College Hospital Medical School Research Articles

Subjective control of emotions in the opinion of students

Emotions influence the subjective feeling of well-being and coping with difficulties and problems in various situations in life. That is why researchers often show them in explaining everyday events that impact the standard of living, education, and productivity at work and translate into the quality of human health. This article aims to analyse the level of emotions in students` lives who started their studies in science and humanities. The research used a self-project among 383 students at The University of Rzeszów and the Rzeszów University of Technology. I used the method of a diagnostic survey and a standardised tool examining the Emotional Control Scale (CECS) by Maggie Watson and Steven Greer from Faith Courtauld Unit, King’s College Hospital Medical School in London, which was adapted to the Polish version by Siegfried Juczyński (Juczyński, 2001, p. 55). The results showed an average level of emotional control among the surveyed students. The following independent variables were considered: University, gender, age, place of residence and wealth of the inhabitants. In one study on the anger scale, there was a variation in the statistical significance depending on the age of the subjects. However, considering the average, students from Rzeszów University showed slightly higher suppression of negative emotions than those from Rzeszów University of Technology students. In terms of gender, women indicated a higher average than men. The average level of suppression of negative emotions among the respondents indicates the strengthening of the system of education in various threats from the manifestation of anger, depression, and anxiety among high school and university students. Teachers must strengthen their abilities to counteract these and other negative features among students.

Editorial introductions.

Editorial introductions.

Retrospective Analysis of Complications and Causes of Mortality in Patients Undergoing Esophagectomy for Esophageal Cancer

Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity. Objective: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer. Material and Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Çukurova University Medical School Hospital were collected and analyzed retrospectively between January 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD grade , respectively. Results: The mean±SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56.38±11.00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0.034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups; however, a higher rate of respiratory complications was observed in Group 2 (P=0.038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2. Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of life in patients.

Differential Expression of MMP2 and TIMP2 in Peripheral Blood Mononuclear Cells After Roux-en-Y Gastric Bypass.

Matrix metalloproteinases (MMP) and their endogenous inhibitor, the tissue inhibitor of metalloproteinases (TIMP), are expressed in many different cell types and play an important role in physiologic and pathological degradation of extracellular matrix (ECM). Starting from these observations and considering the activation state of peripheral blood mononuclear cells (PBMCs) in obesity, we investigated the gene expression of metalloproteinases before and after Roux-en-Y gastric bypass (RYBG). The study was performed in the Ribeirão Preto Medical School University Hospital. Seventy-three women were divided into a study group (SG), composed of 53 individuals with severe obesity before and after 6 months of RYGB, and a control group (CG), composed of 20 normal-weight individuals. Anthropometric and body composition data were collected, and peripheral blood for ribonucleic acid (RNA) extraction. The biological samples were submitted to a quantitative real-time polymerase chain reaction to evaluate the expression of MMP2 and TIMP2 genes. Alterations in weight loss, body mass index (BMI), and fat mass (FM) were observed after 6 months of RYGB (p < 0.05). A reduction of gene expression of TIMP2 was observed after 6 months of RYGB, contributing positively to the weight loss (R2 = 0.33 p = 0.04). The enrichment analyses highlighted the interaction between TIMP2 and MMP2 genes and the molecular pathways involving the ECM remodeling in the obesity condition. RYGB contributes significantly to weight loss, improved BMI, reduced FM, and reduced TIMP2 expression in PBMCs, which might contribute to the ECM remodeling in the obesity and could be useful as a circulating biomarker.

Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic

Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. ClinicalTrials.gov Identifier: NCT04504877.

Nigel Standfield: vascular surgeon who trained generations worldwide

Nigel Standfield was born in Wuppertal, Germany, to John Standfield, who had served in the British and Indian armies during the second world war and then in British intelligence, and...

Genetically determined variations of selenoprotein P are associated with antioxidant, muscular, and lipid biomarkers in response to Brazil nut consumption by patients using statins

