bluuebunny/crossref_metadata_2025_split huggingface dataset:
P013 IBD 101: AN INTRODUCTORY COURSE FOR FIRST YEAR GASTROENTEROLOGY FELLOWS
Authors: Lopatin Sarah , Kane Sunanda , Hong Simon , Hudesman David , Rubin David , Malter Lisa 
Published: January 2020

Abstract

Introduction
Inflammatory bowel disease (IBD) management is changing at a rapid rate, with the emergence of multiple new therapies and evolving care goals. In addition, the quality and quantity of IBD fellowship education is highly variable, based on patient populations and institutional expertise. Therefore, it is crucial to develop improved ways to educate our trainees. Here, we describe an educational initiative designed to familiarize first year gastroenterology (GI) fellows to key concepts in the management of IBD.

Methods
IBD 101 is a one-day course designed to introduce first-year GI fellows to various clinical topics relevant to the management of IBD. The program was held on September 14, 2019. Fellows from U.S. allopathic GI training programs were selected by their training directors for participation. The course included small group didactic sessions led by expert faculty members and group observed structured clinical examinations (OSCEs), in which fellows observed encounters between expert faculty and standardized patients followed immediately by debrief sessions to reinforce key concepts. The topics included need for surgery in IBD, pregnancy and IBD, escalation of care for acute severe UC, initiating biologic therapy, treatment of mild-moderate IBD, treatment of moderate-severe IBD and managing loss of response to therapy. A review of supplemental opportunities for education in IBD was presented at the conclusion of the course. Pre- and post-course surveys using Likert scoring (1=“strongly disagree” through 4=“strongly agree”) were administered to assess baseline knowledge and educational impact of the course on each addressed topic.

Results
55 fellows from 32 programs participated. 49/55 (89%) completed pre- and post-course surveys to assess the educational impact of the program on the didactic sessions and on the group OSCE format. 100% of fellows felt that the course content was appropriate for their scope of clinical practice. Substantial improvement in comfort with all addressed clinical topics was noted (figure 1). In the post-course survey, all fellows reported an improved ability to manage and treat patients with IBD. Comparing career interest in IBD, more participants expressed interest in pursuing a career in IBD after participating (pre: 63% vs post: 75%). 96% of attendees stated that they would strongly recommend this course to future GI fellows.

Conclusions
This single day course for first-year GI trainees was effective and well-received, and offers a novel intervention to address the challenges of IBD education and training. Follow-up of this cohort of trainees and expansion for next year is planned.
P036 ADULT AND PEDIATRIC PATIENT AND PARENT ATTITUDES, PERCEPTIONS, AND EXPERIENCES WITH NUTRITIONAL THERAPIES FOR INFLAMMATORY BOWEL DISEASES: A SYSTEMATIC REVIEW
Authors: Sandell Angela , Michel Hilary , Folb Barbara 
Published: January 2020

Abstract

Background
Nutritional therapy, including exclusive enteral nutrition (EEN), partial enteral nutrition (PEN), the Crohn’s Disease Exclusion Diet (CDED), and the Specific Carbohydrate Diet (SCD), can be used as adjunct or primary treatment for inflammatory bowel diseases (IBD). Patient and parent attitudes and experiences regarding nutritional therapy affect the decision to use them as treatment, and ultimately, their success.

Aims
We aimed to summarize existing literature exploring patient and parent attitudes and experiences regarding using nutritional therapy for IBD.

Methods
We completed a systematic review of the literature to find all publications related to pediatric and adult patient, and pediatric parent attitudes, beliefs, and experiences with implementation of four nutritional therapies for IBD: EEN, PEN, CDED and SCD. In collaboration with a research librarian, we prospectively developed a review protocol in PROSPERO; a search strategy was developed in Embase and translated for MEDLINE, CINAHL, PsycINFO, Cochrane Library, and Web of Science. Authors (AS and HM) reviewed reported titles and abstracts for inclusion for full text review. AS and HM extracted data from full texts meeting inclusion criteria. Results were qualitatively coded in an iterative process to reveal the following themes: attitudes and beliefs, experiences, barriers, and facilitators.

