bluuebunny/crossref_metadata_2025 huggingface dataset:
P663 Mild COVID-19 disease and breakthrough cases among children with inflammatory bowel disease: An update from an international registry
Authors: Brenner E , Zhang X , Agrawal M , Ungaro R , Colombel J F , Kappelman M
Published: January 2022

Background

Coronavirus disease 2019 (COVID-19) tends to cause mild disease in children, although severe disease occurs rarely. Children with inflammatory bowel disease (IBD) often receive immunosuppressive medications that may increase risk of infectious complications. Little is known about the severity of breakthrough infection after COVID-19 vaccination in children with IBD. We describe COVID-19 outcomes among children with IBD, including those with breakthrough infection.

Methods

The Surveillance Epidemiology of Coronavirus Under Research Exclusion for Inflammatory Bowel Disease (SECURE-IBD) is a database created to evaluate COVID-19 outcomes in IBD patients. We included children (age ≤18) from the SECURE-IBD database through November 17th, 2021. We used descriptive statistics to summarize demographic/disease characteristics of the study population, both overall and stratified by hospitalization status, and performed bivariate comparisons. We reported demographic and clinical details of patients requiring an intensive care unit stay and those with breakthrough infection (defined as ≥1 COVID-19 vaccination prior to infection), respectively.

Results

We analyzed 606 pediatric IBD COVID-19 cases from 37 countries. The most common IBD medications were tumor necrosis factor (TNF) antagonist monotherapy (48%) and sulfasalazine/mesalamine (20%). Most patients (85%) had no non-IBD comorbidities. No patients died, and 28 children (5%) were hospitalized. Factors associated with hospitalization included non-IBD comorbid conditions (43% hospitalized vs 13% not; p <0.01), moderate/severe IBD disease activity (61% vs 15%; p <0.01 overall), gastrointestinal symptoms (68% vs 16%, p <0.01), and steroid use (29% vs 6%, p <0.01). TNF antagonist monotherapy was associated with a decreased likelihood of hospitalization (29% vs 49%; p value 0.03) (Table 1). Seven patients needed intensive care, and three (0.5%) required mechanical ventilation (Table 2). There were nine fully vaccinated and five partially vaccinated patients who developed breakthrough infection, of whom only one required hospitalization but did not need a ventilator (Table 3). The majority of patients with breakthrough infection (13/14) were on systemic immunosuppressants at the time of COVID-19 infection (10/14 on TNF antagonists).

Conclusion

We found that children with IBD have a relatively low risk of severe COVID-19 outcomes. Among children with IBD who developed COVID-19 after vaccination, the majority were on immunosuppressants and had mild disease that did not require hospitalization. These data may reassure families and providers of children with IBD during the COVID-19 pandemic and support public health recommendations for COVID-19 vaccination among eligible children with IBD.
P678 Rare and severe complications in paediatric Inflammatory Bowel Disease: results of 5 years of international collaboration through the PIBD-SETQuality Safety Registry
Authors: Klomberg R , Kemos P , Chondrou P , Croft N , de Ridder L
Published: January 2022

Background

In addition to development of complicated disease behavior itself, children with Inflammatory Bowel Disease (IBD) are at risk of several complications, including malignancies, severe sepsis, or venous thrombosis, which can ultimately even cause death. Due of the rareness of these events, little evidence exists on underlying causes and risk factors, and little experience with these events in clinics hampers development of management guidelines.

Methods

In the ongoing international PIBD-SETQuality Safety Registry, participating paediatric gastroenterologists monthly completed an electronic survey since September 2016. In this survey, they indicated whether or not they had seen any predefined rare and severe complication of paediatric IBD (PIBD) or related treatment in a PIBD patient <19 years. In an annual denominator survey, participants also reported the number of PIBD patients under their care. Together with the duration of participation, this number was used to calculate incidence rates of each complication in the registry. Upon report of a complication, specific follow-up forms were sent, collecting patient demographics, complication details (diagnostics, management, outcome) and IBD details (Paris classification, disease severity, IBD treatment).

Results

From September 2016 to October 2021, the registry reached an all-time number of 222 participants. Currently, 139 paediatric gastroenterologists actively report from 127 international pediatric IBD centers in 30 countries, covering a total of 23,239 PIBD patients. The average duration of participation per center was 39.7 (IQR (29 – 55) months, resulting in a total study population of 65,099 patient-years. In total, 245 complications were reported, including 78 classified as other rare and severe complications (Figure 1). Incidence rates for some complications (e.g. renal failure, venous thrombosis, opportunistic infection) were relatively increased, while other complications, (e.g. hemophagocytic lymphohistiocytosis (HLH)) were rare. Among reported malignancies were Hodgkin lymphoma (n = 6) and hepatosplenic T-cell lymphoma (n = 2). Causes of death were IBD-related in 73% of cases and included cancer (n=2), cerebrosinus venous thrombosis (n=2) and severe sepsis (n=2).