Several single nucleotide polymorphisms (SNPs) could indirectly, as well directly, influence metabolic parameters related to health effects in response to selenium (Se)supplementation. This study aimed to investigate whether the selenoprotein SNPs were associated with the response of Se status biomarkers to the Brazil nut consumption in patients using statins and if the variation in Se homoeostasis could affect antioxidant protection, lipid profile, muscle homoeostasis and selenoproteins mRNA. The study was performed in the Ribeirão Preto Medical School University Hospital. Thirty-two patients using statins received one unit of Brazil nut daily for 3 months. Body composition, blood Se concentrations, erythrocyte glutathione peroxidase (GPX) activity, total cholesterol, low-density lipoprotein(LDL), high-density lipoprotein (HDL), triacylglycerol (TAG), creatine kinase (CK) activity and gene expression of GPX1 and selenoprotein P (SELENOP) were evaluated before and after Brazil nut consumption. The volunteers were genotyped for SNP in GPX1 (rs1050450) and SELENOP (rs3877899 and rs7579). SNPs in selenoproteins were not associated with plasma and erythrocyte Se, but SNPs in SELENOP influenced the response of erythrocyte GPX activity and CK activity, TAG and LDL after Brazil nut consumption. Also, Brazil nut consumption increased GPX1 mRNA expression only in subjects with rs1050450 CC genotype. SELENOP mRNA expression was significantly lower in subjects with rs7579 GG genotype before and after the intervention. Thus, SNP in SELENOP could be associated with interindividual differences in Se homeostasis after Brazil nut consumption, emphasising the involvement of genetic variability in response to Se consumption towards health maintenance and disease prevention.

Editorial introductions

Editorial introductions

David Ivor Maurice Siegler

Something of a star pupil, at University College Hospital Medical School David Ivor Maurice Siegler won the Fellowes silver medal in clinical medicine, the senior undergraduate prize for medicine, the...

USP8 Mutations and Cell Cycle Regulation in Corticotroph Adenomas

Corticotroph adenomas frequently harbor somatic USP8 mutations. These adenomas also commonly exhibit underexpression of P27, a cell cycle regulator. The present study aimed to determine the influence of USP8 mutations on clinical features of Cushing's disease and to elucidate the relationship between USP8 mutations and P27 underexpression in these tumors. Retrospective study with 32 patients with Cushing's disease was followed at the Ribeirao Preto Medical School University Hospital. We evaluated the patients' clinical data, the USP8 mutation status and the gene expression of cell cycle regulators P27/CDKN1B, CCNE1, CCND1, CDK2, CDK4, and CDK6 in tumor tissue in addition to the protein expression of P27/CDKN1B. We observed somatic mutations in the exon 14 of USP8 in 31.3% of the patients. Larger tumor size was observed in patients harboring USP8 mutations (p=0.04), with similar rates of remission, age of presentation, salivary cortisol at 23:00 h and after 1 mg dexamethasone, ACTH levels, and early postoperative plasma cortisol. We observed no differences regarding the gene or protein expression of the cell cycle regulators according to USP8 mutation status. In this Brazilian series, the observed frequency of USP8 somatic mutations was similar to that reported in European ancestry populations. Although it was reasonable that USP8 mutations could contribute to cell cycle dysregulation and P27 underexpression in corticotroph adenomas, our data did not confirm this hypothesis. It is possible that increased deubiquitinase activity observed in mutated USP8 might influence other pathways related to cell growth and proliferation.

Injury Profile of Children 0-14 Years Old in Honduras.

Aim:At the University Medical School Hospital in Honduras, a paper-based injury surveillance system (InSS) registered all injury cases in the emergency department in 2013. This is the first study to identify the injury profiles of children in Honduras, using the InSS data.Materials and methods:A case-series study was carried out using the InSS. Children aged 0–14 years were identified in the data set, and the descriptive statistics and bivariate analyzes were completed using this data.Results:Of 17,971 study patients, 5,873 (32.7%) patients were 0–14 years old with an average age of 7.3 ± 4.1 years. Unintentional injuries, most commonly road traffic incidents, falls, and blunt force trauma, constituted 94.2% of the total injuries. In all, 1.9% (109) self-inflicted injuries and 3.9% (230) deliberate interpersonal injuries with 35.8% due to blunt force trauma and 22.6% due to gunshot wounds. The mortality rate was 0.2%, and 84% of children spent 3 or fewer days in the hospital. Firearm injuries were more severe and resulted in a longer hospital stay.Conclusion:Childhood injuries are highly prevalent and a public concern throughout Honduras. This study profiles these injuries of over an entire year and provides insight into the types of interventions that could be effective in preventing and managing the high burden of pediatric injuries in this region.Clinical significance:This study provides the groundwork to profiling the high burden of injuries in Honduran children. Targeted injury prevention strategies and interventions can begin to be developed and implemented using the profile.

John Anthony Lynn

The endocrine surgeon John Anthony Lynn was born in Caversham, Berkshire, on 28 July 1941, the son of a pharmacist. He was educated at the Thomas Hardye School in Dorchester...

Pseudocholinesterase Enzyme Deficiency in Adıyaman City Area.

