补充教育可提高门诊患者肠道准备充分率：基于随机对照试验的系统评价和荟萃分析。
Supplementary education can improve the rate of adequate bowel preparation in outpatients: A systematic review and meta-analysis based on randomized controlled trials.
机构信息
Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Emergency, Affiliated Hospital of Southwest Medical University, Luzhou, China.
出版信息
PLoS One. 2022 Apr 21;17(4):e0266780. doi: 10.1371/journal.pone.0266780. eCollection 2022.
BACKGROUND
Colonoscopy is widely used for the screening, diagnosis and treatment of intestinal diseases. Adequate bowel preparation is a prerequisite for high-quality colonoscopy. However, the rate of adequate bowel preparation in outpatients is low. Several studies on supplementary education methods have been conducted to improve the rate of adequate bowel preparation in outpatients. However, the controversial results presented encourage us to perform this meta-analysis.
METHOD
According to the PRISMA statement (2020), the meta-analysis was registered on PROSPERO. We searched all studies up to August 28, 2021, in the three major electronic databases of PubMed, Web of Science and Cochrane Library. The primary outcome was adequate bowel preparation rate, and the secondary outcomes included bowel preparation quality score, polyp detection rate, adenoma detection rate, cecal intubation time, withdrawal time, nonattendance rate and willingness to repeat rate. If there was obvious heterogeneity, the funnel plot combined with Egger's test, meta-regression analysis, sensitivity analysis and subgroup analysis were used to detect the source of heterogeneity. RevMan 5.3 and Stata 17.0 software were used for statistical analysis.
RESULTS
A total of 2061 records were retrieved, and 21 full texts were ultimately included in the analysis. Our meta-analysis shows that supplementary education can increase the rate of adequate bowel preparation for outpatients (79.9% vs 72.9%, RR = 1.14, 95% CI: 1.08-1.20, I2 = 87%, p<0.00001). Supplementary education shortened the withdrawal time (MD: -0.80, 95% CI: -1.54 to -0.05, p = 0.04) of outpatients, increased the Boston Bowel Preparation Scale (MD: 0.40, 95% CI: 0.36 to 0.44, p<0.00001), reduced the Ottawa Bowel Preparation Scale (MD: -1.26, 95% CI: -1.66 to -0.86, p<0.00001) and increased the willingness to repeat (91.9% vs 81.4%, RR:1.14, 95% CI: 1.04 to 1.25, p = 0.004).
CONCLUSION
Supplementary education for outpatients based on the standard of care can significantly improve the quality of bowel preparation.
背景
结肠镜检查广泛用于肠道疾病的筛查、诊断和治疗。充分的肠道准备是高质量结肠镜检查的前提。然而，门诊患者的肠道准备充分率较低。已经进行了几项关于补充教育方法的研究，以提高门诊患者的肠道准备充分率。然而，有争议的结果促使我们进行了这项荟萃分析。
方法
根据 PRISMA 声明（2020 年），该荟萃分析在 PROSPERO 上进行了注册。我们在 PubMed、Web of Science 和 Cochrane Library 这三个主要电子数据库中检索了截至 2021 年 8 月 28 日的所有研究。主要结局是肠道准备充分率，次要结局包括肠道准备质量评分、息肉检出率、腺瘤检出率、盲肠插管时间、退镜时间、失访率和再次意愿率。如果存在明显的异质性，则使用漏斗图结合 Egger 检验、亚组分析、敏感性分析和 meta 回归分析来检测异质性的来源。使用 RevMan 5.3 和 Stata 17.0 软件进行统计分析。
结果
共检索到 2061 条记录，最终有 21 篇全文纳入分析。我们的荟萃分析表明，补充教育可以提高门诊患者的肠道准备充分率（79.9% vs 72.9%，RR=1.14，95%CI：1.08-1.20，I2=87%，p<0.00001）。补充教育缩短了门诊患者的退镜时间（MD：-0.80，95%CI：-1.54 至-0.05，p=0.04），增加了波士顿肠道准备量表评分（MD：0.40，95%CI：0.36 至 0.44，p<0.00001），降低了渥太华肠道准备量表评分（MD：-1.26，95%CI：-1.66 至-0.86，p<0.00001），并提高了再次意愿率（91.9% vs 81.4%，RR：1.14，95%CI：1.04 至 1.25，p=0.004）。
结论
基于标准护理的门诊患者补充教育可以显著提高肠道准备质量。
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