bluuebunny/crossref_metadata_2025_split huggingface dataset:
A68 DISTAL MIGRATION OF A PERCUTANEOUS GASTROJEJUNAL DUODOPA INFUSION TUBE DUE TO BEZOAR FORMATION AT THE JEJUNAL TUBE TIP
Authors: Akman O , Duerksen D 
Published: March 2021

Abstract

Background
Continuous intestinal infusion of levodopa/carbidopa intestinal gel (LCIG) for the treatment of advanced Parkinson’s Disease (PD) leads to less variability in plasma drug levels and improved symptom control. Percutaneous Gastrojejunostomy (PEG-J) tube placement has a high placement success rate; however, delayed tube malfunctions occur in approximately 58% of cases within two years. A rare complication is bezoar formation at the jejunal tube tip.

Aims
To present a case of bezoar formation at the jejunal tip of a PEG-J tube that caused distal migration of the tube with gastroduodenal ulceration and required surgical extraction.

Methods
Full chart review was conducted including clinical notes, laboratory results, radiographic imaging, endoscopy reports, and surgical reports. A relevant literature review was conducted.

Results
A 57-year-old male with severe PD underwent endoscopic guided PEG-J tube insertion for continuous infusion of LCIG; intestinal administration was effective for symptom control. Two years later, he noted that the gastric tube had retracted approximately 15 cm into the stoma without external manipulation of the apparatus. Attempts to externally pull the tube back into position were unsuccessful.
The patient underwent Gastroscopy (EGD) with fluoroscopy. Contrast was used to confirm placement of the jejunal tip within the jejunum, but also showed migration of the gastric tip into the duodenum. A gastroscope was used to reposition the gastric tube in the stomach; the jejunal tube was visualized to be under traction. The bumper on the apparatus was re-positioned and external tape was used to further secure the apparatus and prevent migration.
A month later the tube had migrated again; repeat EGD showed the jejunal tube to be under traction with some resultant ulceration of the pyloric channel and duodenal bulb where the tube had been pressing against the mucosa. The jejunal tube could not be pulled back and appeared to be fixed distally. A CT scan was obtained to assess for complications and a coiled tip was seen in the proximal jejunum.
Surgical extraction of the malfunctioning tube was required. At laparotomy, the coiled tip of the feeding tube was successfully removed via enterotomy. The tube tip had coiled around itself and was encased with food materials, creating a large bezoar that was being pulled distally by peristalsis. The patient subsequently underwent insertion of a new GJ tube for ongoing administration of LCIG and has been doing well since.

Conclusions
Bezoar formation at the jejunal tip of LCIG PEG-J tubes is a rare complication and can lead to distal migration and traction related gastroduodenal ulceration. Surgical removal may be required.

Funding Agencies
None
A70 PREVALENCE OF SELF-PUBLICATION AMONG EDITORIAL BOARD MEMBERS OF GASTROENTEROLOGY JOURNALS
Authors: Verma Y , Scaffidi M A , Gimpaya N , Panjwani A , Bansal R , Li J , Elsolh K , Khan R , Grover S C 
Published: March 2021

Abstract

Background
Editorial self-publication refers to the practice wherein editors publish research in journals to which they serve as editorial board members. The International Committee of Medical Journal Editors (ICMJE) has detailed recommendations against the practice of self-publication. There is evidence to suggest that editorial board membership may influence the decision to publish academic papers, which may contribute to publication bias. Despite this, there have been few attempts to characterize this practice in gastroenterology journals.

Aims
To determine the prevalence of original gastroenterology research articles published by editorial board members in their own journal.

Methods
We conducted a cross-sectional study to determine the prevalence of editorial board members publishing within their own journals. A list of the top 25 highest impact factor gastroenterology journals was created through InCites Journal reports. Journals were screened to determine eligibility based on whether their primary focus included gastroenterology research and whether archives with the names and affiliations of editorial board members were available. 10 journals were selected based on these criteria. For each journal, we extracted all original research articles published in 2019 using Web of Science (Clarivate Analytics ©). Articles classified as editorial material, meeting abstracts, reviews, and clinical practice guidelines were excluded. We cross-referenced the affiliations of all authors found in each publication with affiliations of editors disclosed on the journal website. For each editorial board member, we determined the number of publications within their own journal.

