Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

Hdl Handle:
http://hdl.handle.net/10147/132291
Title:
Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.
Authors:
Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C
Affiliation:
Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin, Ireland. Royal College of Surgeons of Ireland Medical School, Dublin, Ireland.
Citation:
Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice. 2011:notAliment Pharmacol Ther
Journal:
Alimentary pharmacology & therapeutics
Issue Date:
17-May-2011
URI:
http://hdl.handle.net/10147/132291
DOI:
10.1111/j.1365-2036.2011.04703.x
PubMed ID:
21585410
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/21585410
Abstract:
Background  In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a 'nudge' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
Item Type:
Article
Language:
en
ISSN:
1365-2036

Full metadata record

DC FieldValue Language
dc.contributor.authorHarewood, G Cen
dc.contributor.authorClancy, Ken
dc.contributor.authorEngela, Jen
dc.contributor.authorAbdulrahim, Men
dc.contributor.authorLohan, Ken
dc.contributor.authorO'Reilly, Cen
dc.date.accessioned2011-05-27T14:50:35Z-
dc.date.available2011-05-27T14:50:35Z-
dc.date.issued2011-05-17-
dc.identifier.citationRandomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice. 2011:notAliment Pharmacol Theren
dc.identifier.issn1365-2036-
dc.identifier.pmid21585410-
dc.identifier.doi10.1111/j.1365-2036.2011.04703.x-
dc.identifier.urihttp://hdl.handle.net/10147/132291-
dc.description.abstractBackground  In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a 'nudge' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.-
dc.languageENG-
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/21585410en
dc.titleRandomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.en
dc.typeArticleen
dc.contributor.departmentDepartment of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin, Ireland. Royal College of Surgeons of Ireland Medical School, Dublin, Ireland.en
dc.identifier.journalAlimentary pharmacology & therapeuticsen
dc.description.provinceLeinster-

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