***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES : The impact of bowel preparation on the cost and efficiency of colonoscopy  is uncertain . The aim of this study was to measure the impact of bowel preparation on total direct cost as well as procedure time and volume . METHODS : For 200 consecutive outpatient colonoscopies in persons with intact colons both at a private university hospital and at a public university hospital , we recorded the time spent suctioning fluid and feces from the colon and the time spent washing the colon to clean the mucosa . We prospect ively asked colonoscopists to design ate examinations that should be repeated at an interval sooner than would otherwise be recommended because of imperfect preparation . The data were used to perform a cost analysis of the economic effect of bowel preparation on direct costs of colonoscopy . RESULTS : Suctioning fluid and washing occupied 6 % and 1.5 % of total examination time ( including insertion and withdrawal ) at the public hospital and 9 % and 1.3 % at the private hospital . Patients at the public hospital were more likely to have an aborted examination ( 6.5 % vs 1 % , p = 0.004 ) and to be brought back earlier than suggested or required by current practice st and ards because of imperfect bowel preparation ( 20 % vs 12.5 % , p = 0.04 ) . Cost analysis indicated that to complete the initial examinations and the first round of surveillance , imperfect bowel preparation result ed in a 12 % increase in costs at the university hospital and a 22 % increase at the public hospital . CONCLUSIONS : The increase in colonoscopy costs associated with imperfect preparation is substantial , and seems likely to vary among practice s. Aborted examinations and surveillance examinations performed earlier than recommended because of imperfect preparation are appropriate targets for continuous quality improvement programs . More reliable bowel preparations , or measures to improve patient compliance with bowel preparation , could significantly reduce the costs of colonoscopy in clinical practice Introduction Anxious patients can cause unexpected increases in healthcare costs that are often overlooked . There are no studies examining the use of an educational pamphlet and its effects on secondary outcomes at colonoscopy . The goal of this study was to determine if the use of an educational pamphlet lowers the anxiety levels before colonoscopy , and if its use has any effect on the quality of the prep or medication or the amount of medication use during the procedure . Methods We prospect ively enrolled 121 patients having a first-time screening colonoscopy . Patients were blinded and r and omized into two groups . One group received st and ard prep instructions only ( group P ) , and the other group received the American Gastroenterological Association colonoscopy educational pamphlet along with their prep instructions ( group I ) . All information was sent by mail 3 weeks before the procedure . The endoscopists were blinded as to which of their patients were in the study and of those , which were in the st and ard prep group or the intervention group . Anxiety was measured immediately before endoscopy using the State portion of the ‘ State Trait Anxiety Index ’ . Procedure-related information was recorded and analyzed at the end of the study using a statistical package looking at primary and secondary endpoints . Results Fifteen patients did not show their examination or were otherwise lost to follow-up . Of the 106 patients who completed the study , there were 55 patients in the P group and 51 in the I group . The average State Anxiety score of the P group was 45.18 , and of the I group was 40.54 ( P=0.014 ) . The use of Midazolam was significantly less in the group . The use of Meperidine was lower in the I group but the difference was not statistically significant . Both the groups took the same amount of time to complete the prep , but the I group fasted longer . The I group also completed or drank more of the prep more often than the P group . The prep quality was found to be superior with less frequency of a poor prep in the I group . Most important , the I group was more likely to have a complete colonoscopy . The I group tended to have fewer questions on the day of the procedure , and less fear about what to expect on the basis of their lower anxiety scores . Conclusion We found that providing the American Gastroenterological Association educational pamphlet to patients before colonoscopy lowers the overall anxiety level , provides a reduction in sedative use during the procedure , and leads to better colon preparation when given in addition to st and ard instructions OBJECTIVE The aim of the present study was to test the potential beneficial effects of an information brochure on undergoing a gastrointestinal endoscopy for the first time . The information provided was based on self-regulation theory , and patients could restrict themselves to reading the summary