Results
We identified 844 editorial board members in the 10 journals included. Overall, 337 (39.9%) of the editors had a publication in their own journal, of which, 152 (18.0%) had more than one publication. Across all journals, the median number of editors with self-publication is 27 (IQR=20.3–49.8). The median number of editors with more than one self-publication is 16 (IQR=10.0–25.3). In total, 507 (60.1%) of all editors had no publications within their respective journals.

Conclusions
Despite recommendations against this practice, our results show a high number of research publications authored by editorial board members. These results demonstrate a potential risk for publication bias. However, this study was limited by the inability to investigate beyond the prevalence of self-publication. Furthermore, the explicit implications of our results remain unclear. Further research is required to evaluate factors such as disclosures and the review process associated with increased rates of self-publication as well as its impact on publication bias.

Funding Agencies
None
A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS
Authors: Johnson E , Carbonneau M , Campbell-Scherer D , Tandon P , Hyde A 
Published: March 2021

Abstract

Background
Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta.

Aims
As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation.

Methods
We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively.

Results
Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process.

Conclusions
Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites.

Funding Agencies
Alberta Innovates
A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC
Authors: Gimpaya N , Khan R , Gallinger Z R , Scaffidi M A , Al Abdulqader A K , Ahmed M , Gholami R , Ramkissoon A , James P D , Mosko J , Griller N , Bansal R , Grover S C 
Published: March 2021

Abstract

Background
Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19).

Aims
To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures.

Methods
Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool.

Results
Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox.

Conclusions
The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment.

Funding Agencies
SMHA AFP COVID-Related Innovation Funds
A81 BARRIERS AND FACILITATORS OF PEDIATRIC TO ADULT TRANSITION IN IBD: A PILOT STUDY EVALUATING THE STAKEHOLDER EXPERIENCE
Authors: Chis R , Jawaid N , Fu Y , Bollegala N 
Published: March 2021

Abstract

Background
Inflammatory bowel disease (IBD) is increasing in prevalence with up to 25% of IBD patients diagnosed before 18 years of age. These patients will require graduation from pediatric care to adult services. The transition of care from pediatric to adult gastroenterologists (GIs) is a purposeful transition that requires planning with involvement of all stakeholders to ensure proper transition and avoid interruption in care.

Aims
To identify the transition experiences of adult patients with pediatric diagnoses of IBD, their parents, pediatric and adult GIs and registered nurses (RNs) and identify barriers and facilitators to a successful transition.

Methods
Patients aged 18–25 diagnosed with pediatric-onset IBD were included. Semi-structured focus groups were held with 9 patients and separately with 4 parents. Questions focused on the patient transition experience, opportunities for improvement, and patient quality of life. Transition practices and expectations of 12 adult GIs, 7 pediatric GIs and 9 IBD nurses were also investigated in a series of provider specific focus groups. The groups were audio-recorded, transcribed and qualitative themes were noted.

Results
Patients: Facilitators included ease of access to adult providers outside of clinic time and parental presence in the early stages of transition. Barriers included abrupt transitions to adult care by age 18, lack of choice regarding adult GI and lack of adult nursing.
Parents: Facilitators included an extended transition period, availability of support groups/resources. Barriers related to exclusion from the transition process and lack of input on adult GI choice.
RNs: Facilitators include having champion IBD nurses on the pediatric and adult side during transition. Barriers included lack of educational tools for patients.
Pediatric GIs: Facilitators included effective communication between adult and pediatric GIs, having an emergency assessment protocol, involving families in the transition process and access to multidisciplinary resources. Barriers included prolonged wait time for transfer and lack of adult access to multidisciplinary support.
Adult GIs: Facilitators included succinct transfer summaries and formal transition programs for high risk patients. Barriers included a lack of multidisciplinary support, difficulty reaching rural areas, heavy case loads and prolonged wait time to transfer of care.

