bluuebunny/crossref_metadata_2025_split huggingface dataset:
A99 OPTIMIZING COLONOSCOPY PROCEDURES AND REDUCING PATIENT ANXIETY THROUGH RECENTLY DEVELOPED ONLINE INFORMATION RESOURCES
Authors: Jain A , Jain R , Nugent Z , Davidson D , Solati Z , Restall G , Reynolds K , Shafer L , Singh H 
Published: March 2021

Abstract

Background
Invasive medical procedures such as colonoscopies are known to cause psychological distress and anxiety. Patient anxiety leads to reduce patient compliance for colonoscopy and increased adverse effects. Patient education prior to colonoscopy has previously been shown to have positive effects on outcomes and experience. Based on patient and provider input, we have developed easy to read written materials and easy to follow video materials, which other patients have rated highly. These, along with other materials, are embedded on Mycolonoscopy.ca. Mycolonoscopy.ca is a website that provides online information access for patients regarding preparation and peri-procedural expectations. Information about accessing the website is provided with appointment materials (which includes information about split-dose versus one day bowel preparation, giving patients the option between the two) mailed to all patients undergoing outpatient colonoscopy in Winnipeg.

Aims
(1) To evaluate the current use of mycolonoscopy.ca among patients undergoing colonoscopy (2) To determine whether there is an association between visitation to the website and patient outcomes such as reduction in procedural anxiety, bowel preparation tolerance/compliance, and bowel preparation score.

Methods
A paper-based survey was given out to patients at their colonoscopy appointments. Univariate and multivariate logistic regression analyses was performed to determine the factors associated with website visitation and association with procedural anxiety, bowel preparation compliance and bowel preparation scores.

Results
A total of 593 participants were given the surveys, of which 506 were completed. 17.4% of participants had visited the website prior to their colonoscopy. Visitors to mycolonoscopy.ca and those that had heard of the website were more likely to consume a split-dose bowel preparation (63.9% and 68.2% respectively) compared with non-visitors (52.5%) (p=0.0062). Individuals who consumed split-dose bowel preparation had a median Boston bowel preparation score of 9, compared with a score of 7 for individuals who used other forms of preparation (p&lt;0.0001). 31.3% of website visitors were very or extremely worried about their colonoscopy compared with 17.9% of non-visitors. 76.6% of individuals agreed or strongly agreed that visiting the website helped them prepare for their colonoscopy and 69.7% who visited the website agreed or strongly agreed that it helped to reduce their stress/anxiety for the procedure as well.

Conclusions
Our study suggests that use of an informative online platform such as mycolonoscopy.ca can help to improve patient education prior to colonoscopy, reduce anxiety and stress surrounding the procedure, and improve bowel preparation compliance and bowel cleansing score.

Funding Agencies
CAG
A100 END-STAGE CIRRHOSIS: EXPLORING THE PERSPECTIVES OF PATIENTS AND THEIR CAREGIVERS
Authors: Sharma S , Kelly E 
Published: March 2021

Abstract

Background
Despite therapy advances for patients with liver disease, readmission rates in patients with decompensated cirrhosis remain high. Studies have evaluated clinical risk factors influencing risk of readmission, but limited data exists on patient related outcome measures. Moreover, scant data exists on the impact of decompensated cirrhosis on caregivers.

Aims
We sought to evaluate and understand the patient experience of hospitalization and post-discharge, including factors perceived to be important by patients and their caregivers.

Methods
We identified patients who were admitted to the Ottawa Hospital for decompensated cirrhosis (October 2018-February 2019). Patients were consented to participate at the time of admission, or at the first clinic appointment with Hepatology post-discharge. Participants were administered a set of validated questionnaires exploring their experiences during their admission, and post-discharge. Questionnaires included the SF-36, Multidimensional Caregiver Strain Index, Social Support Scale, and a sociodemographic sheet. Patients were also asked to identify a caregiver, and if consented, a survey was also administered to their caregiver. Descriptive statistics were performed.