Conclusion

After 5 years of international collaboration of more than 200 PIBD specialists, the Safety Registry project has confirmed several complications in PIBD have increased incidence over the general paediatric population. HLH and HSTCL were rarely reported. Clinical phenotyping of patients has resulted in better understanding of underlying aetiologies and outcome of complications. Ultimately, in partnership with PIBD experts, this project will develop and share management guidelines to improve patient care.
P701 Compositional and functional alterations of the gut microbiome are associated with impaired intestinal permeability in healthy relatives of patients with Crohn’s disease
Authors: Leibovitzh H , Lee S H , Xue M , Raygoza Garay J A , Hernandez-Rocha C , Madsen K L , Meddings J B , Guttman D S , Espin-Garcia O , Smith M I , Goethel A , Moayyedi P , Steinhart A H , Panancionne R , Huynh H , Jacobson K , Aumais G , Mack D R , Abreu M , Bernstein C N , Marshall J K , Turner D , Xu W , Turpin W , Croitoru K
Published: January 2022

Background

The gut microbiome may play a role in gut barrier homeostasis including epithelial barrier integrity and function. However, data are scarce and limited to animal studies. We aimed to assess if alterations in the gut microbiome are associated with altered intestinal permeability.

Methods

We utilized the Genetic Environmental Microbial (CCC GEM) cohort of healthy first-degree relatives of patients with Crohn’s disease. Gut barrier function was assessed using the ratio of urinary fractional excretion of lactulose to mannitol (LMR). Stool bacterial DNA was extracted and sequenced for the V4 hypervariable region of the 16S rDNA gene using MiSeq and processed using QIIME2. PICRUSt2 was used to impute Microbial functions. In order to identify robust associations, the overall cohort was divided based on geographic region into a North American discovery cohort (n=2,472) and non-North American external validation cohort (n=655). LMR>0.025 was defined as abnormal. LMR-microbiome associations were assessed using generalized estimating equation multivariable regression model and Random Forest (RF) classifier algorithm. q<0.05 was considered significant when multiple tests were performed.

Results

The median age of the entire cohort was 17.0 years [IQR 12.0; 24.0], 52.6% were females and 25.4% had LMR>0.025. In the discovery cohort, subjects with LMR>0.025 had markedly reduced alpha diversity (Chao1 index, estimate= -0.0037, p=4.0e-04) and altered beta diversity (Bray-Curtis dissimilarity index, PERMANOVA: pseudo-F statistic = 2.99, p=1.0e-03). Eight bacterial genera and 52 microbial pathways were identified to be associated with LMR>0.025 (q<0.05). The compositional associations were replicated in four genera (Adlercreutzia [odds ratio(OR)=0.74, 95% confidence interval (CI) 0.6–0.91], Clostridia-UCG-014 [OR=0.71, 95%CI 0.59–0.86], Clostridium-sensu-stricto-1 [OR=0.75, 95%CI 0.61–0.92] and Colidextribacter [OR=1.65, 95%CI 1.2–2.26]). The pathway associations were replicated in eight pathways (biosynthesis of glutamate [OR=0.4, 95%CI 0.21–0.74], tryptophan [OR=0.06, 95%CI 0.01–0.27] and threonine [OR=0.038, 95%CI 0.003–0.41], among others). Bacterial community composition was associated with gut barrier homeostasis as defined by the RF analysis (p= 1.4e-6).

Conclusion

Gut microbiome community composition and microbial pathways are associated with gut barrier function. These findings may identify microbial targets that enhance barrier function.
P707 Microbial signature of the colon is not associated with response to vedolizumab in Crohn’s disease
Authors: Hageman I , Joustra V , Li Yim A , Davids M , Henneman P , Hakvoort T , Probert F , Satsangi J , D’Haens G , De Jonge W
Published: January 2022

Background

Crohn’s disease (CD) is a complex disease where the gut microbiome plays an important role. One of the established treatments in CD is Vedolizumab (VDZ), an alpha(4)beta(7) integrin antibody. Finding biomarkers to predict therapy response is still a clinical unmet need, since this treatment has shown endoscopic remission in only a third of CD patients. Ananthakrishnan et al. demonstrated a strong relationship between microbial metagenomics signature and therapy response to VDZ in CD based on the metagenomics composition of baseline fecal samples. While the majority of studies focus on fecal samples, mucosa-adherent bacterial signature could bring forth stable biomarkers. In this study, we sought to identify the signature of the adherent microbiome in intestinal biopies to differentiate responders (R) from non-responders (NR) to VDZ treatment at baseline.

Methods

We prospectively collected ileal and colonic biopsies from adult CD patients scheduled to start VDZ treatment during baseline- and follow-up (FU) endoscopies. After median 27 weeks of follow-up, patients were classified as either R or NR based on endoscopic response (≥50% reduction in SES-CD score), steroid-free clinical response (≥3 point drop in HBI or HBI ≤4, no systemic steroids) and/or biochemical response (≥50% reduction in C-reactive protein (CRP) and fecal calprotectin or a basal CRP ≤5 g/mL and fecal calprotectin ≤250 µg/g). Microbiome composition of the biopsies was determined using 16S RNA gene V3V4 amplicon sequencing. We measured alpha and beta diversity using Wilcoxon and Adonis metrics.