Conclusions
This study explores the stakeholder experience of pediatric to adult transition in IBD. Themes noted related to efficient communication between GIs, streamlining transfer summaries, ensuring a gradual transition process, involving parents and ensuring access to multidisciplinary resources. Identifying barriers and facilitators during the transition process can provide insight into creating a successful pediatric to adult transitions program in IBD.

Funding Agencies
None
A88 PATIENT AND PHYSICIAN PERSPECTIVE OF TELE-HEALTH IN GASTROENTEROLOGY
Authors: Tomaszewski M , Zhao B , Kim H , Enns R A , Bressler B , Moosavi S 
Published: March 2021

Abstract

Background
Given the social distancing measures employed to reduce the transmission of SARS-CoV-2, tele-health has rapidly expanded and is now routinely used in new patient encounters and in follow up appointments across Canada.

Aims
To determine the patient and physician perspective towards tele-health in a gastroenterology outpatient setting.

Methods
An anonymous voluntary online survey was distributed to patients who had previously undergone at least one tele-health visit in a tertiary care gastroenterology outpatient setting. A separate online survey was distributed to gastroenterologists practising across Canada.

Results
A total of 181 patients from British Columbia (59.8% female) completed the survey. The tele-health appointment was the first visit for 21.8% of patients. Appointments occurred by phone call alone (61.4%) or by video and audio software (38.6%) and started within 5 minutes of the scheduled time in 75% of visits. Patient satisfaction with the tele-health visit was high (8.54 on a scale of 0–10; 0 completely dissatisfied, 10 extremely satisfied; IQR 8–10). Most patients did not perceive a difference in likelihood of compliance compared to a non-tele-health visit (90.6%), were not concerned about the lack of physical exam during a tele-health visit (82.4%) and did not with-hold information they would have revealed in person (88.7%). After the COVID-19 pandemic, some patients would prefer tele-heath visits (39.2%), whereas others would prefer in office visits (28.5%) and the remainder were indifferent (32.3%). Post-pandemic, most patients would prefer tele-health for follow up visits (68.4%), over tele-health for all possible visits (27.9%) or no tele-health visits (3.8%).
A total of 25 Canadian gastroenterologists (28.0% female; 60% academic practice, 40% community practice) completed a separate survey. Regarding the lack of physical exam in tele-health, 44% of physicians believed this did not affect the quality of their assessment, whereas some physicians believed it had either minimally (48%) or greatly (8%) impaired the quality of their assessment. Almost all physicians (96%) perceived that patients either appreciate tele-health as much as or more than in office visits.
Post-pandemic, most physicians (96%) supported a hybrid model of both tele-health and in office visits. Appointments for follow up of benign endoscopic pathology results (96%), follow up visits (92%), consultations prior to endoscopy (76%) were deemed to be most appropriate for tele-health. Follow up of malignant pathology results (24%) and consultations for new patients (32%) were thought to be less appropriate for tele-health visits.

Conclusions
Patient and physician satisfaction with tele-health in a Canadian outpatient gastroenterology setting is high. Most patients and physicians wish for tele-health to remain available in the post-pandemic setting.

Funding Agencies
Gastrointestinal Research Institute, Vancouver, British Columbia
A92 PREVIOUS VIRTUAL CONSULTATION EXPERIENCE IS RELATED TO PRECEPTOR’S WILLINGNESS TO INVOLVE TRAINEES IN VIRTUAL CARE DURING THE COVID-19 PANDEMIC
Authors: Olayinka L , Kaplan G G , Reeb L , Panaccione R , Kroeker K 
Published: March 2021

Abstract

Background
The COVID-19 pandemic has accelerated the need for healthcare service reform in order to reduce the risk of transmission of SARS-CoV-2 infection between patients, healthcare providers and medical trainees. Gastroenterologists have been challenged to adopt to virtual consultations and accommodate medical trainees in their virtual clinics.