Results
A total of 20 patients and 10 caregivers were captured in the study. Of these, 72% (n=13) self-identified being disabled, retired, or unemployed and not currently looking for work, while 16% (n=3) were working full time. Income wise, 42% (n=8) of patients made between 20–50 thousand dollars, 42% (n=8) made more than fifty thousand, and n=2 had an income less than twenty thousand. With regards to education, 42% (n=8) had some college or technical school training, and 26% (n=5) were college graduates. All patients lived in stable housing, with the majority living alone (n=12, 63%). When assessing health-related quality of life, patients’ general health perception was low (34%), with significant impairment noted in physical role functioning (21%), and vitality (35%). Perceived social support was high, with 78% of patients noting they had a special person they could rely on in need, and someone they could share their feelings with. Our caregiver survey did not reveal any significant burnout trends. Caregivers expressed they were happy to care for their loved one (80%, n=8), and when asked whether they felt resentment or anger towards their spouse or family member, (80%, n=8) said never. Given the exploratory nature and small sample size of the study, we did not run statistical analyses.

Conclusions
Overall, our study revealed that patients with decompensated cirrhosis experience low health-related quality of life, however feel supported by their caregivers. Caregivers did not express significant burnout at first post-discharge visit. Larger studies and longitudinal data would be helpful to better characterize the patient experience in advanced cirrhosis.

Funding Agencies
The Ottawa Hospital Academic Medical Organization (TOHAMO) Quality & Patient Safety Grant
A101 OPTIMIZING MATERNAL AND NEONATAL OUTCOMES IN IBD: TIGHT CONTROL MANAGEMENT OF IBD DURING PREGNANCY – PILOT STUDY
Authors: Jogendran R , O’Connor K , Jeyakumar A , Huang V W 
Published: March 2021

Abstract

Background
Managing inflammatory bowel disease (IBD) during pregnancy is challenging as pregnancy-related symptoms may overlap with symptoms of active IBD. Fecal calprotectin (FCP) is an optimal non-invasive measure of assessing disease activity during pregnancy. However, regular FCP during pregnancy may be impractical due to collection techniques. Rather, a home point-of care rapid lateral assay FCP test such as IBDoc® and a self-reported clinical disease activity program (IBD Dashboard) may be beneficial in routine monitoring of IBD activity during pregnancy.

Aims
To assess whether tight control of objective IBD disease activity using a point-of-care FCP (IBDoc®) monitoring is concordant with self-reported clinical symptoms (IBD Dashboard) in pregnant women with IBD.

Methods
Pregnant patients, aged ≥18 years, with IBD (Crohn’s Disease (CD) or Ulcerative colitis (UC)), in the 1st trimester (&lt;13 weeks) with a singleton pregnancy were identified and enrolled. Patients were required to have access to a smartphone and internet to use the IBDoc® and IBD Dashboard. Patients completed a IBDoc® FCP and IBD Dashboard assessment at three study time points, 1) screening/baseline in 1st trimester, 2) 2nd trimester (14 to 18 weeks), and 3) 3rd trimester (28 to 32 weeks). Clinical disease activity was assessed by the modified HBI (Harvey Bradshaw Index) for CD and partial Mayo Index (pMayo) for UC. Elevated FCP (≥250 µg/g), mHBI ≥5 or pMayo ≥2 triggered an intervention to investigate or optimize therapy if required. A 5-point Likert scale questionnaire assessed patient satisfaction and feasibility of the IBDoc® and IBD Dashboard. Median values with interquartile ranges (IQR) were calculated for all continuous variables using SPSS.

Results
29 patients (17 CD, 12 UC) were included. Median mHBI and pMayo were 2.0 (IQR 2.0) and 0.5 (IQR 1.25) respectively. A total of 17.6% (3/17) of CD patients, and 25.0% (3/12) of UC patients had active clinical disease. Median IBDoc® FCP was 73 µg/g (IQR 343) in the CD group and 267 µg/g (IQR 677) in the UC group. At baseline, disease activity was categorized into four groups: 1) clinical remission (CR) and normal FCP (n=16, no treatment Δ, 100% stayed in CR); 2) clinical disease and elevated FCP (n=5, treatment Δ in all five patients, 80% stayed in CR, 20% had a clinical flare); 3) clinical remission and elevated FCP (n=5, treatment Δ in three patients, 100% stayed in CR); 4) clinical disease and normal FCP (n=1, no treatment Δ, 100% stayed in CR). Median IBDoc® and IBD Dashboard feasibility scores were 5.0 (IQR 1.0).