Results

In total, 44 CD patients were included in the baseline cohort (28 R and 16 NR) and 53 CD patients were included in the follow up cohort (37 R and 20 NR), for which 21 patients overlap between baseline and follow up. When comparing alpha-diversity between R and NR, we did not find significant differences in ileal (Wilcoxon, p=0.78) and colonic (Wilcoxon, p=0.70) samples at baseline nor at follow up (ileal Wilcoxon, p=0. 27 and colonic Wilcoxon, p=0. 63). Next, comparing the beta-diversity, we demonstrated no significant differences between R and NR in ileal (baseline p=0.96, follow up p=0.11) and colonic (baseline p=0.11, follow up p=0.4). Microbiome profiles did show high inter-individual variation but were highly similar intra-individually both between body site and over time.

Conclusion

Here, we investigated the microbial signature of VDZ R and NR and demonstrated mucosa-associated microbiome is mostly stable after resolution/non-resolution of inflammation in CD and does not predict response to VDZ therapy. Further analyses on data of infliximab, adalimumab and ustekinumab treated patients, as part of the EPIC Pioneer study, are ongoing.
P721 Faecal microbiota analysis with body composition and nutritional habits simultaneously amongst Crohn’s disease patients
Authors: Bálint A , Bacsur P , Resál T , Jójárt B , Gyuris Z , Jaksa G , Pintér L , Takács B , Pál S , Gácser A , Szántó K J , Rutka M , Bor R , Fábián A , Farkas K , Maléth J , Szepes Z , Molnár T
Published: January 2022

Background

Changes in microbiome of the gut and decreased diversity in inflammatory bowel disease(IBD) is the subject of intense researches. The exact pathophysiological connection is lacking, but the systemic inflammation due to the microbial alterations are assumed. This study aimed to perform analysis of faecal microbiota composition simultaneously with body composition by bioelectrical impedance and nutrition habits in Crohn’s disease(CD) patients to find specific microbiota profiles connected with obesity, mesenterial fat, signs of systemic inflammation, nutritional and body composition characteristics.

Methods

In our prospective cohort study, CD patients were enrolled. At the inclusion, demographic and clinical data, blood, and faecal samples were obtained. Clinical disease activity was assessed by CDAI, and SES-CD. Laboratory tests were made including C-reactive protein(CRP), albumin and lipids (triglyceride, cholesterol). Faecal bacterial composition was assessed using shotgun metagenomics sequencing technique. Each patient underwent a body composition analysis via bioelectrical impedance analysis. A nutritional questionnaire was filled by each subject.

Results

Data of 27 CD patients with different localisation was analysed in this study (mean age was 35±11 years). According to the gut inflammation, some Blautia species correlated positively with SES-CD (p=0,004), and correlated with faecal calprotectin negatively (p=0,02), while Roseburia hominis negatively with CDAI scores(p=0,01). High CDAI scores were also associated with dysbiosis. Adlercreutzia equolifaciens and Blautia hansenii associated with triglyceride(negatively p=0,04, positively p=0,05). Firmicutes has a lower, while Bacteroidetes has a higher abundance at high cholesterol level(p=0,001, p=0,023). Lower Adlercreutzia and Lactobacillus abundance were seen in patients with high visceral fat area(p=0,05, p=0,01), while Clostridia correlated with percent body fat(p=0,025).Bifidobacterium bifidum were associated in people with low body weight or low skeletal muscle mass(p=0,01, p=0,03). Beside Clostridia, Eubacteriales also correlated with waist-hip ratio(p=0,04, p=0,04).

Conclusion

To our knowledge this is the first study to analyse microbiota profiles by shotgun sequencing technique in CD patients depending on body composition via bioelectrical impedance and nutrition. Changes in Blautia, Lactobacillus, Adlercreutzia, Roseburia and Bifidobacterium abundances in patients with CD and obesity highlight the importance of correlations between lipid metabolism, adipose tissue mass, and chronic inflammation. Through this, it helps to develop new therapeutic approaches, such as personalized pre- or probiotics or faecal microbiota transplantation.
N06 Assessing stakeholder identified barriers and enablers to Ultrasound implementation for assessment of Crohn’s Disease in the UK: A qualitative interview study
Authors: Radford S , Leighton P , Coad J , Moran G
Published: January 2022

Background

Data from the METRIC trial (PMID:29914843) has shown that small bowel ultrasound (US) has very good diagnostic accuracy for disease extent, presence and activity in Crohn’s Disease, is well tolerated by patients and is cheaper when compared to MRI. A recent survey (unpublished) undertaken by the authors via the British Society of Gastroenterology indicated that there is enthusiasm for the use of US in IBD care in the UK. However, uptake of US in the UK is limited, however it is unclear why this is the case.

Methods

A qualitative semi-structured interview study, utilising template analysis using the Normalisation Process Theory (NPT) codebook, was undertaken. NPT was used to guide the analysis framing the findings in relation to the implementation processes related to integrating US into daily IBD care. Interviews were undertaken utilising virtual meeting software.