Aims
To assess the impact of virtual care on medical education during the COVID-19 pandemic

Methods
A REDCap survey was disseminated among gastroenterology providers via email. The subsection of the survey on medical education consisted of 4 questions pertaining to inclusion of trainees in virtual clinics, type of virtual clinic, observation method and an open-ended question for additional comments. Quantitative data was analyzed using IBM SPSS Statistics 27 and qualitative theme analysis was applied for short answer responses.

Results
Of the 24 respondents that completed the survey, only 6 (25%) had trainees involved in their clinics (Table 1). The type of clinic consultations conducted were telephone only (50%), a combination of telephone, video and hospital-base telehealth (33.3%) and hospital-based telehealth only (16.7%). There was an equal split between direct and indirect observations. Preceptors that had previous experience with virtual consultation prior to the pandemic, were more likely to include trainees in their virtual clinics (66.6% vs 33.4%; Fisher’s exact test, p=0.033). For preceptors who included trainees in their virtual clinics, their overall satisfaction averaged 0.51 points lower (95% CI: 0.19–0.84, p=0.004). Concerns identified were lack of trainee engagement, adequate remuneration for healthcare providers, and lack of training for trainee and preceptors on how to navigate virtual platforms.

Conclusions
This survey demonstrates that gastroenterologists with previous experience with virtual clinics are more likely to accommodate trainees in their virtual clinics. However, involving trainees seem to reduce preceptor’s satisfaction with virtual clinic. Our findings suggest that there is a need to provide telemedicine training for both educators and trainees, in order to alleviate concerns and promote its adoption as organizations seek to continue to provide high-quality medical education while providing virtual care.

Funding Agencies
None
A95 HOW ENDOSCOPY TEACHERS MAKE POLYPECTOMY ENTRUSTMENT DECISIONS IN CLINICAL AND SIMULATION-BASED SETTINGS
Authors: Jeyalingam T , Walsh C M , Tavares W , Mylopoulos M , Hodwitz K , Liu L W , Brydges R 
Published: March 2021

Abstract

Background
Entrustment, a central construct in competency-based medical education (CBME), represents the point at which clinical supervisors trust a trainee to perform a task independently. Many implementations of CBME involve assessing entrustment through observation of entrustable professional activities (EPAs). While EPAs are frequently assessed in both clinical and simulation-based settings, research has yet to clarify how faculty who teach endoscopy form judgments of entrustment across these two contexts.

Aims
We aimed to explore the features that endoscopy teachers report as influencing their entrustment decisions regarding polypectomy across clinical and simulation-based assessment settings.

Methods
We designed an interview-based, constructivist grounded theory-informed study involving endoscopy teachers and trainees in the University of Toronto gastroenterology residency program. Teachers completed separate EPA assessments of each trainee’s performance of an endoscopic polypectomy (colonic polyps &lt; 1cm, Paris 0-Is or 0-Ip in morphology) in both settings. Teachers were interviewed after each assessment to explore how they made their entrustment decision within and across settings. Transcribed interview data were coded iteratively using constant comparison to generate themes.

Results
Based on 14 interviews with 7 endoscopy teachers, we found that they: (1) held multiple meanings of entrustment for polypectomy, both within and across participants, (2) expressed variability in how they justified their entrustment decisions, the related narrative, and numerical scoring, (3) held unique personal criteria for making decisions ‘comfortably,’ including authenticity of the task, variability in terms of polyp shape, location, and morphology, as well as the ability to assess trainee response to procedural complications (e.g., post-polypectomy bleeding), and (4) perceived a relative freedom when using simulation to make entrustment decisions due to the absence of a real patient.

Conclusions
We found that faculty who teach endoscopy defined polypectomy entrustment in a variety of ways, leading to variability in how they judged entrustment within and across trainees and assessment settings. The observed idiosyncrasies suggest gastroenterology competence committees cannot assume equivalence of EPA data obtained from different settings. Furthermore, educators designing faculty development for CBME will need to attend to the criteria that endoscopy teachers report they need to comfortably make entrustment decisions.

Funding Agencies
Royal College of Physicians and Surgeons of Canada