Pseudocholinesterase (PChE) is an enzyme responsible for the hydrolysis of succinylcholine. In case of its deficiency, the effect of succinylcholine that is approximately 5-10 min is prolonged up to few hours. The use of succinylcholine has been declined recently. However, it is still actively used in some special conditions and in developing countries. In this study, incidence of PChE enzyme deficiency around Adiyaman city was investigated and presented with the literature review. After obtaining an approval from the investigational board of our hospital (Adiyaman University Medical School, Biomedical Research Ethics Board, 30.12.2012, Nr: B.30.2.ADY.0.20.00-600/51), patients undergoing any elective operation under general anaesthesia in the Adiyaman University Medical School Hospital between March and December 2013 were recruited for the study. After obtaining the patients' written consents, blood PChE, alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, creatinine, international normalisation ratio (INR) and activated partial thromboplastin time (aPTT) values of the patients were analysed. Possible association of the PChE deficiency with other values was also investigated. The normal value of PChE was taken as 4260-11250 for females aged 16-40 years and 5320-12920 U L(-1) for other patients. The study was completed with 964 patients, 702 (72.8%) of whom were females. PChE enzyme levels were under the normal in 7.2% of the patients. There were no correlation between patient group, ALT, INR, aPTT and creatinine elevation with PChE deficiency (p>0.05), whereas AST and urea level elevation was significantly associated with PChE deficiency (p<0.05). The risk of PChE deficiency was 4.5 and 9 times higher in the patients with the elevation of AST and urea levels, respectively. Pathological elevations of AST and urea that are a part of normal pre-operative biochemical analysis of blood will indicate the possible deficiency of PChE enzyme.

Effect of clinical and pathological features of gastrointestinal stromal tumors on overall survival and prognosis: Single center experience

Abstract Aim Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We aimed to evaluate the clinicopathological features of the patients in Thrace and improve our management. Material and Method In this retrospective study, 68 patients with a diagnosis of GIST referred to Trakya University Medical School Hospital between 1997 and 2015 were evaluated. Results The most common symptom was abdominal pain (38.2%) and the location was small-intestine (42.6%). Large masses had higher metastasis and relapse rate. The mean tumor size with relapse was 11.8 ± 3.8 cm meanwhile it was 6.5 ± 3.0 cm in non-relapsed patients (p = 0.01). The mean size of the tumor was 13.5 ± 4.4 in the metastatic group although this data was 8.8 ± 4.7 cm in the non-metastatic group (p = 0.01). With necrotic tumors, mitotic rate and size were higher. The mean mitosis count was 21.0 ± 3.6 in necrotic tumors and 7.2 ± 9.9 in non-necrotic tumors (p = 0.005). The mean size was 10.8 ± 5.0 cm in necrotic tumors and 5.6 ± 3.0 cm in non-necrotic tumors (p = 0.009). According to AFIP criteria, most of the patients were in the high-risk group (57.4%). Overall survival (OS) was longer in non-smokers and non-drinkers. Median OS was 80.16 months in non-smoker group (95% CI, 27.83–132.49) and 24.64 months (95% CI, 15.49–33.78) in the smoker group (p = 0.001). The median OS was 80.09 months in the non-drinker group (95% CI, 13.99–146.20) and 24.64 months (95% CI, 13.18–36.10) in drinker group (p = 0.05). Median OS in stomach GIST was 41.39 months, in small-intestine were 80.09 months and in the colon were 35.68 months (p = 0.032). Patients underwent surgery had longer overall-survival. Median OS was 80.09 months in patients undergone surgery and 16.98 months in patients had not been operated (p = 0.001). Overall survival was longer in GIST with mitotic rate 5/50HPF. Median OS was 80.16 months in patients who had less than 5 mitosis and 39.22 months in higher mitotic rate (95% CI, 31.58–46.87) (p = 0.034). Overall survival was shorter in GIST with Ki-67 > 5% than with 5%>. Median OS was 80.16 months (95% CI, 28.80–49.65) in Conclusions The most important factors about the survival and prognosis of GIST are location, size, mitotic rate, Ki-67, necrosis and surgery status. Using tobacco/alcohol may be related to survival. This study should be further investigated with extensive data.

Dr Joseph Dudley 'Benjy' Benjafield: Microbiologist, soldier and Bentley Boy racing driver.