Results

Fourteen participants were enrolled in the interview study (table #). Participants were enrolled between 02/06/2021-and 06/09/2021, with interviews taking place during the same time period. Enrolled were three patients living with CD (21.4%), two IBD Nurse specialists (14.3%), two IBD Nurse consultants (14.3%), one surgical IBD nurse specialist (7.1%), two consultant gastroenterologists (14.3%), two consultant radiologists (14.3%) and two gastroenterology service managers (14.3%). Participants reported that perceived barriers included reliance on MRI and established care pathways, reluctance to change, lack of trust in US in relation to perceived lack of precision when compared to MRI and the initial financial and time outlay in establishing a US service (buying equipment and training staff). Participants were enthusiastic for the uptake of US and discussed enablers to US uptake being the benefits to patients in terms of reduction in waiting times and earlier diagnosis and treatment allocation (leading to improved clinical outcomes), reduced hospital appointments, reduced costs to the NHS, patients having better understanding of their health and improvements in the therapeutic relationships between patients and healthcare professionals.

Conclusion

There is an enthusiasm to establish and utilise US in IBD care in the UK, however there are perceived barriers in achieving this. There is scant literature to effectively assess these reported barriers and enablers. Therefore there is further research required in the areas of the impact of the use of US on the confidence of clinical decision making of healthcare professionals and the relative cost effectiveness when compared to MRI use for the assessment of IBD in the UK.
N07 Current practices of Ultrasound for assessment of Crohn’s Disease in the UK
Authors: Radford S , Moran G
Published: January 2022

Background

Data from the METRIC trial (PMID:29914843) has shown that small bowel ultrasound (US) has very good diagnostic accuracy for disease extent, presence and activity in Crohn’s Disease (CD), is well tolerated by patients and is cheaper when compared to MRI. However, Uptake of US in the UK is limited

Methods

We designed and conducted an online survey to assess the current usage of US throughout the UK. The survey was undertaken by BSG IBD group members between 9 June 2021 - 25 June 2021. Responses were anonymous, respondents were able to skip questions.

Results

103 responses were included in the data analysis Responses came from 14 different regions of the UK, from 66 individual NHS trusts. 99.03% (n=103) respondents reported that they currently have an MRI service for Crohn’s disease, where only 30.1% (31) had access to US service. Numbers of MRIs per month was reported as an average of 15.14, with a range of 3–75. The average number of US undertaken was reported as 7.67 per month, with a range of 0–50. Average time for results to be reported for MRI scans was reported as between 4–6 weeks, with a range of 2 days to 28 weeks. The average time for an US to be reported was stated as 1–4 weeks, with a range of 0–8 weeks. 48.51% of respondents reported that they were ‘very confident’ when using MRI data to make clinical decisions. 25.24% were ‘extremely confident’, 22.33% were somewhat confident and 2.91% were not so confident. 11% of respondents stated they would be extremely confident in using US to make clinical decisions, 22% stated they would be very confident, 27% somewhat confident, 20% not so confident and 20% not at all confident. Of those respondents who did not have access to an US service, 92.31% (72) stated that they would be interested in developing an US service.

Conclusion

There is an appetite for the uptake of US in the UK for assessment of CD, however there remains a significant number of UK centres with little or no access to an US service. There is a difference in the levels of confidence that clinicians have in using US as a diagnostic tool in the UK. Further research is necessary to understand why this is the case. Results from this survey will go on to inform our future work in developing an implementation package for US in the UK in the NHS.
N08 The influence of the Covid-19 epidemic on access to medical advice for children with Inflammatory Bowel Disease (IBD), based on patients from The Children’s Memorial Health Institute, Warsaw (IPCZD)
Authors: Kotkowicz Szczur M , Matuszczyk M , Kierkuś J
Published: January 2022

Background

COVID -19 significantly affected all levels of medical care as well as access to medical care for children with Inflammatory Bowel Diseases (IBD).The purpose of the study was to investigate how the Covid-19 epidemic influenced on the access to medical care for children with IBD, on the quality of medical care during this period and on the health of young patients.

Methods

The analysis was based on the results of the questionnaire containing 15 questions addressed to the parents of children with IBD. The questions concerned mainly access to GP consultations and gastroenterology consultations, but also access to medicines and parents’ concerns about the health of children during the pandemic.

Since December 2020, 150 questionnaires have been sent to parents of children with IBD. 72 completed questionnaires were returned and 60 of them were included into the analysis (12 were excluded due to lack of complete data). The T-Student test was used for statistical analysis.

Results

Only 5 % of respondents (n=3) stated that the pandemic had no impact on access to a GP, as many as 83% (n = 50) indicated that the epidemic made access to primary care physicians very difficult.

Changes in access to health care during the Covid-19 epidemic caused anxiety about further treatment of the child in 96.7% (n = 58, p<0,05) of the surveyed parents.

In The Children’s Memorial Health Institute due to the limitations of visits related to the development of the pandemic, telemedicine was introduced on a large scale. Due to the easy access to medical telepaths and the resulting, if necessary, outpatient visits, the respondents assessed the access to medical consultations of doctors from the IBD team in IPCZD as much better than before the pandemic 58% (n = 35, p<0,05) or no changes compared to the time before the pandemic 42% (n = 25). 90% (n=54) of the surveyed parents indicated that they would also like to use telemedicine after the epidemic as an alternative to some hospital visits.

