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Roshini Claire Anthony, 3 days ago

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Fatigue of physician, not timing, affects colonoscopy quality

10 Jul 2018

The time of day does not appear to have a significant effect on colonoscopy adenoma detection rates (ADR), when the procedure is performed by endoscopists working block shifts, according to a recent meta-analysis. However, those working full-day blocks may show significantly lower detection rates in the afternoon.

Pooled analysis of 16 studies, including 38,063 participants, showed that there was no significant difference in ADR between colonoscopies performed in the morning and in the afternoon (relative risk [RR], 1.08; 95 percent CI, 1.00–1.16; p=0.06).

In contrast, polyp detection rates (PDR) were significantly lower in procedures performed in the afternoon than in the morning (RR, 1.12; 1.04–1.20; p=0.002). The same was true for coecal intubation rates (CIR; RR, 1.01; 1.00–1.02; p=0.004). In all cases, heterogeneity of the findings was high.

In subgroup analyses, physicians who worked full-day block shifts showed significantly lower ADR (RR, 1.18; 1.09–1.28), CIR (RR, 1.08; 1.02–1.13) and PDR (RR, 1.17; 1.07–1.29) in colonoscopies performed in the afternoon than those performed in the mornings.

The quality of colonoscopy was not significantly influenced by the participation and help of staff members.

“The key finding of our study is that colonoscopies of the afternoon and morning do not differ in quality, and therefore schedule alone is not a risk factor,” said researchers, however noting that in full-day shifts, colonoscopy quality suffers in the afternoon.

“A half-day shift may prevent endoscopist fatigue, and split-dose bowel preparation could improve bowel preparation for colonoscopies scheduled in the afternoon,” they added.

For the meta-analysis, researchers accessed the databases of Embase, Cochrane Library, Web of Science and Medline, and searched for studies that reported ADR, CIR and PDR for morning and afternoon colonoscopy schedules.

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Most Read Articles
Roshini Claire Anthony, 3 days ago

Patients with mild hypertension who are at low risk for cardiovascular disease (CVD) do not appear to derive mortality or CVD benefit from antihypertensive treatments, raising questions on the need for treatment in this population, according to a recent study from England.

Pearl Toh, 6 days ago
A personalized computerized neurofeedback intervention for training attention and memory shows potential in cognitive training for healthy elderly men, who improved in cognitive performance after the training, although no significant improvements were seen in the overall study population.
4 days ago
The simple Atrial fibrillation (AF) Better Care (ABC) pathway holistically updates the integrated care for AF patients and helps reduce the risk of adverse outcomes such as all-cause mortality, stroke/major bleeding/cardiovascular death and hospitalization, according to a study.
Yesterday
Type 1 diabetes impairs cognitive functioning in children, and this effect is exacerbated by extreme glycaemic levels, according to a recent meta-analysis.