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AI-Assisted Double-Headed Capsule Endoscopy: Multicentre Prospective Diagnostic Accuracy Study Across Small Bowel Indications
Background/Aims: Double-headed capsule endoscopy enhances visualization and diagnostic yield in small bowel evaluation but increases reading time. This study aimed to assess the diagnostic performance of AI-assisted double-headed capsule endoscopy (MiroCam MC2000) across all small bowel indications and to compare its reading efficiency with the standard manual reading mode. Methods: From May to December 2023, 242 consecutive patients (mean age 50.17 years, SD 18.3; 53% female) underwent small bowel capsule endoscopy at two UK centres for suspected Crohn’s disease (48.8%), iron-deficiency anemia (23.6%), bleeding (18.6%), or other (9%). Seven experienced readers reviewed videos in standard mode (blinded to clinical data), then AI-assisted (MiroCam AI Scan) methods were applied after de-identification/randomization. Two experts provided reference standards. No adverse events occurred. Results: AI-assisted reading had sensitivity 95.3% (95% CI 90.1–98.3%) and specificity 96.5% (95% CI 91.3–99.0%) for diagnostic findings, vs. standard reading: 96.5% (95% CI 91.2–99.0%) and 85.3% (95% CI 78.0–90.9%). The positive findings rate was 83.6% vs. 80.2% (p = 0.040). Reading time decreased by 52% (38.1 vs. 18.26 min; p < 0.001). Conclusions: AI-assisted reading offers high diagnostic accuracy, superior specificity and reduced reading times, supporting its adjunctive role with expert oversight. Registered: ERGO ID 82419.
Journal Article
P361 The reliability of ‘coffee-ground’ vomiting as an indicator of active UGIB: A tertiary centre experience
IntroductionAcute Upper GI Bleeds (UGIB) are a common medical emergency and account for significant morbidity and mortality. ‘Coffee-ground’ vomiting is considered indicative of UGIB however its reliability as an indicator of active bleeding is contentious. OGD is the current gold standard in the diagnosis and management of UGIB however UGI capsule endoscopy is an emerging alternative which can rapidly screen for bleeding and has benefits over OGD in terms of invasiveness, patient tolerance, rapid deployment anywhere and thus reduced hospital admission rates and ultimately cost-effectiveness. The aim of this study was to establish whether coffee-ground vomiting is a reliable indicator of active UGIB.MethodsElectronic referrals for OGD, which contained the phrase ‘coffee-ground vomiting’, were analysed and endoscopy reports assessed to identify whether active UGIB was identified.ResultsDuring a 12-month period; 552 electronic endoscopy referrals for UGIB were submitted. 62 referrals contained the specific phrase ‘coffee-ground vomiting’; 9 patients were excluded. 33/53 referrals came from inpatient medical wards. 35 patients were male, mean age at time of referral was 67.5 years (22.0 – 90.0). Mean Glasgow Blatchford Score at referral was 7.4 (1.0 – 15.0). Mean time between referral and endoscopy was 1.3 days (0.0 – 12.0).The most common endoscopic diagnoses were oesophagitis (16/53 cases) and gastritis (9/53 cases). OGD findings were normal in 10 cases. Active bleeding was identified in 6 patients and in 2 patients a visible vessel was visualised without evidence of active bleeding at endoscopy. 4 patients required endotherapy namely injection and clipping, 1 patient required variceal banding. All 6 patients with confirmed active bleeding on endoscopy had melaena on presentation.Mean length of stay (LOS) was 8 days (1.0 – 203.0) and in 1 case a repeat OGD was required during the same admission.ConclusionsThe results of this study demonstrate that only a minority of OGDs performed for the indication of ‘coffee-ground’ vomiting demonstrated active UGIB. In addition, a significant proportion of the cohort had a normal study. No patients with coffee ground vomiting without melaena had active UGIB and none of these patients required endotherapy.This study could be used to support the proposal that patients with coffee-ground vomitus without other corroborating evidence of UGIB are very unlikely to have active bleeding and/or the need for endoscopic haemostasis. These patients could have an UGI capsule endoscopy in the emergency department as opposed to hospital admission and subsequent wait for an inpatient OGD. This could consequently have significant implications on admission rates, LOS and hospital associated morbidity.
Journal Article
Interaction and innovation: practical strategies for inclusive consumer-driven research in health services
IntroductionDespite advances in the co-creation of clinical research involving consumers in the last few decades, consumer engagement in health services research generally remains inconsistent and is too often treated as a perfunctory exercise.ObjectiveDrawing on a health services study on diagnostic test result management, communication and follow-up, we: (1) outline practical strategies used to enhance the contribution of health consumer representatives across all stages of health services research, including active involvement in prioritising objectives for data analysis and participating in data analysis and the dissemination of findings; and (2) describe the impact of continued engagement of consumers on the programme of research, the interpretation of findings and their translational potential.Key innovationsKey enabling innovations for engagement included: (1) planned opportunities for long-term consumer involvement across all stages of the research process from conception to dissemination; (2) enhanced consumer engagement capacity; (3) purposeful recruitment of appropriately trained consumers; (4) provision of support structures for active consumer involvement in research design, analysis and write-up; and (5) financial support for consumer involvement.Impact/ConclusionEnhancing consumer contribution and establishing inclusive research design requires a negotiated, interactive, meaningful and transparent process. As a collaborative approach, consumer-driven research involvement offers opportunities for new, often unexpected or unexplored perspectives to feature across the whole research process. In a move away from tokenistic consumer involvement, consumers and researchers who participated in this novel and immersive research project identified inclusive research as a powerful tool to enhance health services research and its translation into effective policy.
