Audit and feedback interventions to improve endoscopist performance: Principles and effectiveness

Tinmouth, Jill; Patel, Jigisha; Hilsden, Robert J.; Ivers, Noah; Llovet, Diego

doi:10.1016/j.bpg.2016.04.002

Cited by 28 publications

(34 citation statements)

References 48 publications

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“…Individual components of trial quality for each RCT, as assessed according to the Cochrane Risk of Bias Tool (23), are summarized in Table 2. Study quality was generally low-moderate, with two studies lacking reporting of allocation concealment and only one trial specifying blinding of outcome assessors.…”

Section: Resultsmentioning

confidence: 99%

“…Trials then underwent an assessment of quality by both reviewers, including a final rating (23). Discrepancies between the reviewers were resolved by consensus (SJH).…”

Section: Methodsmentioning

confidence: 99%

“…Discrepancies between the reviewers were resolved by consensus (SJH). The elements of the quality and bias assessments were designed to meet the Cochrane standards for reporting of meta-analyses (23).…”

Section: Methodsmentioning

confidence: 99%

“…Univariate metaregression analyses were considered but ultimately not reported, in compliance with the Cochrane Handbook for Systematic Reviews of Interventions, which states that metaregression should not generally be performed in reviews with fewer than 10 studies (23). Subgroup analyses were performed according to prespecified variables associated with an increased risk of delayed bleeding; specifically, polyp size, shape, location and anticoagulant status were selected.…”

Section: Methodsmentioning

confidence: 99%

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Routine Prophylactic Endoscopic Clipping Is Not Efficacious in the Prevention of Delayed Post-Polypectomy Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Forbes

Frehlich

James

et al. 2018

Journal of the Canadian Association of Gastroenterology

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Background and Aims Colorectal cancer (CRC) can be prevented through colonoscopic polypectomy, but this exposes patients to risks, including delayed post-polypectomy bleeding (DPPB). Endoscopists increasingly use clips prophylactically with the aim of preventing DPPB. However, clips are costly, and data to support their efficacy in this context are inconsistent. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of prophylactic clipping for preventing DPPB. Methods We searched electronic databases and other relevant sources for randomized controlled trials assessing the efficacy of prophylactic clipping versus no clipping for the prevention of DPPB. Pooled relative risks were determined using a fixed-effects model. Subgroup analyses were also performed. Results A total of 2305 citations were initially screened. Seven randomized controlled trials satisfied all criteria for inclusion. The quality of included studies was generally low to moderate. A total of 2851 patients underwent 5405 polypectomies. Delayed post-polypectomy bleeding occurred at an overall pooled rate of 2.5%. No overall benefit of clipping for preventing DPPB was observed, with a pooled relative risk of 0.86 (95% confidence interval [CI], 0.55 to 1.36). No significant patient or polyp factors predicting DPPB were found through subgroup analyses. No publication bias was identified. Conclusions Randomized trials to date do not demonstrate a protective effect of prophylactic clipping for the prevention of DPPB, and therefore, the practice of routine prophylactic clipping appears unjustified. Additional high quality randomized trials are required to identify higher-risk groups that may benefit from prophylactic clipping.

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Section: Resultsmentioning

confidence: 99%

“…Trials then underwent an assessment of quality by both reviewers, including a final rating (23). Discrepancies between the reviewers were resolved by consensus (SJH).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Routine Prophylactic Endoscopic Clipping Is Not Efficacious in the Prevention of Delayed Post-Polypectomy Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Forbes

Frehlich

James

et al. 2018

Journal of the Canadian Association of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…Since most poor performers are identified through a process of audit or prospective monitoring compared to a benchmark, it is important to be cognizant of the important limitations of the audit and feedback process, and to apply it in a way that is designed to engage the individual and improve outcomes. The evidence base of the process of audit and feedback is comprehensively described in this issue of Best Practice & Research Clinical Gastroenterology [9].…”

Section: New Models Of Training and Upskillingmentioning

confidence: 99%