only . METHODS Patients were r and omly assigned to an experimental group receiving the brochure at least 1 day before the gastroscopy ( N=47 ) , or to a control group not receiving the brochure ( N=48 ) . RESULTS The results show that all experimental subjects , except one , fully read the brochure . Those receiving the brochure experienced less anxiety before the gastroscopy and , afterwards , they reported greater satisfaction with the preparation for it . With regard to coping style there were some small moderating effects into the direction expected : low blunters ( those not seeking distraction under impending threat ) as compared to high blunters showed extra reduced anxiety after reading the brochure . They also tended to read the brochure more often . High monitors ( those seeking information under impending threat ) receiving the brochure showed reduced anxiety during the gastroscopy as compared to low monitors ( tendency ) . CONCLUSION We conclude that providing patients with the developed brochure constitutes an efficient , beneficial intervention . PRACTICE IMPLICATION S The brochure could easily be implemented in st and ard practice without the necessity to take the patient 's coping style into account Background Little is known about how to most effectively deliver relevant information to patients scheduled for endoscopy . Methods To assess the effects of combined written and oral information , compared with oral information alone on the quality of information before endoscopy and the level of anxiety . We design ed a prospect i ve study in two Swiss teaching hospitals which enrolled consecutive patients scheduled for endoscopy over a three-month period . Patients were r and omized either to receiving , along with the appointment notice , an explanatory leaflet about the upcoming examination , or to  oral information delivered by each patient 's doctor .  Evaluation of quality of information was rated on scales between 0 ( none received ) and 5 ( excellent ) . The analysis of outcome variables was performed on the basis of intention to treat- analysis . Multivariate analysis of predictors of information scores was performed by linear regression analysis . Results Of 718 eligible patients 577 ( 80 % ) returned their question naire . Patients who received written leaflets ( N = 278 ) rated the quality of information they received higher than those informed verbally ( N = 299 ) , for all 8 quality -of-information items . Differences were significant regarding information about the risks of the procedure ( 3.24 versus 2.26 , p < 0.001 ) , how to prepare for the procedure ( 3.56 versus 3.23 , p = 0.036 ) , what to expect after the procedure ( 2.99 versus 2.59 , p < 0.001 ) , and the 8 quality -of-information items ( 3.35 versus 3.02 , p = 0.002 ) . The two groups reported similar levels of anxiety before procedure ( p = 0.66 ) , pain during procedure ( p = 0.20 ) , tolerability throughout the procedure ( p = 0.76 ) , problems after the procedure ( p = 0.22 ) , and overall rating of the procedure between poor and excellent ( p = 0.82 ) . Conclusion Written information led to more favourable assessment s of the quality of information and had no impact on patient anxiety nor on the overall assessment of the endoscopy . Because structured and comprehensive written information is perceived as beneficial by patients , gastroenterologists should clearly explain to their patients the risks , benefits and alternatives of endoscopic procedures . Trial registration : Current Controlled trial number : IS RCT N34382782 OBJECTIVES : The success of colonoscopy depends on high- quality bowel preparation by patients ; yet inadequate preparation is common . We developed and tested an educational booklet to improve bowel preparation quality . METHODS : We conducted patient cognitive interviews to identify knowledge and belief barriers to colonoscopy preparation . We used these interviews to create an educational booklet to enhance preparatory behaviors . We then prospect ively r and omized patients scheduled for outpatient colonoscopy at a VA Medical Center to receive usual instructions vs. the booklet before colonoscopy . Patients in both groups received st and ard pharmacy instructions for single-dose bowel preparation ; the protocol did not specify which purgatives to prescribe . The primary outcome was preparation quality based on blinded ratings using the vali date d Ottawa score . We performed bivariate analyses to compare mean scores between groups using a t-test , and logistic regression to measure the booklet effect on preparation quality , adjusting for potential confounders . RESULTS : A total of 436 patients were r and omized between arms . In an intention-to-treat analysis of the primary outcome , mean Ottawa scores were superior in patients allocated to booklet vs. controls ( P=0.03 ) . An intention-to-treat analysis of the secondary outcome revealed a “ good ” preparation in 68 vs. 46 % of booklet and control patients , respectively ( P=0.054 ) . In a per- protocol analysis limited to patients who actually received the booklet , preparation was good in 76 vs. 46 % patients , respectively ( P<0.00001 ) . Regression analysis revealed that booklet receipt increased the odds of good preparation by 3.7 times ( 95 % confidence interval=2.3–5.8 ) . CONCLUSIONS : Provision of a novel educational booklet considerably improves preparation quality in patients receiving single-dose purgatives . The effect of the booklet on split-dose purgatives remains untested and will be evaluated in future research Background : Quality of bowel preparation and patient knowledge remains a major barrier for completing colorectal cancer screening . Few studies have tested unique ways to impact patient underst and ing centering on interactive computer programs , pictures , and brochures . Two studies explored instructional videos but focused on patient compliance and anxiety as endpoints . Furthermore , excessive video length and content may limit their impact on a broad patient population . No study so far has studied a video ’s impact on preparation quality and patient underst and ing of the colonoscopy procedure . Methods : We conducted a single blinded prospect i ve study of inner city patients presenting for a first time screening colonoscopy . During their initial visit patients were r and omized to watch an instructional colonoscopy video or a video discussing gastroesophageal reflux disease ( GERD ) . All patients watched a 6 minutes long video with the same spokesperson , completed a demographic question naire ( Supplemental Digital Content 1 , http://links.lww.com/JCG/A352 ) and were enrolled only if screened within 30 days of their visit . On the day of the colonoscopy , patients completed a 14 question quiz of their knowledge . Blinded endoscopist grade d patient preparations based on the Ottawa scale . All authors had access to the study data and review ed and approved the final manuscript . Results : Among the 104 subjects enrolled in the study , 56 were in the colonoscopy video group , 48 were in GERD video group , and 12 were excluded . Overall , 48 % were male and 52 % female ; 90 % of patients had less than a high school education , 76 % were African American , and 67 % used a 4 L split-dose preparation . There were no differences between either video group with regard to any of the above categories . Comparisons between the 2 groups revealed that the colonoscopy video group had significantly better Ottawa bowel preparation score ( 4.77 vs. 6.85 ; P=0.01 ) than the GERD video group . The colonoscopy video group also had less-inadequate repeat bowel preparations versus the GERD video group ( 9 % vs. 23 % ; P<0.01 ) . The overall score on the knowledge question naire ( Supplemental Digital Content 1 , http://links.lww.com/JCG/A352 ) was significantly higher in the colonoscopy video group as compared with the GERD video group ( 12.77 vs. 11.08 ; P<0.001 . In all patients the overall quiz score positively correlated with preparation quality ( odds ratio , 2.31 ; confidence interval , 1.35 - 3.94 ; P<0.001 ) . Conclusions : Our unique population represented an overwhelmingly under-educated ( 85 % had a high school education or less ) and minority group ( 76 % African American ) . They are one of the most at risk of having multiple barriers such as comprehension and reading difficulties result ing in poor preparation examinations and no shows to procedures . Our instructional video proved to be high yield in this population . The patients assigned to watch the colonoscopy video showed a significant increase in “ excellent ” grade adequate bowel preparation quality by > 23 % and a significant decrease in “ inadequate ” bowel preparations by almost 50 % . Our study proves that an educational video can improve both comprehension with regard to all aspects of colonoscopy . Clinical Trials.gov number , NCT02906969 Colonoscopy is the preferred modality for colon cancer screening . A successful colonoscopy requires proper bowel preparation . Adequate bowel preparation continues to remain a limiting factor . One hundred thirty-three patients scheduled for an outpatient colonoscopy  were prospect ively r and omized in a single-blinded manner to video or nonvideo group . In addition to written bowel preparation instructions , patients in the video group viewed a brief instructional video .  Quality of colon preparation was measured using the Ottawa Bowel Preparation Quality scale , while patient satisfaction with preparation was evaluated using a question naire . Statistical analyses were used to evaluate the impact of the instructional colonoscopy video . There were significant differences in the quality of colonoscopy preparation between the video and the nonvideo groups . Participants who watched the video had better preparation 
    Output:
    
Conclusion Compared to usual care , patient education interventions appear efficacious in improving the quality of bowel preparation .