Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) is a major worldwide cause of cancer-related mortality. Colonoscopy programs based on guideline-recommended surveillance intervals have been put in place to reduce the morbidity and mortality associated with CRC. We were interested to evaluate clinical practice adherence to guideline-recommended surveillance intervals, the potential extent of early repeat colonoscopies, and causes of nonadherence to guideline recommendations. METHODS: We performed a literature search for articles reporting on guideline adherence for surveillance colonoscopies. Exclusion criteria included inflammatory bowel disease and hereditary CRC syndrome cohorts. Primary outcome was correct interval assignment in patients undergoing surveillance colonoscopy. Groups were assessed for adherence according to their respective guideline recommendations (North American or European). RESULTS: 16 studies were included in the analysis. The mean colonoscopy surveillance interval adherence rate was 48.8 % (95 % confidence interval [CI] 37.3 - 60.4). For North American guidelines, surveillance interval assignments were adherent to guideline recommendations in 44.7 % (95 %CI 24.2 - 66.3) of patients after detection of low risk lesions and in 54.6 % (95 %CI 41.4 - 67.4) after detection of high risk lesions. For European guidelines, surveillance interval assignments were adherent to recommendations in 24.4 % (95 %CI 1.1 - 63.4) of patients after detection of low risk lesions and in 73.6 % (95 %CI 35.5 - 98.8) after detection of high risk lesions. CONCLUSIONS: The worldwide adherence to surveillance colonoscopy guidelines was low, with more than 50 % of patients undergoing repeat colonoscopies either too early or too late. Early repeat colonoscopies occurred with the highest frequency for patients in whom only hyperplastic polyps or low risk adenomas were found.

Optical Diagnosis of Colorectal Polyps: Recent Developments.

PURPOSE OF REVIEW: Optical diagnosis of diminutive colorectal polyps has been recently proposed as an alternative to histopathologic diagnosis. Recent developments in imaging techniques, new classification systems, and the use of artificial intelligence have allowed for increased viability of optical diagnosis. This review provides an up-to-date overview of optical diagnosis recommendations, classifications, outcomes, and recent developments. RECENT FINDINGS: There are currently seven major classification systems and three major society recommendations for quality benchmarks for optical diagnosis of diminutive polyps. The NICE classification has been extensively studied and meets quality benchmarks for most imaging techniques but does not allow for the diagnosis of sessile serrated polyps (SSPs). The SIMPLE classification has met quality benchmarks for NBI and i-Scan and allows for the diagnosis of SSPs. Other classification systems need to be further studied to validate effectiveness. Computer-assisted diagnosis of colorectal polyps is a very promising recent development with first studies showing that society-recommended quality benchmarks for real-time colonoscopies on patients are being met. Limitations include a non-negligible percentage of failure to diagnose, low specificity, and low number of real-time diagnostic studies. More research needs to be performed to further understand the value of artificial intelligence for optical polyp diagnosis. Optical diagnosis of diminutive colorectal polyps is currently a viable strategy for experienced endoscopists using validated classifications and imaging-enhanced endoscopy. Artificial intelligence-based diagnosis could make optical diagnosis widely applicable but is currently in its early developmental stage.

Content Analysis of Vomit and Diarrhea Cleanup Procedures To Prevent Norovirus Infections in Retail and Food Service Operations.

Human noroviruses are the leading cause of foodborne disease in the United States, sickening 19 to 21 million Americans each year. Vomit and diarrhea are both highly concentrated sources of norovirus particles. For this reason, establishing appropriate cleanup procedures for these two substances is critical. Food service establishments in states that have adopted the 2009 or 2013 U.S. Food and Drug Administration Food Code are required to have a program detailing specific cleanup procedures. The aim of our study was to determine the alignment of existing vomit and diarrhea cleanup procedures with the 11 elements recommended in Annex 3 of the 2011 Supplement to the 2009 Food Code and to determine their readability and clarity of presentation. In July 2015, we located vomit and diarrhea cleanup procedures by asking Norovirus Collaborative for Outreach, Research, and Education stakeholders for procedures used by their constituency groups and by conducting a Google Advanced Search of the World Wide Web. We performed content analysis to determine alignment with the recommendations in Annex 3. Readability and clarity of presentation were also assessed. A total of 38 artifacts were analyzed. The mean alignment score was 7.0 ± 1.7 of 11 points; the mean clarity score was 6.7 ± 2.5 of 17 points. Only nine artifacts were classified as high clarity, high alignment. Vomit and diarrhea cleanup procedures should align with Annex 3 in the Food Code and should, as well, be clearly presented; yet, none of the artifacts completely met both conditions. To reduce the spread of norovirus infections in food service establishments, editable guidelines are needed that are aligned with Annex 3 and are clearly written, into which authors could insert their facility-specific information.