Results
Our search revealed 2,127 abstracts of which 276 full texts met inclusion criteria. Of these, 28 were included for data extraction and 21 for final analysis (Figure 1); 16 were non-randomized studies and 5 were randomized control trials. Regarding attitudes and beliefs, patients using EEN and PEN in several studies reported being willing to utilize this therapy again in the future. Patients using the SCD felt that the diet was superior to medications and feared long-term medication side effects. Patients using EEN, PEN, and SCD commonly experienced improved quality of life (QOL) scores. Frequently, QOL scores in those on EEN or PEN were the same as or better than those on biologic medications. Another common experience reported both by patients on EEN and SCD was occasional “cheating” on the diet or eating “illegal foods.” The most common barrier to implementation of EEN and PEN was palatability. For the SCD, time to prepare foods was a barrier. Few reports of facilitators to implementation exist. No studies of the CDED met inclusion criteria. Studies are summarized in Table 1.

Conclusions
Nutritional therapy is an essential component of IBD management, yet studies focusing on the patient and parent experience with these diets are limited. Future studies with the primary aim of exploring patient and parent perceptions of and experiences with nutritional therapy may guide appropriate therapy recommendations and allow the medical team to provide adequate support to ensure their success.
P032 E-CIGARETTE AND CIGARETTE USE AMONG U.S. ADULT IBD PATIENTS: POPULATION-LEVEL SURVEY
Authors: Suk Ryan , Suk Heetae , Sonawane Kalyani , Deshmukh Ashish 
Published: January 2020

Abstract

Background
Cigarette smoking can negatively affect treatment response in inflammatory bowel disease (IBD) patients, especially among those with Crohn’s disease (CD). E-cigarette has been considered a safer alternative to delivering nicotine for IBD patients who smoke. However, given the recent large number of reported e-cigarette-related lung injury cases, CDC released an interim guidance update on those lung injuries. They also coined a term EVALI (e-cigarette, or vaping, product use associated lung injury) emphasizing the possible harms in e-cigarette smoking. To the best our knowledge, we currently do not know the recent smoking habits in American IBD patients, especially when it reveals that e-cigarette use might cause serious lung injuries.

Methods
We used National Health Interview Survey (NHIS) for 2015–2016, which is a nationally representative survey for noninstitutionalized adults in the US. Weighted counts and percentages were estimated using survey design for the population-level results. We identified those who reportedly were told by a doctor or healthcare professional that they have IBD. We first estimated the prevalence of current e-cigarette or cigarette use among IBD patients. We then estimated the frequency of use (every day or some days) among the current users. We also categorized IBD patients into 4 groups by smoking type: those using e-cigarette only, cigarette only, using both, and neither. To see the characteristics of e-cigarette users, we stratified e-cigarette users by current/former/never cigarette use status.

Results
We identified 951 participants (population estimate: 3.1 million) with IBD. Among those people, 5.0% (95% CI: 3.1–6.9) was current e-cigarette users while 17.9% (95% CI: 14.8–21.0) was current cigarette smokers. Prevalence of every-day use and some-day use of e-cigarette was similar (2.4% vs 2.6%), while there was much higher prevalence of every-day use than some-day use in cigarette (15.3% vs 2.6%). Those who were using both e-cigarette and cigarette was 3.2% (Table). Majority of e-cigarette users were also currently using cigarette (63.6%, 95% CI: 48.9–78.3), while 32.7% (95% CI: 18.4–47.0) of them were former cigarette smokers. Only 3.7% (0.0–8.9) of them never used cigarettes.

Conclusion
While numerous studies show e-cigarette use is generally increasing rapidly in the US, we found that 5% of IBD patients are currently using e-cigarette. Almost two-thirds of them were also currently smoking cigarette and one-third of them were former smokers. It is possible that most of the e-cigarette users are still in the process of transitioning from cigarette smoking and thus using both types. We lack information on effects of using e-cigarette or both e-cigarette and cigarette in IBD treatment outcomes, as well as how e-cigarette use will complicate other health risks in IBD patients (e.g. lung injuries). We need further research on these effects to properly guide IBD patients who are in need of smoking cessation.
P031 PERCEPTIONS AMONG PATIENTS WITH ULCERATIVE COLITIS: TREATMENT AND SELF MANAGEMENT METHODS
Authors: DuBois Kelli , Blake Christine , Rudisill Caroline , Harrison Sayward , Hébert James 
Published: January 2020

