was considered inadequate. Fisher's exact, χ tests and univariate and multivariate binary logistic regression were performed to assess the strength of the association for selected factors with a BBPS<5. In total, 467 patients (76.3% response rate) completed the survey between August 2017 and October 2017. The median BBPS score was 7, and 81.4% of patients had an adequate bowel preparation (BBPS≥5). There was significant association between bowel preparation adequacy and level of education, health literacy, functional status, income, and medication burden. When adjusted for other factors, poor confidence in filling forms (OR, 24.1; P<0.001), multiple daily prescription medications (OR, 12.49; P=0.02) and poor functional status (OR, 2.82; P=0.03) had the highest odds of predicting inadequate bowel preparation. Inadequate bowel preparation is a significant problem accounting for reduced yield of screening and increased health care costs. Poor health literacy, functional status, and number of daily medications are significant factors predicting inadequate bowel preparation in the tertiary care setting.

Accuracy of Trans-abdominal Ultrasound in Evaluating Bowel Preparation Adequacy Before Colonoscopy

Accuracy of Trans-abdominal Ultrasound in Evaluating Bowel Preparation Adequacy Before Colonoscopy

Factors affecting bowel preparation adequacy and procedural time.

Background and AimPoor bowel preparation results in difficult colonoscopies, missed lesions, and repeat procedures. Identifying patient risk factors for poor bowel preparation, such as prolonged runway time and prolonged cecal intubation, will aid in interventions prior to a procedure.MethodsThis was a retrospective, single‐center analysis of 3 295 colonoscopies performed between May 2012 and November 2014. Indications for colonoscopy included gastrointestinal bleed and anemia, change in bowel habits, for screening, and others (including planning re‐anastomoses, abdominal distension, family history and angioectasias). Data were collected from medical charts and endoscopy reports. Comparisons between patient factors and runway time were made with adequacy of bowel preparation as the primary outcomes.ResultsMale and diabetic patients had statistically higher rates of inadequate bowel preparation and prolonged cecal intubation times. A previous history of abdominal surgery also demonstrated prolonged cecal intubation. A runway time of ≤7.63 h was associated with higher rates of adequate bowel preparation by multivariate analysis. The optimal time frame is 3–6 h for the highest success rates.ConclusionPatient risk factors for inadequate bowel preparation or prolonged cecal intubation should signal clinicians to intervene prior to colonoscopy. A runway time between 3 and 6 h is optimal for adequate bowel preparation. This may involve further patient education, along with work flow optimization, to facilitate ideal runway times. Future studies should explore how to avoid repeat endoscopies using protocols enforcing this timeframe.

Multicentre endoscopist-blinded randomised clinical trial to compare two bowel preparations after a colonoscopy with inadequate cleansing: a study protocol

IntroductionInadequate bowel preparation is common and negatively impacts colonoscopy quality. The objective of this study is to compare two bowel preparation regimens in cleansing the colon after an index colonoscopy...

Mo1093 A FORMULARY CHANGE FROM SPLIT-ADMINISTERED STANDARD DOSE PEG-ELS TO HIGH DOSE PEG-ELS FOR INPATIENT COLONOSCOPY PREPARATION

Inpatient (inpt) colonoscopy is performed almost exclusively to evaluate symptoms or signs. Effective bowel preparation is crucial but is frequently inadequate in inpts. We previously compared 4L PEG-ELS PM to split dose 2L PEG-ELS with vitamin C (PEG-Asc) (MoviPrep®) for inpt colonoscopy and found no significant difference with respect to adequacy (67%-72%). This study evaluated whether a formulary change from standard dose to high dose PEG-Asc improved preparation adequacy.

Impacto de la adecuación del protocolo de preparación prequirúrgica en la incidencia de infección de localización quirúrgica en cirugía cervical

BackgroundSurgical wound infection is one of the leading causes of healthcare-associated infections. One of the most common measures for its reduction is the pre-surgical preparation. The aim of this study was to evaluate the adequacy to the pre-surgical protocol in patients undergoing neck surgery and the relationship with the incidence of surgical wound infection. Material and methodsObservational cohort study, conducted from January 2011 to December 2017. Variables related to patient, pre-surgical preparation and infection were collected. Infection rate was calculated after a maximum period of 30days after surgery. The effect of the pre-surgical preparation's adequacy and infection was evaluated. ResultsThe study included 131 patients. The global adequacy of the pre-surgical protocol was 84.7%, being the main cause of inadequacy the application of the mouthwash (7.6% of the interventions). The overall incidence of surgical wound infection during the follow-up period was 4.6% (95%CI: 1.0%-8.2%). No relationship between the adequacy to the protocol and the presence of infection was found (P=.59). ConclusionsAdequacy of the pre-surgical preparation in our hospital was high and the incidence of surgical wound infection was low, and no relationship was found between the two. The results show a high safety culture in this surgery. However, there is still room for improvement in the quality of care of our patients.

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit.

Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients. Case-control study of older patients who underwent colonoscopy. Gastroenterology institute at an academic medical center. Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy. Colonoscopy. Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30-day mortality, advanced adenoma and carcinoma detection rate, treatment, and long-term survival of patients diagnosed with colorectal cancer. Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30-day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11-878) days in those who underwent surgery and 112 (48-341) in those treated conservatively (P = .055 log-rank test). Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.

Usefulness of Personal Bowel Habits as a Predictive Factor for Inadequate Bowel Preparation for Colonoscopy: A Prospective Questionnaire-Based Observational Study.

Background/AimsThe quality of bowel preparation is important for optimal colonoscopy. It is influenced by medical and personal factors. We aimed to evaluate the effect of bowel habit on the quality of bowel preparation and to identify predictors of inadequate bowel preparation among bowel habit factors.MethodsFrom June 2017 to September 2017, 90 volunteers were enrolled in this study. Each participant answered a questionnaire consisting of multiple questions about personal bowel habits, including stool form, frequency of bowel movements per week, duration, and degree of straining for bowel movement. Then, all volunteers underwent colonoscopic exam. Eleven endoscopists performed colonoscopies and used the Boston Bowel Preparation Scale (BBPS) as the index for bowel preparation. Two expert endoscopists simultaneously reviewed all colonoscopic images to confirm the final BBPS. Univariate and multivariate logistic regression analyses were performed to verify the correlation between bowel preparation adequacy and bowel habit.ResultsAmong the 90 participants, 20 (22.2%) had inadequate bowel preparation (total BBPS ≤6 or any segmental BBPS ≤1). In univariate analysis, infrequent bowel movement (0–2/week) (odds ratio [OR], 12.60; 95% confidence interval [CI], 1.22 to 129, p=0.03) and moderate straining (more than 1/4 of defecations) (OR, 4.40; 95% CI, 1.44 to 13.39; p=0.01) were significantly associated with inadequate bowel preparation. However, only moderate straining was significantly associated with inadequate bowel preparation in multivariate analysis (OR, 3.99; 95% CI, 1.26 to 12.65; p=0.02).ConclusionsStraining is a significant predictor for inadequate bowel preparation. For patients with straining during bowel movements, an intensified preparation regimen should be considered.

Graduates’ Continuing Work as Scholarly Practitioners after Participation in a Carnegie Project on the Education Doctorate Guided, EdD Program

Aim/Purpose: This paper examined whether, and how, graduates of an EdD program continued to (a) engage in scholarly practitioner efforts and (b) employ inquiry skills in their workplace settings after completion of their doctoral studies. Background: Little research has been conducted on follow-up of graduates of doctoral programs. The limited research that has been done, typically, was conducted to examine employment status and satisfaction, salary, and adequacy of preparation. Generally, studies have not explored the effects of graduates’ preparation on subsequent use of the skills. Methodology: A mixed method study was conducted. In all, 67 graduates completed an online questionnaire (~52% response rate) assessing their efforts with respect to using scholarly practitioner skills and inquiry skills. Eleven of the graduates were interviewed and these data were used to examine more closely graduates’ use of these skills. Graduates worked in various K-12, community college, university, and other education-related settings. Contribution: This study begins to fill the gap that exists with respect to examining the effects of graduates’ preparation on subsequent use of those skills. In particular, the study was conducted to examine whether and how program graduates continued to use scholarly practitioner and inquiry skills developed during their doctoral preparation in their subsequent professional work. Findings: The quantitative and qualitative data indicated graduates continued to act as scholarly practitioners and engaged in inquiry skills. The interview data were particularly robust and replete with examples of how graduates used these skills/abilities in their workplaces. Recommendations for Practitioners: EdD programs that provide affordances for students to apply skills as scholarly practitioners and employ inquiry as practice methods during students’ preparation will foster skills/abilities that can be applied in subsequent professional practice by educators after graduation. Recommendation for Researchers: Additional studies of graduates’ application of skills/abilities learned in doctoral programs are warranted because of the limited research that has been conducted in this area. Impact on Society: Developing educators’ scholarly practitioner skills and inquiry as practice methods will allow educators to more effectively attack the problems of practice they encounter on a daily basis and improve the educational situations of those they teach and serve. Future Research: A likely next step would be to explore the use of scholarly practice skills and inquiry skills using a case study approach to examine more closely how educators apply these skills/abilities in daily practice.