Statistical analysis also showed a correlation between difficulties with access to specialized medications during a pandemic and the occurrence of an exacerbation of the disease in a child during that period.

Out of the 40 (67%) group of parents who showed difficulties in purchasing medicines for their children in the survey, as many as 75% (n = 30, p <0.05) reported exacerbation of the disease during the epidemic.

Conclusion

Based on the above results, we concluded that the pandemic had a major impact on access to medical care as well as on access to specialized medications. In The Children’s Memorial Health Institute, thanks to the development of telemedicine, access to specialist care in the IBD team has not changed.
N19 Improving the standard of care for patients with IBD - translating the N-ECCO Consensus Statements
Authors: Kjaer-Mikkelsen E , Hindhede A , Bager P
Published: January 2022

Background

In 2018 the Second N-ECCO Consensus Statements were published in JCC and presented at the ECCO Congress. The statements aim to show the ‘ideal’ standard of care for patients with IBD and support IBD nursing practice. The statements comprise several sections: Fundamental IBD Nursing, Advanced IBD Nursing, and The benefit of an IBD Nurse. The Statements are presented in English and are available via the ECCO webpage. In order to raise awareness of the Statements and allow the Statements to be used in IBD nursing practice in Denmark, we aimed to translate the statements and to evaluate how the translated version were used.

Methods

Translation of statements into Danish by a physician who also is a journalist. Supported by the last author of the Statements (Bager). Distribution of the Statements to the Danish Community of IBD nurses. Open e-survey asking IBD nurses about the Danish version.

Results

Translation were done in autumn 2020. Promotion and distribution were done in spring 2021. This included 2 video recordings explaining the aim of the statements and how they could be used. Furthermore, the statements became online via our national organisation for IBD-nurses.

The survey was launched in autumn 2021. As of November 22th. 2021, 16 nurses from across Denmark have responded. A large majority knew about the Danish version and aimed to use the Statements. However, implementation of the statements was delayed due to the covid-pandemic and a 10 weeks long strike among nurses in the summer of 2021. Furthermore, the responders highlighted the statements of most clinical importance. The top 5 most important statements were; 1) Fundamental IBD Nursing, 2) Impact of IBD on patients’ lives, 3) The Advanced IBD Nurse caring for complex patients, 4) The Advanced IBD Nursing assessment, and 5) Patient information and education.

Conclusion

Translation of the Second N-ECCO Consensus Statements into Danish was appreciated by IBD nurses in Denmark. A majority aimed to include the statements in the development of IBD nursing in clinical practice.
Running During Pregnancy and Postpartum, Part A: Why Do Women Stop Running During Pregnancy and Not Return to Running in the Postpartum Period?
Authors: James Megan L. , Moore Isabel S. , Donnelly Gráinne M. , Brockwell Emma , Perkins Joanna , Coltman Celeste E.
Published: January 2022

Background:

In the absence of complications or contraindications, running is recognized as a safe mode of exercise for women who ran before pregnancy. Despite this, participation in running decreases during pregnancy and postpartum, with limited research conducted to examine why women who were runners before pregnancy cease running during pregnancy and do not return postpartum.

Objectives:

To understand the experiences of women who have recently given birth and were runners before pregnancy, specifically reasons for not running during pregnancy or returning to running postpartum, as well as postpartum running concerns.

Study Design:

Observational, cross-sectional, mixed methods.

Methods:

In total, 883 postpartum females completed an online questionnaire related to running habits, reasons for not running during pregnancy, not returning to running postpartum, and concerns returning to running postpartum. Most questions were closed-ended, with opportunity to provide free-text responses. Descriptive statistics of close-ended questions and thematic analysis of free-text responses were conducted.

Results:

Women did not run during pregnancy due to nausea/morning sickness, fatigue, fear of or experience of miscarriage and anxiety, nervousness, and fear. Women had not returned to running postpartum due to experience of symptoms/pain and complications postpartum and were concerned about leaking urine, vaginal heaviness, and not knowing how to return safely. Pelvic floor concerns were prevalent throughout pregnancy and postpartum.

Conclusion:

There is a need for evidence-based guidance for women to return to running postpartum gradually and safely. This includes greater pelvic health education and support, including access to treatment. Importantly, return-to-running guidance postpartum needs to be considered as an ongoing and longitudinal process.
Fever management in acute brain injury
Authors: Bogossian Elisa Gouvea , Taccone Fabio Silvio
Published: January 2022

Purpose of review

Fever is common after acute brain injury and is associated with poor prognosis in this setting.

Recent findings

Achieving normothermia is feasible in patients with ischemic or hemorrhagic stroke, subarachnoid hemorrhage and traumatic brain injury. Pharmacological strategies (i.e. paracetamol or nonsteroidal anti-inflammatory drugs) are frequently ineffective and physical (i.e. cooling devices) therapies are often required. There are no good quality data supporting any benefit from therapeutic strategies aiming at normothermia in all brain injured patients when compared with standard of care, where mild-to-moderate fever is tolerated. However, recent guidelines recommended fever control in this setting.