Abstract

Background
Patients with Ulcerative Colitis (UC) experience a range of gastrointestinal and extraintestinal symptoms that generate a significant burden on daily life. For the majority of individuals with UC, pharmacotherapy is insufficient to maintain a ‘normal’ lifestyle. Many of those diagnosed with UC seek out complementary or alternative treatments and undertake socio-behavioral and lifestyle adaptations to self-manage disease symptoms, reduce dependence upon pharmaceuticals, and respond to the challenges of living with chronic illness. The purpose of this qualitative study is to describe patient perspectives and experiences with UC treatment and self-management methods.

Methods
Qualitative data were collected using individual semi-structured interviews to obtain in-depth data reflecting the perspectives and experiences of individuals with UC on treatment and self-management of symptoms. Patients were recruited in collaboration with the Prisma Health Gastroenterology department in Greenville, SC and the Carolina’s Crohn’s and Colitis support group. Eligibility criteria included: 1) diagnosis of UC; 2) duration of illness ≥5 years; and 3) a minimum of one disease flare during the illness trajectory. Interviews were audio recorded and transcribed. Thematic analysis was conducted using NVivo 11 software.

Results
All participants reported active involvement with a gastroenterologist for disease management and progressive use of medications over the course of their illness in response to disease flares. Most participants identified stress reduction as beneficial to managing their UC. All participants discussed diet as a method to manage their UC. The majority of participants spoke about foods as culprits for symptom incidents. Other participants described dietary intake as essential in managing the severity of their UC and overall well-being. Patients who expressed need for formal mental health treatment perceived little support or assistance among gastroenterologists. Patients who underwent colorectal surgery described a continuing need to self-manage gastrointestinal symptoms.

Discussion
Patients expressed reliance on physicians for pharmaceutical treatment, yet identified diet restrictions and stress management as a main approach for self-management of UC. Framing patient education on how diet, stress management, and other health behaviors improve immune system functioning may lead to greater long term adoption of health behaviors and improved health outcomes among individuals with UC.
P082 ANTI-TNF EFFICACY AFTER PRIMARY VEDOLIZUMAB FAILURE IN PEDIATRIC INFLAMMATORY BOWEL DISEASE
Authors: Dolinger Michael , Rolfes Priya , Phan Becky , Pan Stephanie , Dubinsky Marla 
Published: January 2020

Abstract

Background
Vedolizumab (VDZ) is less effective in Inflammatory Bowel Disease (IBD) when used in anti-Tumor Necrosis Factor (TNF) failures as compared to anti-TNF naïve patients. However, the outcomes of sequencing anti-TNF after VDZ failure remain unknown. We report on the effectiveness and safety of anti-TNF as a second-line biologic after VDZ failure in pediatric IBD patients.

Methods
Data was collected as part of an ongoing pediatric IBD observational treatment registry and included demographics, disease behavior, location, disease activity (Harvey Bradshaw index (HBI) for Crohn’s disease (CD) or partial Mayo score (pMS) for ulcerative colitis (UC) and IBD-unspecified (IBD-U)), adverse events, treatment and surgical history. Primary outcome was steroid-free clinical remission at last follow up. Secondary outcomes were CRP normalization and adverse events including infusion reactions, infections, hospitalizations, and IBD related surgeries. Descriptive statistics summarized the data (median [interquartile range (IQR)]) and univariate analyses tested associations.

Results
A total of 21 children and young adults (6 CD:14 UC:1 IBD-U; 19/21 colonic only disease) were treated with VDZ for a median [IQR] duration of 25 [11–59] weeks. VDZ was discontinued due to primary non-response (57%), secondary loss of response (38%), or an adverse event (5%). Nineteen (90%) patients were induced with infliximab (IFX), 1 with adalimumab, and 1 with golimumab and were followed for a median of 100 [35–148] weeks after anti-TNF induction (Table 1). Fifteen (71%) patients remained on anti-TNF therapy at last follow up for a median duration of 53 [34–112] weeks. All 15 patients achieved steroid-free clinical remission, and 9 (60%) patients also had a normal CRP (Figure 1). Remission rates were numerically higher in UC/IBD-U vs. CD (80% vs. 50% P = 0.27). All 6 (28%) patients (3 CD and 3 UC) who discontinued anti-TNF therapy after a median duration of 15 [7–24] weeks initially had a primary non-response to VDZ. Three patents had a primary non-response to anti-TNF, 2 had a secondary loss of response, and 1 had an anaphylactic infusion reaction. No serious adverse events, hospitalizations or serious infections attributable to anti-TNF therapy occurred.