Dr Joseph Dudley 'Benjy' Benjafield qualified from University College Hospital Medical School, London in 1912. He joined the Royal Army Medical Corps during World War I and was in charge of the 37th Mobile Bacteriological Laboratory serving with the British Egyptian Expeditionary Force when the Spanish flu struck in late 1918. He observed the features and clinical course of the pandemic and published his findings in the British Medical Journal in 1919. On return to civilian life, he was appointed as Consultant physician to St George's Hospital, Hyde Park Corner, London where he remained in practice for the rest of his career. He was a respected amateur gentleman racing driver frequently racing at the Brooklands circuit from 1924 after buying a Bentley 3-litre and entering the Le Mans 24 h race seven times between 1925 and 1935, winning in 1927. He was one of an elite club of young men known as The Bentley Boys and went on to become a founding member of the British Racing Drivers Club (BRDC) in 1927. He rejoined the Royal Army Medical Corps during World War II, serving briefly again in Egypt. He died in 1957.

1866P - Clinical utility of metabolic tumor volume in papillary thyroid carcinoma

BackgroundThe management of papillary thyroid carcinoma (PTC) should be decided by Risk-adapted approach. However, intermediated risk PTC needs to be stratified more precisely. Otherwise, the utility of 18F-FDG PET images in patients with PTC is restrictive. The aim of this study was to investigate the prognostic value of Metabolic Tumor Volume (MTV) measured on 18F-FDG PET images in patients with papillary thyroid carcinoma treated with surgery. MethodsWe retrospectively analyzed 102 patients with PTC who underwent 18F-FDG PET/CT between Feburary 2009 and June 2017 at Osaka University Medical School Hospital for initial staging before surgery. We evaluated the association of MTV of primary tumor (T-MTV) with relapse-free survival (RFS) using Cox regression analysis. Receiver operating characteristic (ROC) curves were used to estimate the optimal cut-off values for T-MTV. We also conducted recursive partitioning analyses to offer a novel risk stratification system. ResultsThe 3-year RFS for all patients were 81.2% with median follow-up of 42 months (range 11-111). In Cox model, T-MTV (Hazard Ratio, 1.23; 95% CI, 1.08 to 1.38; P=0.002) was significantly associated with RFS. ROC analyses showed that the optimal cutoff value of T-MTV was 10.3ml. We classified the patients as having a low, intermediate, or high risk of relapse or death on the basis of T-MTV and lymph node metastasis. ConclusionsMTV of primary tumor was a significant prognostic factor for RFS in patients with PTC treated with surgery. Incorporation of T-MTV into staging may lead to a better risk stratification. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

A specialized university outpatient clinic of the department of Plastic and Aesthetic Surgery

In a retrospective study, outpatients consulting the clinic of the Department of Plastic and Aesthetic Surgery of Hannover Medical School university hospital between 2013 and 2014 were analyzed. The epidemiology and distribution of disease entities previously treated in the different medical specialties such as surgery, internal medicine, dermatology, neurology and psychiatry, dentistry and ophthalmology were investigated. During a two-year period (2013/2014) 9272 patients with 821 different ICD-coded diagnoses were seen. 57 % of the primary and secondary diagnoses were related to surgery and 36 % to internal medicine. 7 % of the diagnoses were derived from other clinical specialties such as dermatology, neurology, psychiatry, dentistry and ophthalmology. Geriatric surgery comprised 22 %, post oncological 7 %, postoperative complication management 6 %, sequelae of conservative (non-surgical) treatment 3 % and congenital malformations 3 %. In 29 % of patients, surgical treatment was recommended. The analysis shows that patients with complex and a wide range of disease entities presented at our outpatient clinic of plastic- and aesthetic surgery. The variety of diagnoses requires not only extensive specialized expertise, but also broad medical knowledge in order to reach adequate treatment strategies. The setting of complex as well as a broad spectrum of diseases of the university outpatient clinic is thus particularly suitable for teaching of differential diagnoses, diagnostic algorithms and development of treatment strategies during medical training and student education.

Discontinuation due to immune-related adverse events is a possible predictive factor for immune checkpoint inhibitors in patients with non-small cell lung cancer.

