scholarly journals Safe and appropriate use of laxatives for colonoscopy

2021 ◽  
Vol 64 (8) ◽  
pp. 561-569
Author(s):  
Won Shik Kim ◽  
Beom Jae Lee
Keyword(s):  
Polyethylene Glycol ◽  
Patient Education ◽  
Patient Compliance ◽  
Bowel Preparation ◽  
Gas Bubbles ◽  
Appropriate Use ◽  
Poor Patient ◽  
Poor Patient Compliance ◽  
Underlying Diseases

Background: Appropriate bowel preparation is essential for effective colonoscopy. Inadequate use of bowel preparation solutions reduces patient compliance, makes the detection of lesions such as adenoma difficult, and increases the risk of complication such as perforation. Current Concepts: A 4-L polyethylene glycol (PEG) solution can be safely used for bowel preparation, even in most individuals with underlying diseases. However, it requires a high preparation-volume intake and has poor patient compliance due to its unpleasant taste. Therefore, a 2- or 1- L sulfate-free, PEG-based laxative was developed to, reduce the amount of PEG and improve the taste. Furthermore, simethicon-containing laxative formulation was developed to eliminate gas bubbles. In addition, oral bowel preparation solutions with enema agents and prokinetics were used to improve bowel preparation, but no improvement was observed. Various alternative laxatives are available; however, PEG-based bowel preparation solutions are still recommended in most cases due to their stability. Discussion and Conclusion: Although a 4-L PEG solutions recommended for bowel preparation in most cases, several laxatives have been introduced to overcome its disadvantages. The laxative agent must be selected according to each patient’s specific characteristics. Moreover, the method of taking bowel preparation solutions and additional bowel preparation medications must be carefully chosen. In addition, patient education via various methods, such as using a smartphone, when taking a bowel preparation agent may help improve bowel preparation quality.

scholarly journals Educational virtual reality videos in improving bowel preparation quality and satisfaction of outpatients undergoing colonoscopy: protocol of a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029483
Author(s):  
Yi Zhao ◽  
Feng Xie ◽  
Xiaoyin Bai ◽  
Aiming Yang ◽  
Dong Wu
Keyword(s):  
Virtual Reality ◽  
Patient Education ◽  
Patient Compliance ◽  
Bowel Preparation ◽  
Detection Rate ◽  
Peking Union Medical College ◽  
College Hospital ◽  
Medical College ◽  
Poor Patient

IntroductionColonoscopy is the reference method in screening and diagnosis of colorectal neoplasm, but its efficacy is closely related to the quality of bowel preparation. Poor patient compliance is a major risk factor for inadequate bowel preparation likely due to poor patient education. Such an education is usually provided via either oral or written instructions by clinicians. However, multiple education methods, such as smartphone applications, have been proved useful in aiding patients through bowel preparation. Also, it was reported that a large proportion of patients feel anxious before colonoscopy. Virtual reality (VR) is a novel method to educate patients and provides them with an immersive experience. Theoretically, it can make patients better prepared for bowel preparation and colonoscopy. However, no prospective studies have assessed the role of this novel technology in patient education before colonoscopy. We hypothesise that VR videos can improve bowel preparation quality and reduce pre-procedure anxiety.Methods/designThe trial is a prospective, randomised, single-blinded, single-centre trial. Outpatients who are scheduled to undergo colonoscopy for screening or diagnostic purposes for the first time will be randomised to receive either the conventional patient education or the conventional methods plus VR videos, and 322 patients will be enrolled from the Peking Union Medical College Hospital. The primary endpoint is the quality of bowel preparation, measured by the Boston bowel preparation score. Secondary endpoints include polyp detection rate, adenoma detection rate, cecal intubation rate, patient compliance to complete bowel cleansing, withdrawal time, pre-procedure anxiety, overall satisfaction and willingness for the next colonoscopy.Ethics and disseminationThe study has been approved by the institutional review board of the Peking Union Medical College Hospital (No. ZS-1647). The results of this trial will be published in an open-access way and disseminated among gastrointestinal physicians and endoscopists.Trial registration numberNCT03667911

Recent Developments in Alpha-Glucosidase Inhibitors for Management of Type-2 Diabetes: An Update

2019 ◽  
Vol 25 (23) ◽  
pp. 2510-2525 ◽  
Author(s):  
Bashir Usman ◽  
Neha Sharma ◽  
Saurabh Satija ◽  
Meenu Mehta ◽  
Manish Vyas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Patient Compliance ◽  
Postprandial Hyperglycemia ◽  
Diabetic Patients ◽  
Poor Patient ◽  
Glucosidase Inhibitors ◽  
Poor Patient Compliance ◽  
Recent Developments ◽  
Alpha Glucosidase