Conclusions
Our results suggest that anti-TNF therapy is efficacious and safe after primary failure with VDZ in pediatric IBD patients and this was particularly so in patients with colonic disease location, regardless of IBD classification.
P089 REAL-WORLD EXPERIENCE: CLINICAL AND ENDOSCOPIC EFFECTIVENESS OF STANDARD VEDOLIZUMAB DOSING AND MODIFIED MAINTENANCE DOSING IN PATIENTS WITH MODERATE-SEVERE CROHN’S DISEASE
Authors: Lee Scott D , Singla Anand , Kerwin Caitlin , Clark-Snustad Kindra 
Published: January 2020

Abstract

Background
Vedolizumab (VDZ) is an effective treatment for Crohn’s disease (CD); however, inadequate and loss of response is common. Pivotal VDZ trials evaluated alternative dosing intervals, demonstrating numeric but not statistical superiority in efficacy as compared to FDA-approved dosing. The safety and effectiveness of FDA-approved and modified-dosing schedules in a real-world population are unknown. We aimed to evaluate clinical and endoscopic effectiveness & safety of standard and modified maintenance VDZ dosing in a real world cohort.

Methods
We retrospectively reviewed CD patients (pts) treated with &gt;3 months VDZ, assessing Harvey Bradshaw Index (HBI), Simple Endoscopic Score for Crohn’s disease (SESCD), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), C-reactive protein (CRP), albumin and hematocrit prior to and following standard VDZ dosing, and prior to and following modified VDZ maintenance dosing. We measured duration on therapy and adverse events.

Results
We identified 226 eligible pts, mean age 41.5 years, 55.3% female, median disease duration 10 years, 88.9% with prior biologic exposure. Mean duration on VDZ was 28.3 months.
Standard VDZ dosing: 61.5% of pts with active clinical disease and adequate follow up data achieved clinical response after 3–12 months; 41.0% had clinical remission. 51.9% of pts with active endoscopic disease and adequate follow up data achieved mucosal improvement; 42.3% had endoscopic remission; 26.0% had mucosal healing after 3–24 months. 50.0% of pts with elevated CRP and adequate follow up data normalized CRP after 3–12 months.
Modified maintenance dosing: 72 non-remitters to standard VDZ dosing received modified VDZ maintenance dosing. 51.5% of pts with active clinical disease prior to starting dose modification and adequate follow up data achieved clinical response after 3–12 months of modified maintenance dosing; 42.4% had clinical remission. 22.2% of pts with SESCD ≥3 prior to starting dose modification achieved mucosal improvement after 3–24 months; 22.2% had mucosal healing. 26.7% of pts with SESCD ≥4 prior to starting modified dosing had endoscopic remission after 3–24 months. 50.0% of pts with elevated CRP and adequate follow up data normalized their CRP after 3–12 months.
Safety: 82.7% of pts reported ≥1 adverse events, most commonly infection and worsening CD symptoms.

Discussion
Standard VDZ dosing resulted in clinical and endoscopic improvement in pts with moderate-severe CD, with prior exposure to multiple advanced therapies. For non-remitters to standard dosing, modified VDZ maintenance dosing improved clinical disease activity in ∼50% of pts and improved endoscopic disease activity in ∼20% of pts, suggesting that for pts who did not achieve remission with standard VDZ dosing, modified VDZ dosing may result in clinical and endoscopic improvement.
Empirical comparisons of multiple Mendelian randomization approaches in the presence of assortative mating
Authors: Minică Camelia C , Boomsma Dorret I , Dolan Conor V , de Geus Eco , Neale Michael C 
Published: January 2020

Abstract

Background
Mendelian randomization (MR) is widely used to unravel causal relationships in epidemiological studies. Whereas multiple MR methods have been developed to control for bias due to horizontal pleiotropy, their performance in the presence of other sources of bias, like non-random mating, has been mostly evaluated using simulated data. Empirical comparisons of MR estimators in such scenarios have yet to be conducted. Pleiotropy and non-random mating have been shown to account equally for the genetic correlation between height and educational attainment. Previous studies probing the causal nature of this association have produced conflicting results.