BackgroundImmune‐related adverse events (irAEs) should be anticipated with treatment by immune checkpoint inhibitors (ICIs). Although the relationship between irAEs and efficacy of ICI has been reported, it has not yet been clarified whether the benefit from ICI outweighs the low frequency of proceeding to subsequent therapies after discontinuation due to irAEs.MethodsThe study comprised 61 patients with non‐small cell lung cancer who underwent treatment with ICIs (nivolumab or pembrolizumab monotherapy) at the Saga University Medical School Hospital from December 2015 to January 2018. Therapeutic effect and progression‐free survival (PFS) were compared between the irAEs discontinuation group (AEg) and the group with discontinuation due to all causes other than irAEs (Non‐AEg).ResultsA total of 30% patients(18/61) had therapy discontinued due to irAEs: 22.5% (9/40) with nivolumab and 42.9% (9/21) with pembrolizumab. The response rate was 50.0% in the AEg and 8.1% in the on‐AEg (P = 0.001). The median PFS was significantly longer in the AEg (9.3 months; 95% CI 2.1–12.1) than in the non‐AEg (1.9 months; 95% CI 0.9–3.6): HR 0.45 (95%CI 0.20–0.89; log‐rank test P = 0.026). The prevalence of drug‐induced interstitial lung disease (ILD) was 6.1% (3/49) in cases without interstitial pneumonia (IP) as the underlying disease, whereas it was 50% (6/12) in cases with IP (P = 0.001).ConclusionDiscontinuation of treatment with ICIs due to irAEs predict a good response to ICIs and favorable outcome since their anti‐cancer effects continue even after discontinuation. However, the presence of IP as the underlying disease increases the risk of drug‐related ILD onset.

A trauma registry experience from the main referral center of Honduras: A call for action

Background: Honduras is one of the most violent countries in the world and it has limited epidemiological data that describes the extent of intentional and unintentional injuries. This research is needed to develop and inform prevention programs in Honduras, as well as to spread international awareness.Methods: A cross-sectional study was carried out on a paper-based injury surveillance system (InSS) with the help of Honduras’ University Medical School Hospital (UMSH), the main referral medical center in Tegucigalpa-Honduras. Descriptive statistics and bivariate analysis were carried out using data from all registered injuries in 2013.Results: Of the 17,971 injuries reported, intentional injuries made up 18.14% of all injuries. Interpersonal violence from gun violence, robberies, and physical altercations accounted for 14.68%. Self-inflicted injuries made up 3.46% of injuries, with suicide falls and poison intoxications being the most frequent (1.9% and 1.2%, respectively). Sexual harassment was minimally reported (0.27%, n = 48). Unintentional injuries made up 81.79% of the total injuries. The most common causes of unintentional injuries were falls (38.01%) and road traffic injuries (16.65%). Motorocyclists made up 35.4% of those injured by road traffic accidents. In general, injuries occured during the weekend and mainly affected men during the ages when they would be most likely to work and maintain jobs. The modified Kampala trauma score (M-KTS) showed that most of the injuries were mild (range 3–11), with 59.59% of the patients with a M-KTS of 9, and an overall mortality rate of 0.65% (n = 117).Conclusion: The description of injuries provides the basis for prevention. The disproportionate number of unintentional injuries (4:1) seen in Honduras’ referral hospital calls for further research in: 1) trauma care logistics and emergency systems, 2) mortality and lethality of intentional injuries, and 3) analysis of the types of unintentional injuries. Further research is necessary to evaluate interventions and identify the socioeconomic effects of injuries in the region.

The New Jersey Bowel Preparation Scale: A More Objective and Detailed Scoring System for Screening Colonoscopies.

Goals The goal of this study was to develop an objective and detailed scoring system to assess the quality of bowel preparation. Background The quality of bowel preparation impacts the success of the colonoscopy. We developed and compared a new bowel preparation scoring system, the New Jersey Bowel Preparation Scale (NJBPS), with existing systems that are limited by a lack of detail and objectivity in the Boston Bowel Preparation Scale (BBPS) and the Ottawa Bowel Preparation Scale (OBPS). Methods This was a single-center, prospective, dual-observer study performed at Rutgers New Jersey Medical School University Hospital. Patients who were at medium risk for colorectal cancer and undergoing outpatient screening colonoscopy were enrolled in the study, and their bowel preparation was assessed separately by an attending and a fellow using each of the bowel preparation scoring systems. Results 98 patients were analyzed in the study, of which 59% were female. Most of the patient population was African American (65%) or Hispanic (25%). The average age of the patient was 60 years. Chi-squared analysis using SPSS software revealed intraclass correlation coefficient values between attending and fellow scores for each scale. The NJBPS had the highest value at 0.988, while the BBPS and OBPS had values of 0.883 and 0.894. Limitations Single-center study. Conclusions The NJBPS and BBPS scores demonstrated a statistically significant agreement with each other. Overall, there was good interobserver agreement for all three scoring systems when comparing attendings to fellows for the same scoring system. However, the NJBPS possessed a stronger correlation.