As fever is considered a clinically relevant secondary brain damage, we have provided an individualized therapeutic approach to treat it in brain injured patients, which deserved further validation in the clinical setting.
Pain Prevalence Among Children Visiting Pediatric Emergency Departments
Authors: Míguez-Navarro María Concepción , Escobar-Castellanos María , Guerrero-Márquez Gloria , Rivas-García Aristides , Pascual-García Patricia ,   the Clinical Working Group of Analgesia and Sedation of the Spanish Society for Pediatric Emergencies (SEUP)
Published: January 2022

Objectives

The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children.

Methods

This was a multicenter, survey-based research study on 0- to 18-year-old patients visiting 1 of the 15 hospitals that form part of the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergency Medicine between October and December 2018. The surveys recorded pain presence, intensity, characteristics, and location.

Results

The study included 1216 surveys. At the time of the interview, 646 patients were experiencing pain, a prevalence of 53.1% (95% confidence interval, 50.3%–55.9%), with 25.38% reporting mild, 36.68% moderate, and 37.46% intense pain. Among the patients, 29.9% had abdominal pain and 14.1% pain in their legs.

The pain lasted less than 24 hours in 48.2% of the patients, whereas only 3.0% experienced pain during more than 15 days. The parents of 50.7% of the children had provided an analgesic at home.

Interrater agreement regarding pain levels was k = 0.35 between professionals and children, k = 0.38 between children and parents, and k = 0.17 between parents and professionals. For children unable to cooperate, the agreement between professional/child and the parents was k = 0.11.

Conclusions

Pain is a common symptom among emergency department patients, and its evaluation should therefore be obligatory. We found low interrater agreement on pain levels between patients, professionals, and parents, which confirms how difficult it is to accurately evaluate pain intensity.
Combining Isocitrate Dehydrogenase Inhibitors With Existing Regimens in Acute Myeloid Leukemia
Authors: Lachowiez Curtis , DiNardo Courtney D. , Stein Etyan
Published: January 2022

Identification of recurrent mutations in isocitrate dehydrogenase genes (IDH1 and IDH2) in patients with acute myeloid leukemia (AML) coupled with an understanding of the pathologic role these mutant IDH isoforms impart in leukemogenesis resulted in the development of IDH1 and IDH2 inhibitors comprising a novel, molecularly defined class of targeted therapies for the treatment of AML. This review herein describes the unique cellular pathophysiology and vulnerabilities in IDH-mutated AML; the clinical development, efficacy, and known resistance mechanisms to first-generation IDH inhibitors; summarizes the literature surrounding combination therapies incorporating targeted or cytotoxic therapies with IDH inhibitors in patients with IDH-mutated AML; and identifies future challenges and areas of active ongoing investigation within this molecular subgroup.
The Evolving Role of Allogeneic Stem Cell Transplant in the Era of Molecularly Targeted Agents
Authors: Kinsella Francesca , Craddock Charles
Published: January 2022

Allogeneic stem cell transplantation (allo-SCT) is an increasingly important treatment strategy in fit adults with acute myeloid leukemia (AML). Increased donor availability and a steady reduction in transplant-related mortality (TRM) over the last 2 decades have transformed access to the curative potential of allo-SCT. The identification of patients with AML in first complete remission who will benefit from allo-SCT requires a dynamic assessment of the risk of disease relapse and TRM. Increased accuracy in predicting both relapse risk and transplant toxicity has allowed recommendations for allo-SCT to become increasingly personalized. Notwithstanding its now central position in the treatment algorithm of patients with AML, there, however, has been little progress in reducing the main cause of transplant failure, which remains disease relapse. Novel molecularly targeted therapies have the potential to augment the curative potential of nontransplant therapies, and this may influence the proportion of newly diagnosed fit patients deemed to be allomandatory. At the same time, the ability of such therapies to improve transplant outcomes, either by reducing TRM or the risk of relapse, has the potential to further embed allo-SCT as a key therapeutic modality in AML.
A Quality Improvement Initiative to Improve Patient Safety Event Reporting by Residents
Authors: Herchline Daniel , Rojas Christina , Shah Amit A. , Fairchild Victoria , Mehta Sanjiv , Hart Jessica
Published: January 2022

Introduction:

Residents play a key role in patient care at academic medical centers and have unique insights into safety improvement opportunities. At our institution, <1% of safety events were reported by resident trainees. The primary objective of this quality improvement (QI) initiative was to increase the monthly incidence of event reporting by pediatric residents by 20% from baseline within 12 months.

Methods:

A QI team used the model for improvement to identify barriers to submitting safety event reports. The team used multiple intervention cycles to increase knowledge and promote engagement in event reporting. Interventions included educational tip sheets, a hospital-wide Morbidity and Mortality (M&M) conference, peer recognition and acknowledgment by senior leadership for report submission, and an interactive reporting activity. The outcome measure was monthly number of reports filed by residents. The process measure was the number of unique residents submitting a report each month. Time to complete a report was a balancing measure.

Results:

The number of reports placed by residents increased significantly, with a centerline shift from 15 to 29 reports per month (statistical process control chart—Fig. 3). The number of unique residents submitting reports increased from 10 to 22 per month. The time to complete a report was unchanged.