Methods
We estimated the causal effect of height on educational attainment in various MR models, including the MR-Egger and the MR-Direction of Causation (MR-DoC) models that correct for, or explicitly model, horizontal pleiotropy.

Results
We reproduced the weak but positive association between height and education in the Netherlands Twin Register sample (P= 3.9 × 10–6). All MR analyses suggested that height has a robust, albeit small, causal effect on education. We showed via simulations that potential assortment for height and education had no effect on the causal parameter in the MR-DoC model. With the pleiotropic effect freely estimated, MR-DoC yielded a null finding.

Conclusions
Non-random mating may have a bearing on the results of MR studies based on unrelated individuals. Family data enable tests of causal relationships to be conducted more rigorously, and are recommended to triangulate results of MR studies assessing pairs of traits leading to non-random mate selection.
Hydrodynamic shear-based purification of cancer cells with enhanced tumorigenic potential
Authors: Cermeño Efraín A , O’Melia Meghan J , Han Woojin M , Veith Austin , Barber Graham , Huang Emina H , Thomas Susan N , García Andrés J 
Published: January 2020

AbstractTumor-initiating cells (TICs), a subpopulation of cancerous cells with high tumorigenic potential and stem-cell-like properties, drive tumor progression and are resistant to conventional therapies. Identification and isolation of TICs are limited by their low frequency and lack of robust markers. Here, we characterize the heterogeneous adhesive properties of a panel of human and murine cancer cells and demonstrate differences in adhesion strength among cells, which exhibit TIC properties and those that do not. These differences in adhesion strength were exploited to rapidly (~10 min) and efficiently isolate cancerous cells with increased tumorigenic potential in a label-free manner by use of a microfluidic technology. Isolated murine and human cancer cells gave rise to larger tumors with increased growth rate and higher frequency in both immunocompetent and immunocompromised mice, respectively. This rapid and label-free TIC isolation technology has the potential to be a valuable tool for facilitating research into TIC biology and the development of more efficient diagnostics and cancer therapies.
Direct detection of intact Klebsiella pneumoniae carbapenemases produced by Enterobacterales using MALDI-TOF MS
Authors: Yoon Eun-Jeong , Lee Eun Hee , Hwang Dong Hwi , Lee Hyukmin , Baek Je-Hyun , Jeong Seok Hoon 
Published: January 2020

Abstract

Objectives
A MALDI-TOF MS-based identification method for KPC-producing Enterobacterales was developed.

Methods
The molecular mass of the intact KPC-2 polypeptide was estimated for blaKPC-2 transformants using MALDI Microflex and the exact mass was confirmed by LC and a high-resolution MS/MS system. A total of 1181 clinical Enterobacterales strains, including 369 KPC producers and 812 KPC non-producers, were used to set up the methodology and the results were compared with those from PCR analyses. For external validation, a total of 458 Enterobacterales clinical isolates from a general hospital between December 2018 and April 2019 were used.

Results
The exact molecular mass of the intact KPC-2 protein was 28 718.13 Da and KPC peaks were observed at m/z 28 708.87–28 728.34 using MALDI Microflex. Most of the KPC-2 (99.1%, 335/338) and KPC-3 (100%, 6/6) producers presented a clear peak via this method, while 12.0% (3/25) of the KPC-4 producers had a peak of weak intensity associated with low levels of gene expression. It took less than 20 min for the entire assay to be performed with colonies on an agar plate. External validation showed that the analytical sensitivity and specificity of the method compared with PCR were 100% (59/59) and 99.50% (397/399), respectively.

Conclusions
The MALDI-TOF MS-based method for directly detecting the intact KPC protein is applicable to routine tests in clinical microbiology laboratories, supported by its speed, low cost and excellent sensitivity and specificity.