The incidence of diabetes has increased globally in recent years and figures of diabetic patients were estimated to rise up to 642 million by 2040. The disorder is accompanied with various complications if not managed at the early stages, and interlinked high mortality rate and morbidity with time. Different classes of drugs are available for the management of type 2 diabetes but were having certain limitations of their safety. Alphaglucosidase is a family of enzyme originated from the pancreas which plays a role in the anabolism of 80-90% of carbohydrate consumed into glucose. This glucose is absorbed into the blood and results in frank postprandial hyperglycemia and worsens the conditions of diabetic patients which precipitate complications. Inhibition of these enzymes helps to prevent postprandial hyperglycemia and the formation of glycated end products. Alphaglucosidase inhibitors are reported to be more important in adequate control of type 2, but marketed drugs have various side effects, such as poor patient compliance and also expensive. This proves the needs for other class of drugs with better efficacy, safety, patient compliance and economic. In this review, we have emphasized the recent advances in the field of new alpha-glucosidase inhibitors with improved safety and pharmacological profile.

scholarly journals Mnenje pulmologov o pomenu vdihovalnikov pri bolnikih z astmo ali KOPB

2017 ◽  
Vol 86 (3-4) ◽  
Author(s):  
Mitja Košnik ◽  
Nadja Triller ◽  
Julij Šelb
Keyword(s):  
Disease Control ◽  
General Practitioners ◽  
Patient Compliance ◽  
Delphi Method ◽  
Interquartile Range ◽  
Critical Event ◽  
Two Stage ◽  
Poor Patient ◽  
Poor Patient Compliance ◽  
Selection Of

Background: Medications for asthma and COPD are mainly used in the form of inhalations. A survey was performed to obtain the opinion of experts about the importance of inhalers in inhaled drug therapy.Methods: All members–pulmonologists of the Slovenian Respiratory Society were invited to participate in the survey using a two-stage Delphi method. The result of each response were shown by the median and interquartile range, whereby we calculated the level of consensus.Results: 176 doctors were invited. Most questions were answered by 49 (27.8 %) participants. In the second round 42 doctors responded. As many as 33 out of 41 respondents (80.5 %) felt that in the treatment of asthma and COPD the selection of medicines and inhalers are equally important. When choosing an inhaler, it is crucial that it is simple to instruct the patients about its use. Respondents highly agreed with the statement that patients should receive a prescription for inhaler only after they have been trained on how to use it. As appropriate persons for the training of patients on the use of inhalers the respondents recognized (from most to least suitable) pulmonologists, nurses, general practitioners or pharmacists. 53.8 % of respondents considered that the patient’s skill of the use of inhaler should be checked on every visit to the doctor. Respondents believed that replacing inhalers without consulting the treating doctor may result in incorrect use of the inhaler, poor patient compliance, more exacerbations of the disease and poorer disease control. Some consensus with an indifferent median of 4.5 was reached with regard to the argument that the doctor should prescribe the inhaler that is the cheapest for society.Conclusions: Slovenian pulmonologists believe that any change of inhaler is a critical event, which must be coordinated with the patient and the doctor.

scholarly journals Study on Factors that Contribute to Poor Patient Compliance with Medication in Japan.

1999 ◽  
Vol 25 (6) ◽  
pp. 634-642 ◽  
Author(s):  
HIROMI HASHIMOTO ◽  
MASAYO TANAKA ◽  
TADASHI OYAKE ◽  
TOMOKO GOMI ◽  
TOSHIO IKEDA ◽  
...  
Keyword(s):  
Patient Compliance ◽  
Poor Patient ◽  
Poor Patient Compliance

scholarly journals A Randomized, Endoscopist-Blinded, Prospective Trial to Compare the Efficacy and Patient Tolerability between Bowel Preparation Protocols Using Sodium Picosulfate Magnesium Citrate and Polyethylene-Glycol (1 L and 2 L) for Colonoscopy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sang Hoon Kim ◽  
Ji Hyeong Kim ◽  
Bora Keum ◽  
Han Jo Jeon ◽  
Se Hyun Jang ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Patient Compliance ◽  
Bowel Preparation ◽  
Prospective Trial ◽  
Liquid Sodium ◽  
Magnesium Citrate ◽  
Patients Satisfaction ◽  
Significant Difference ◽  
Blinded Study ◽  
Sodium Picosulfate