Conclusions:

Engaging residents in patient safety initiatives through education, experiential learning, and recognition can increase safety event reporting by residents. Future planned interventions include enhancing safety event reporting technology, developing patient safety faculty and resident champions, and increasing transparency regarding outcomes of safety event reports.
A Standardized Peer Review Program Improves Assessment and Documentation of Child Sexual Abuse
Authors: Starling Suzanne P. , Martinez Kimberly A. , Frasier Lori D.
Published: January 2022

Introduction:

The objective was to assess the impact of interventions associated with ongoing expert peer review on the quality of child abuse medical providers’ written and photograph documentation in child sexual abuse cases.

Methods:

Pediatricians participated in a HIPAA compliant blind peer review process on a web platform developed to provide the American Board of Pediatrics maintenance of certification. Participants submit sequential photograph and written documentation of child sexual abuse examinations over 1 year. Documentation includes genital examination descriptions and interpretation of findings. Reviewers evaluate the photographic quality and written documentation of examination findings utilizing a numerical rating system. Each case cycle is reviewed by one of four experts in child abuse who received training in a uniform evaluation process. Reviewers follow each case throughout three cycles of documentation, selecting from several interventions that have been customized to address the quality issues noted. The third and final cycle includes summary comments from the reviewer.

Results:

Forty-one participants completed the program at the time these data were collected. A paired t test analysis of the combined scores of the three measures, such as Image Quality, Quality of Written Documentation, and Accuracy of Exam Interpretation, showed a statistically significant improvement (P < 0.001) between the first and last sets. In addition, each of the individual measures was statistically significant between the first and last case sets with a P value of <0.05 for each.

Conclusion:

Peer review with interventions customized to address quality issues improved the quality of the assessment and documentation of child sexual abuse evaluations.
Behavioral and Psychological Aspects of the Physician Experience with Deimplementation
Authors: McDaniel Corrie E. , House Samantha A. , Ralston Shawn L.
Published: January 2022

Introduction:

Deimplementation, or the structured elimination of non-evidence–based practices, faces challenges distinct from those associated with implementation efforts. These barriers may be related to intrinsic psychological factors, as perceptions and emotions surrounding the discontinuation of established practices appear to differ from those associated with practice adoption. This study aims to explore barriers and facilitators experienced by pediatric clinicians engaging in deimplementation projects.

Methods:

We used behavioral economics concepts to inform our qualitative study design following a theory-informed inductive approach. We conducted semistructured interviews with participants from two national quality improvement collaboratives where the primary outcomes were deimplementation measures. Using purposeful sampling, we recruited project leaders at institutions in the top and bottom quartiles from within each collaborative. Finally, we conducted a thematic analysis using a combination of inductive and deductive coding.

Results:

In total, we interviewed participants from 12 high-performing sites and 7 low-performing sites. Participants identified nine concepts associated with successful deimplementation practice and three psychological barriers that impacted behavior change: (1) loss, (2) fear, and (3) action bias. Participants further identified four overarching strategies for mitigating the identified psychological barriers, including (1) making allowance for nonconformism; (2) permission to change; (3) normalizing; and (4) reframing.

Conclusion:

There is potential for more effective deimplementation through the proactive incorporation of an awareness of specific psychological barriers of loss, fear, and action bias, as well as specific mitigation strategies to address the psychocognitive experience.
Reduction in incidents during COVID-19 in a Secure Children’s Home: an opportunity for learning
Authors: McKeown Annette , MacMillan Gemma , Watkins Ella , Caveney Domanic , Smith Anna , Kennedy Patrick Jack , Atkins Rachel , Lee Robyn
Published: January 2022

Purpose

The COVID-19 pandemic is unprecedented for young people within the UK. The pandemic has presented particular challenges for vulnerable children and young people. For example, a recent study in the UK indicated that 83% of young people with existing mental health conditions said the pandemic had made their condition worse (Young Minds, 2020). To date, the impact upon populations such as young people in Secure Children’s Homes (SCHs) is unknown. This study aims to elucidate this area.

Design/methodology/approach

SCHs provide a safe, supportive environment for vulnerable young people who frequently present with multiple and complex needs. Young people residing within a SCH may be residing at the setting because of a Secure Accommodation Order under a Section 25 Order of the Children’s Act (1989) or for criminal justice reasons, i.e. serving a Remand period or custodial sentence. Preliminary research compared a baseline period to a follow-up period after the commencement of COVID-19 national lockdown measures within a SCH in the North of England to develop understanding of the impact for young people.

Findings

A significant decrease in overall incidents (t (5) = −6.88, p < 0.001), restraints (t (5) = −9.07, p < 0.001) and other incidents including assaults occurred during follow-up. The SECURE STAIRS framework supports trauma-informed care and enhances support within the setting. Consistent with the framework, provision of formulation meetings was significantly increased within the follow-up period (Welsh’s t (74) = −2.74, p < 0.001). Reflections and future recommendations are outlined.