Journal Article
Panenteric capsule endoscopy in patients with melaena and a negative oesophagogastroduodenoscopy: a multi-centre real-world study
BackgroundGastrointestinal (GI) bleeding is a common event that can be life-threatening. Mussetto et al demonstrated the feasibility of panenteric capsule endoscopy (PCE) in patients with melaena and a negative oesophagogastroduodenoscopy (OGD)—the bleeding source was identified in 80% of patients and colonoscopy was avoided in 50%. However, there are no large prospective trials and limited real-world data.At two tertiary centres in the UK, we retrospectively evaluated the outcomes of patients who underwent an inpatient PCE following a negative OGD for suspected upper GI bleeding.MethodsCapsule databases at each institution were reviewed from 2021 to 2024. The inclusion criteria were patients who had a suspected upper GI bleed (melaena and haemoglobin drop of >10 g/L) and underwent an inpatient PCE following a negative OGD. Data was extracted from the patient’s electronic health records.Results23 patients met the inclusion criteria. The mean age was 56 years. The median time from OGD to capsule ingestion was 4 days. The source of bleeding was identified by PCE in 70% of cases. A small bowel source was identified in 43%. PCE prevented unnecessary lower GI endoscopy in 70%. Capsule retention occurred in 1 patient and was managed conservatively. Rebleeding rates at 30 days, 6 months and 12 months were 9%, 4% and 0%.ConclusionPCE is an option for patients presenting with melaena and has a negative upper GI endoscopy. The findings from this study are promising with a diagnostic yield of 70%. Large, multi-centre randomised studies are required to further investigate this strategy.
Journal Article
Cheating and Its Dangers
Theses (dissertations and masters' theses) can be particularly important resources because they represent sources of detailed information that may not be included in a communication of an article in a highly popular journal, owing to space limitations. In addition, a thesis is a document
presumably prepared under supervision of an experienced faculty member with the aid of a committee of faculty peers. The supervisory committee constitutes an in-house group of experts who can prevent mistakes from being disseminated, as editors and reviewers do for articles sent to journals.
Unfortunately, the value of a thesis may be limited when committee members do not perform their traditional functions, when students cheat, or when students commit plagiarism. Examples of these problems are presented as case studies and as cautionary examples. In addition, suggestions are
made to limit damage that can be caused by those guilty of less than exemplary behavior.
Journal Article
Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, Australia
Background
Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia.
Methods
We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome.
Discussion
If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally.
Trial registration
Australia New Zealand Clinical Trials Register, ID:
ACTRN12617000457347
. Prospectively registered on 28 March 2017.
https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR
Protocol Version: 1.0, 31 May 2019.
Journal Article
Thoughts on Improving Innovation: What Are the Characteristics of Innovation and How Do We Cultivate Them?
This paper will review current thinking about innovation and identify key innovative traits as initial steps in exploring the feasibility of teaching innovative thinking. While education may not be able to create innovative traits in individuals, education may improve the ability of
individuals to utilize the traits they already possess. Therefore, we begin by defining innovation and identifying the characteristics, traits, and thought processes of innovative individuals or groups of individuals and the environments that they exist in using the existing literature and
personal experience. This information will help formulate a process to educate individuals to better utilize their innovative traits. If we can envision a curve depicting the utilization of traits, where on the left of the curve we would place individuals with a low utilization, on the right
of the curve would be individuals with a very high utilization rate, and in the middle a distribution between the two extremes, our goal would be to develop an educational process whereby we could show individuals how to fully utilize the traits they have, awaken traits that are dormant, and,
in so doing, shift the distribution toward fuller utilization. With greater utilization of innovative traits, we could then expect to increase the number of innovations that individuals or groups of individuals contribute to our society.
Journal Article
EVALUATION OF THE REMOVAL OF AQUEOUS HALIDES FROM AQUEOUS MEDIA BY OCTOLIG
Good and cogent reasons exist for the removal of halides from natural water systems. This study was concerned with evaluating the ease or possibility of removing fluoride, chloride, and bromide ions from water by column chromatography with Octolig®, commercially available supported chelating agents (polyethylenediimines covalently attached to a high-surface-area silica gel) (CAS Registry No. 404899-06-5). Previous research suggested a mechanism, for removal of certain anions, subsequent research indicated the efficacy for removal of fluoride ion, and still other research indicated that bromide was not removed under similar conditions. Plotting percent removal as a function of charge/ion volume ratio suggested that perhaps 20% removal might be anticipated for chloride ion; the actual result in deionized water was consistently ∼10%. Anomalous results observed with the attempted removal of chloride from solutions of well water are presented and considered.
Journal Article