Patient compliance during bowel preparation is important for successful colonoscopy. Bowel preparation with polyethylene glycol (PEG), the most commonly used solution for cleansing, involves the unpleasant ingestion of a large amount of liquid. Sodium picosulfate magnesium citrate (SP-MC) solution is an alternative option with better palatability than PEG. Therefore, in this study, we compared the efficacy and patient tolerability among the following three bowel preparation protocols: 2 L PEG-ascorbic acid (ASc), 1 L PEG-ASc plus bisacodyl, and SP-MC 340 mL plus bisacodyl. We conducted a randomized prospective endoscopist-blinded study between August 2018 and January 2019. A total of 311 patients were randomly classified into three groups according to the above-described bowel preparation protocols. To evaluate the efficacy of bowel cleansing, we used the Boston Bowel Preparation Scale. The degree of symptoms and the patients’ satisfaction with each bowel preparation method were investigated using a questionnaire completed before sedation for colonoscopy. The baseline characteristics were similar among the three groups. There was no significant difference in the bowel preparation quality among the three groups. However, the incidence of symptoms, such as abdominal fullness and pain, was significantly lower (P=0.006 and 0.027, respectively) while the patients’ satisfaction rate was significantly higher (P=0.012) in the SP-MC plus bisacodyl group than in the two PEG groups. In this study, the efficacy of the SP-MC plus bisacodyl solution was similar to that of the PEG solutions. However, patient tolerability and satisfaction were better in the SP-MC plus bisacodyl group than in the other groups. In conclusion, the use of SP-MC plus bisacodyl bowel preparation solution might be a better method for providing good intestinal cleansing and improving patient compliance.

Paroxetine Hydrochloride Push-pull Osmotic Pump Tablets: Designing an Innovative, Scalable Push-pull Osmotic Drug Delivery System Using QbD Approach

2020 ◽  
Vol 10 (2) ◽  
pp. 104-116
Author(s):  
Prathmesh P. Kenjale ◽  
Manjusha A. Joshi ◽  
Umesh N. Khatavkar ◽  
Vividha V. Dhapte ◽  
Varsha B. Pokharkar
Keyword(s):  
Patient Compliance ◽  
Risk Mitigation ◽  
Release Kinetics ◽  
In Vitro Release ◽  
Osmotic Pump ◽  
Wet Granulation ◽  
Poor Patient ◽  
Poor Patient Compliance ◽  
Paroxetine Hydrochloride

Background: Paroxetine hydrochloride hemihydrate (PHH) is a serotonin reuptake inhibitor useful for the treatment of diverse psychiatric problems. Existing marketed formulations with frequent administration lead to gastrointestinal (GI) reactions and abrupt fluctuations in plasma level with poor patient compliance. These prerequisites are sufficed by controlled release push-pull osmotic pump tablets (PPOP). Objective: Objective of the present study was to develop robust and reliable PPOP formulation via Quality by design (QbD) approach to achieve desired release kinetics. Methods: PPOP was formulated using wet granulation method followed by osmotic coating. QbD strategy for defining the risk assessment of influential variables such as swelling polymers and osmogen on in vitro release kinetics of designed PPOP. Results: Presence of Polyox in push and pull layer along with osmogen controlled the drug release pattern from formulated PPOP system as depicted in 33 factorial design. These formulated optimized PPOP systems demonstrated 2 hrs lag time with zero-order kinetics, a peculiar feature of PPOPs. Conclusions: Scalable, stable PPOP tablets were fabricated by applying systematic QbD approach. The developed PPOP systems with improved concentration-independent behavior helped to address the challenges of existing marketed formulations. Risk mitigation and control strategy assured quality of the system during scalability. Application of QbD strategy in establishing the PPOP formulation would help in formulating drug candidates having gastric limitations and poor patient compliance. The present study is the detailed account of QbD based PPOP formulation, therefore it can be of potential importance from academics as well as industrial perspective.

scholarly journals Is Oral Sulfate Tablet Effective and Safe for Bowel Preparation Before Colonoscopy in Elderly People 65 Years of Age and Older?

2021 ◽  
Author(s):  
Jae Hyun Kim ◽  
Yong Eun Park ◽  
Tae Oh Kim ◽  
Jongha Park ◽  
Won Moon ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Polyethylene Glycol ◽  
Adverse Events ◽  
Elderly Patients ◽  
Elderly People ◽  
Patient Compliance ◽  
Bowel Preparation ◽  
Abdominal Distension ◽  
Efficacy And Safety ◽  
Better Than

Abstract Background Recently, a novel oral sulfate tablet (OST) has been introduced for bowel preparation before colonoscopy. However, whether elderly patients can take OST is not yet clear, as OST consists of 28 tablets. We aimed to compare the efficacy and safety of OST and polyethylene glycol (PEG) for bowel preparation for colonoscopy according to age. Method: We randomly divided subjects into a OST group and a PEG group and compared Boston bowel preparation score (BBPS), bubble score, patient compliance and satisfaction, and safety between the two groups according to age (under 65 years of age vs. 65 years of age and older). Results Among the 179 participants, sixty-one were 65 years of age and older. The BBPS and bubble score of the OST group were better than that of the PEG group, regardless of age. The satisfaction of the OST group was better than that the PEG group, regardless of age. The compliance was not different between the two groups, however, the OST group under 65 years of age had a higher rate of completing the dose within 2 h compared with the PEG group under 65 years of age. Adverse events including abdominal distension, abdominal pain, nausea or vomiting were not different between the two groups. Conclusion The use of OST for bowel preparation before colonoscopy is as effective and safe as PEG, and these results were consistent in elderly people 65 years of age and older.

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