Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios.

Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34-1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01-1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46-2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.

[Endoscopic polypectomy of colorectal adenomas: Monitoring patients in order to review the colonoscopic surveillance interval]. / Polipectomía endoscópica de adenomas colorrectales: Seguimiento de los pacientes con el objeto de evaluar el intervalo entre las videocolonoscopías de control.

OBJECTIVE: To determine the risk of advanced adenomas at surveillance colonoscopy after polipectomy. To review the colonoscopic surveillance interval and to compare the prevalence of adenomas in patients with low-risk and high-risk adenomas at screening colonoscopies. METHODS: A cohort retrospective study. It was used a database of colonoscopies performed between 1999 and 2012. Seven hundred and sixty patients who had adenomas at first colonoscopy were included (465 males and 295 females, mean age 62 years old). They were divided into two groups: group A, low-risk adenomas, and group B, high-risk adenomas. In each group, it was compared the presence of adenomas in videocolonoscopies performed at 3 and 5 years. RESULTS: At the first colonoscopy 409 patients (53.8%) belonged to group A and 351 (46.2%) than group B. In both groups the risk of new advanced adenomas in endoscopic surveillance at 5years was similar to the control at 3 years. Comparing both groups, the risk of new advanced adenomas in endoscopic surveillance at 3 years in group B was 1.96 times greater than in group A (P = 0.012). CONCLUSIONS: At present, surveillance endoscopy is performed before the suggested interval. In both groups there were no statistically significant differences between surveillance control at 3 or 5 years. However, 62% of patients in group B have developed new advanced adenomas in endoscopic surveillance at 3 years. Therefore, it is recommended the endoscopic control with this interval.

Diagnóstico y tratamiento de la infección por Helicobacter pylori: su relación con la úlcera gastrointestinal y la resistencia a los antimicrobianos / Diagnosis and treatment of Helicobacter pylori infection: its relationship with grastrointestinal ulcer and antimicrobial resistance

En nuestro país, no se encuentran datos disponibles confiables sobre la eficacia de los diferentes esquemas de triple terapia para la erradicación de Helicobacter pylori. Se randomizaron en tres grupos diferentes, pacientes con dispepsia no ulcerosa o enfermedad úlcero péptica activa infectados con Helicobacter pylori. Un grupo recibió omeprazol 20 mg, claritromicina 500 mg, amoxicilina 1000 mg, cada doce horas durante una semana (OCA 1, 40 pacientes). El segundo grupo recibió el mismo tratamiento durante dos semanas(OCA 2, 40 pacientes). El tercer grupo recibió omeprazol 20 mg, claritromicina 500 mg y metronidazol 500 mg cada doce horas durante una semana (OCM, 40 pacientes) . El objetivo primario del estudio fue la erradicación de Helicobacter pylori, evaluada mediante la negatividad de la prueba del aire espirado, 4 semanas después de finalizado el tratamiento. De 120 pacientes reclutados para el estudio, 113 cumplieron con los criterios de inclusión. De ellos, 103 completaron el tratamiento. Al analizar los resultados por intención de tratamiento, 4 semanas después de finalizado el mismo, Helicobacter pylori se erradicó en 92.3 por ciento de los pacientes en OCA 1, 89.7 por ciento en OCA 2 y 82.8 por ciento en OCM. La eficacia en la erradicación no mostró diferencias significativas entre los tres grupos. La presencia de efectos colaterales fue significativamente mayor en OCA 2 y OCM. No se demostró resistencia primaria a amoxicilina y claritromicina en las cepas aisladas, mientras que un 20 por ciento de las mismas fueron resistentes a metronidazol. En pacientes con enfermedad úlcero péptica o dispepsia no ulcerosa, la triple terapia con omeprazol y dos antibióticos es altamente efectiva en la erradicación de Helicobacter pylori. El esquema OCA durante una semana tiene menos efectos adversos y similar efectividad que el esquema de dos semanas, o el OCM durante una semana.