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Naomi C Sacks,1,2 Abhishek Sharma,1 Philip L Cyr,1,3 Gerald Bertiger,4 David N Dahdal,5 Stuart P Brogadir5 1Precision Xtract, Boston, MA, USA; 2Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 3College of Health and Human Services, University of North Carolina, Charlotte, NC, USA; 4Hillmont GI, Flourtown, PA, USA; 5Ferring Pharmaceuticals Inc., Parsippany, NJ, USA Background and aims: Proper bowel cleansing is necessary prior to colonoscopy, but poor tolerability to bowel preparation agents may increase the odds of poor cleansing and incomplete screenings. The aim of this study was to evaluate the real-world effectiveness and safety of bowel preparation agents. Methods: Claims data were extracted for individuals who had a screening colonoscopy from July 1, 2012, to June 30, 2015, were ≥18 years of age, and who could be observed ≥6 months before and ≥3 months after the screening. Data were stratified by agent class, including over-the-counter (OTC), low-volume (LV), and high-volume (HV) agents. Rates of incomplete screenings, repeat screenings, and hospitalizations were reported. Multivariate logistic regression was conducted to compare outcomes for sodium picosulfate, magnesium oxide, and citric acid (P/MC) vs other agents. Results: Of 2.8 million individuals, 71.5% were average risk and 28.5% were high risk for colorectal cancer. Rates of use were 2.8% for P/MC, 30.1% for other LV agents, 9.4% for HV agents, and 56.6% for OTC agents. All individuals who used P/MC had significantly lower odds of incomplete screenings compared to those who used other LV agents or HV agents (P

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.

Nine patients with polymyositis or dermatomyositis associated with arthritis without antinuclear antibodies have been studied. In eight patients a mildly inflammatory nonerosive arthritis occurred coincident with early manifestations or before the appearance of symptomatic muscle disease. Hands, wrists and knees were prominently involved. This arthritis responded to corticosteroids given for the myositis. One patient had erosive arthritis and periarticular calcifications associated with acute inflammation that seemed to diminish with colchicine therapy. Synovial biopsy specimens showed surface fibrin deposition, focal loss of lining cells and mild inflammation--findings similar to those in scleroderma. By electron microscopy tubuloreticular structures were found in vascular endothelium in synovium, as in other tissues in polymyositis. All patients surprisingly had pulmonary manifestations suggesting the possibility that the condition in this group of patients may represent a distinctive subset of polymyositis.

The morbidity of exploratory laparotomy and splenectomy in Hodgkin's disease was determined at three institutions—a university hospital, a major university affiliated hospital and a large community hospital. Of the 90 patients who underwent exploratory laparotomy, 33 (37 per cent) sustained a major or minor complication within two weeks of surgery. Seventeen patients (19 per cent) sustained a minor complication and 16 patients (18 per cent) a major complication. There was no mortality. A higher complication rate occurred in patients more than 28 years of age (p = 0.01), and in patients with advanced clinical stage when age was controlled (p = 0.05). We suggest that prior to performing an exploratory laparotomy in a given patient, the necessity of the procedure be weighed against its potential hazards.