BACKGROUNDIn North America, colorectal cancer (CRC) remains the second most common cause of cancer-related deaths, after lung cancer [1,2]. However, CRC mortality rates have declined in many developed countries [3,4], and it is believed that screening has had a large role in this trend [5][6][7][8]. A model by Edwards et al. [5] estimated that screening accounted for 53% of the CRC mortality reduction for the period 1975-2000 in the United States. Screening can reduce CRC mortality by detecting early-stage CRC and by detecting and removing precancerous lesions [9]. In North America, the CRC screening rate among people of 50-74 years of age is only 55-58% [10]. This indicates that CRC screening is still underutilized in a substantial portion of the population. There are many barriers associated with this low uptake at the patient, provider, and system levels [11]. Numerous studies have looked for ways to address these barriers in order to improve uptake of screening [12].Tests such as the fecal occult blood test are often used as a first step in CRC screening. Colonoscopy and flexible sigmoidoscopy (FS) are also essential first or intermediate tests for CRC screening and are also used widely for other diagnostic purposes. Among all the barriers to acceptance of a recommendation for CRC screening, anxiety associated with colonoscopy or FS is a commonly cited factor [13][14][15][16][17][18][19][20][21][22]. A better understanding of anxiety concerning these

Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.

Summary Background It has been reported that thalidomide may be effective in treating inflammatory bowel disease (IBD). Aim To review the evidence examining the efficacy and safety of thalidomide for inducing and maintaining remission in Crohn's disease (CD) and ulcerative colitis (UC). Methods The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed (1950–August 2014), EMBASE (1984–August 2014), Scopus, and Web of knowledge were searched for randomised controlled trials (RCTs), observational studies and case series. The primary outcomes were induction of remission or response for active IBD or relapse rate for patients in remission and subsequently on thalidomide/analogues for at least 3 months. Results Twelve studies (2 RCTs and 10 case series) met the inclusion criteria for inducing remission and included 248 patients (10 with UC, 238 with CD). Only one RCT of paediatric CD achieved high quality scores (remission rate thalidomide: 46%, placebo: 12%; p=0.01). The crude pooled remission rate for thalidomide was 49% and 25% in luminal and perianal CD respectively. For UC, 50% achieved remission and 10% had partial response. One case series reported 21 patients (17 CD, four UC) who maintained remission for 6 months. Many adverse events were reported including sedation (32%) and peripheral neuropathy (20%). Conclusions One high quality RCT showed that thalidomide is effective for inducing remission in paediatric CD. The current evidence is insufficient to support using thalidomide to induce remission in UC or adult CD, or to maintain remission in IBD. Significant adverse events may occur, necessitating discontinuation of thalidomide.

Supplemental Digital Content is available in the text

Introduction  Many endoscopists do not use split-dose bowel preparation (SDBP) for morning colonoscopies. Despite SDBP being recommended practice, they believe patients will not agree to take early morning bowel preparation (BP). We assessed patients’ opinions about waking early for BP. Methods  A self-administered survey was distributed between 08/2015 and 06/2016 to patients in Winnipeg, Canada when they attended an outpatient colonoscopy. Logistic regression was performed to determine predictors of reluctance to use early morning BP. Results  Of the 1336 respondents (52 % female, median age 57 years), 33 % had used SDBP for their current colonoscopy. Of the 1336, 49 % were willing, 24 % neutral, and 27 % reluctant to do early morning BP. Predictors of reluctant versus willing were number of prior colonoscopies (OR 1.20; 95 %CI: 1.07 – 1.35), female gender (OR 1.65; 95 %CI: 1.19 – 2.29), unclear BP information (OR 1.86; 95 %CI: 1.21 – 2.85), high BP anxiety (OR 2.02; 95 %CI: 1.35 – 3.02), purpose of current colonoscopy being bowel symptoms (OR 1.40; 95 %CI: 1.00 – 1.97), use of 4 L of polyethylene glycol laxative (OR 1.45; 95 %CI: 1.02 – 2.06), not having SDBP (OR 1.96; 95 %CI: 1.31 – 2.93), and not having finished the laxative for the current colonoscopy (OR 1.66; 95 %CI: 1.01 – 2.73). Most of the same predictors were identified when reluctance was compared to willing or neutral, and in ordinal logistic regression. Conclusions  Almost three-quarters of patients do not express reluctance to get up early for BP. Among those who are reluctant, improving BP information, allaying BP-related anxiety, and use of low volume BP may increase acceptance of SDBP.