Accurate Identification of Colonoscopy Quality and Polyp Findings Using Natural Language Processing

The aim of this study was to test the ability of a commercially available natural language processing (NLP) tool to accurately extract examination quality-related and large polyp information from colonoscopy reports with varying report formats. Colonoscopy quality reporting often requires manual data abstraction. NLP is another option for extracting information; however, limited data exist on its ability to accurately extract examination quality and polyp findings from unstructured text in colonoscopy reports with different reporting formats. NLP strategies were developed using 500 colonoscopy reports from Kaiser Permanente Northern California and then tested using 300 separate colonoscopy reports that underwent manual chart review. Using findings from manual review as the reference standard, we evaluated the NLP tool's sensitivity, specificity, positive predictive value (PPV), and accuracy for identifying colonoscopy examination indication, cecal intubation, bowel preparation adequacy, and polyps ≥10 mm. The NLP tool was highly accurate in identifying examination quality-related variables from colonoscopy reports. Compared with manual review, sensitivity for screening indication was 100% (95% confidence interval: 95.3%-100%), PPV was 90.6% (82.3%-95.8%), and accuracy was 98.2% (97.0%-99.4%). For cecal intubation, sensitivity was 99.6% (98.0%-100%), PPV was 100% (98.5%-100%), and accuracy was 99.8% (99.5%-100%). For bowel preparation adequacy, sensitivity was 100% (98.5%-100%), PPV was 100% (98.5%-100%), and accuracy was 100% (100%-100%). For polyp(s) ≥10 mm, sensitivity was 90.5% (69.6%-98.8%), PPV was 100% (82.4%-100%), and accuracy was 95.2% (88.8%-100%). NLP yielded a high degree of accuracy for identifying examination quality-related and large polyp information from diverse types of colonoscopy reports.

New nurses and community maternal care education: A qualitative study.

There is ongoing focus in Indonesia to lower the maternal mortality rate. One strategy has been increasing numbers of health care practitioners, including nurses, in the community. While much is known about transition experiences of new registered nurses, little is known about the adequacy of educational preparation of new nurses in Indonesia to provide maternal care in community settings. This qualitative descriptive study explored new diploma prepared nurses' perceptions of their educational preparation for providing community maternal care. Semi-structured interviews were conducted with five new nurses working in community health care centres in Gowa District, South Sulawesi, Indonesia. Thematic analysis was used to analyse data. Three key themes emerged: Practice context, Professional role delineation, and Education programs. Nurses reported encountering a range of aspects of maternal care, and community expectations of their skills and knowledge. These were particularly necessary in rural areas. Educational preparation was found to be insufficient for the activities that graduates were engaged in. There is a need for more research into maternal care content in undergraduate nursing programs in Indonesia to ensure optimal maternal care in community settings.

One-day oral polyethylene glycol based cleanout is effective for pre-colonoscopy preparation in children

BackgroundThe adequacy of pre-procedure preparation is the principal determinant of the quality of colonoscopy in pediatric as in adult patients. There is a lack of consensus, among providers on a standard pre-procedure regimen. Professional society guidelines include the use of Polyethylene glycol (PEG). Herein we report on the provider-assessed adequacy of a one day, age-categorized dosing, PEG based cleanout regimen in children undergoing colonoscopy in a tertiary institution.MethodsThe standard bowel preparation regime at our institution includes an age dependent minimum PEG dosing regimen in addition to clear liquids the day prior to the procedure. We retrospectively abstracted relevant indices including patient demographics, prep quality, procedure impairment, duration and completion from an institutional quality monitoring survey tool between 2015 and 2016 and similarly abstracted prospectively recorded indices that included the dataset above as well as additional fields for procedure deviations and additional laxative use.ResultsA total of 642 procedures (mean age 12.2 years; F: 380) were accrued, nonadherence to the cleanout regimen (7.3%) and additional laxative use (3.1%) were observed in a small proportion of the prospective dataset subjects, adequate cleanout defined as thin or thick liquid but no solids present was reported in 79.5% and 15.8% of cases and impaired study from inadequate cleanout was reported in 11.8% of studies albeit the cecum was reached and the terminal ileum was intubated in 97.8 and 93.6% of studies. The duration of the study was significantly longer with the presence of a fellow trainee assisting in the procedure. Patient age and gender did not correlate with prep adequacy or cecal and ileal intubation rates, inadequate cleanout was significantly associated with impairment and incomplete studies.ConclusionA one day, single agent, osmotic laxative (Polyethylene glycol) based cleanout regimen is effective in routine pre-procedure cleanout for standard colonoscopy in pediatric age range patients.

Factors influencing nurses' willingness to lead.

To identify factors influencing nurses' willingness to lead. Given the ageing workforce and the projected retirement of nurse leaders, there is a concern about nursing leadership shortages in the next decade. Several studies have shown that nurses are not interested in pursuing leadership positions, but studies investigating nurses' willingness to lead and related predictors remain limited. A workforce survey of 1,201 direct-care nurses was conducted in Oregon. Logistic regression modelling was used to identify factors influencing the likelihood of nurses' willingness to lead. Fifty-three percent of nurses were willing to pursue leadership roles. Years of experience, job burnout, the perception of the work environment, adequacy of leadership preparation, and the amount of salary and compensation were significant predictors of nurses' willingness to lead. Increasing nurses' participation in hospital affairs and providing adequate leadership preparation, parts of the work environment, prior to engaging them in leadership roles is recommended to improve their attitudes about leading. Recruitment of future nursing leaders should not be based solely on demographics such as age and gender. Rather, recruiters should focus on creating more favourable work environments in which to lead.