Originality/value

The unanticipated results highlight the value of examining incident data within secure environments and could lead to effective practice changes for practitioners working within this domain. This research also demonstrates how frameworks such as SECURE STAIRS can be beneficial for vulnerable young people during periods of change and stress in mitigating some of the potential negative effects. The implementation of such frameworks within SCHs is still novel and thus evaluative research is valuable.
“Defund the police:” Perceptions among protesters in the 2020 March on Washington
Authors: Cobbina‐Dungy Jennifer , Chaudhuri Soma , LaCourse Ashleigh , DeJong Christina
Published: January 2022

Research summary: Using qualitative interviews, this study examines how protesters with varying levels of commitment to the Black Lives Matter movement perceive the slogan defund the police. Findings indicate while a small number had reservations regarding the term, the vast majority of protesters associate defunding as a two‐step process that starts with reduction of police budgets, followed by reallocation of these resources toward much needed services in the very communities the departments serve. Findings also revealed prior engagement with the Black Lives Matter movement, and the level of commitment of participants did play an important role in being able to provide nuanced context to the call for action.

Policy implications: Implementation of reduction of police budgets indicates a need to reimagine the role and function of police in most affected communities. In addition, there is a need to reinvest in local resources that would provide the much needed support toward marginalized communities. Further, social movement organizations should partner with corporate brands and advertising agencies to effectively promote their goals and slogans toward a diverse range of audience in media.
Does Restricting Managers' Discretion through GAAP Impact the Usefulness of Accounting Information in Debt Contracting?†
Authors: Cheng Lin , Jaggi Jacob , Young Spencer
Published: January 2022

We examine whether restricting managers' discretion through GAAP impacts the usefulness of accounting information in debt contracting. Our study informs standard setters and regulators regarding the debt contracting implications of limiting managers' discretion via accounting standards. We predict and find that under more restrictive standards, lenders make more non‐GAAP modifications to GAAP‐based performance measures, suggesting that restrictions of managers' discretion reduce the usefulness of accounting information. We perform two additional analyses to enhance identification. First, in line‐item‐level analysis, we document a positive relation between the exclusion of specific nonrecurring items from contractual definitions of earnings and the number of restrictions in the GAAP standards that apply to each specific item each year. Second, using difference‐in‐differences tests around standard changes, we find that the propensity to exclude items varies positively with changes in the restrictiveness of related standards. Moreover, we predict and find that restrictive standards are also positively associated with loan spreads but significantly less so when lenders adjust GAAP numbers in loan contracts. Overall, this study improves our understanding of how attributes of accounting standards impact the usefulness of accounting information.
Miniaturization eliminates detectable impacts of drones on bat activity
Authors: Kuhlmann Kayla , Fontaine Amélie , Brisson‐Curadeau Émile , Bird David M. , Elliott Kyle H.
Published: January 2022

Advances in operational simplicity and cost efficiency have promoted the rapid integration of unoccupied aerial vehicles (UAVs) into ecological research, yet UAVs often disturb wildlife, potentially biasing measurements. Studies of UAV effects on wildlife to date have focused on UAV trajectory or distance; however, UAV size and noise could be critical variables influencing wildlife responses.

Bats are cryptic aerial species that are difficult to survey using conventional means, and so we tested the effectiveness of drone‐based acoustic surveys for bats. We recorded the number of acoustic bat detections with and without a UAV present. We used three small, commercial rotary UAVs varying in size and noise intensity (249, 907, 1,380 g).

Larger and louder UAVs deterred significantly more bats, with no effect of take‐off distance on bat activity. The smallest and quietest UAV model had a similar change in bat activity compared with control measurements. Drone noise increased with drone size, but all drones emitted in a similar range of frequencies that overlapped with the larger bat species that were also those most impacted by the UAV. During the 5‐minute surveys, there was no evidence of bat habituation to UAVs although bats returned quickly once the UAV survey ended.

We urge wildlife researchers to consider drone size during wildlife surveys. Smaller and quieter models have negligible impacts on wildlife, eliminating the impact of drones on wildlife in some cases.
Selected stage IV rectal cancer patients managed by the watch‐and‐wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?
Authors: Custers Petra A. , Hupkens Britt J. P. , Grotenhuis Brechtje A. , Kuhlmann Koert F. D. , Breukink Stéphanie O. , Beets Geerard L. , Melenhorst Jarno ,   the Dutch Watch‐and‐Wait Consortium (collaborators)
Published: January 2022

Aim

The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch‐and‐wait approach following a (near‐)complete response of the primary rectal tumour after radiotherapy.

Method

Patients registered in the Dutch watch‐and‐wait registry since 2004 were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow‐up and survival were collected. The 2‐year local regrowth rate, organ‐preservation rate, colostomy‐free rate, metastatic progression‐free rate and 2‐ and 5‐year overall survival were analysed.

Results

After a median follow‐up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2‐year local regrowth rate was 39.9%, the 2‐year organ‐preservation rate was 77.1%, the 2‐year colostomy‐free rate was 88.1%, and the 2‐year metastatic progression‐free rate was 46.7%. The 2‐ and 5‐year overall survival rates were 92.0% and 67.5%.

Conclusion

The watch‐and‐wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near‐)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.