Conclusions
A combination of both clinical scores and objective disease markers may better predict disease relapse compared to either clinical scores or objective markers in isolation. A home point-of-care FCP test is feasible among pregnant patients with IBD.

Funding Agencies
None
A103 PIVOTING IN A PANDEMIC: THE IMPACT OF COVID-19 ON THE PROVISION OF CARE FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PRELIMINARY ANALYSIS
Authors: Malhi G , Mikail M , Minhas G , Chambers J , Khanna R , Wilson A 
Published: March 2021

Abstract

Background
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, also known as COVID-19, was declared a worldwide pandemic in March of 2020. Since the onset of the pandemic, the focus of many healthcare systems has shifted toward limiting non-essential visits to hospitals in order to prioritize and allocate resources toward treating those affected by COVID-19, and preventing further exposures. While the effect of COVID-19 has been felt amongst many patient populations, those with inflammatory bowel disease (IBD) have been particularly impacted through delayed appointments and endoscopy, which is critical in disease monitoring.

Aims
We aimed to determine how changes to the provision of IBD care due to the COVID-19 pandemic have affected IBD patients.

Methods
A retrospective cohort study was conducted using administrative data comparing IBD patients admitted to the gastroenterology ward from March 17 to August 31 2019, with IBD patients admitted from March 17 to August 31 2020 at a tertiary care centre in London, Ontario. Patients were reviewed to assess differences in care utilization and IBD-related outcomes such as hospitalization, surgery and length of stay and in-patient drug therapy.

Results
A total of 538 patients (259 in 2019 cohort and 279 in 2020 cohort) were reviewed with 48 and 60 IBD patients meeting the inclusion criteria for 2019 and 2020 respectively. Patient demographics were similar between 2019 and 2020 cohort for age, sex, rurality, disease type, and biologic exposure. A greater proportion of patients were admitted with IBD flares in 2020 (86.7% vs 75%, p=0.03). Furthermore, the 2020 cohort also had a 45% increase in in-patient surgical consultations (p=0.07), a 50% increase in in-patient IBD-related surgeries (p=0.39), a 69% increase in inpatient Remicade prescription (p=0.13) and a 70% increase in infectious complications at presentation to hospital (p=0.21). A shorter median length of stay was reported for patients in the 2020 cohort (4 days IQR 3.95 vs 5.85 IQR 4.65, p=0.09).

Conclusions
Preliminary data suggest that during the COVID-19 pandemic, we have seen more deleterious outcomes in our IBD patients such as increased flares necessitating hospital admission. There was also a non-significant trend toward increased infectious complications as well as in-patient surgeries and need for in-patient Remicade. Though these results cannot be fully interpreted due to the need for further sampling, they suggest that IBD patients may be at-risk for poor outcomes in the current climate of medical care. Completion of this study will help define the full impact of care shifts related to reducing the spread of the novel coronavirus on IBD patients and highlight areas of care that need careful assessment and consideration to protect IBD patient health.

Funding Agencies
None
A107 IMPROVING ACCESS TO URGENT GASTROENTEROLOGICAL CONSULTATION: A POSITIVE PANDEMIC IMPACT
Authors: Stewart M J , Kohansal A R , Peltekian K , Jones J 
Published: March 2021

Abstract

Background
The global COVID-19 pandemic has resulted in a dramatic re-alignment of clinical service delivery. In mid-March 2020 the Division of Digestive Care and Endoscopy at Dalhousie University leveraged eHealth technology to rapidly implemented a new referral management and triage system and established a new rapid outpatient consultation service to facilitate urgent virtual and face-to-face appointments. Standardized procedures for triaging, booking, and staffing the urgent gastroenterology consultation service were implemented.

Aims
The aim of this study was to evaluate the impact of the implementation of a standardized triage and consultation process on access to urgent gastroenterology consultative services at a single tertiary care center during the COVID-19 pandemic.

Methods
We performed a pre- and post-implementation study comparing efficiency metrics for urgent triage and urgent consultation. The pre-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2019 to September 30, 2019. The post-implementation cohort included all patients referred and triaged to an urgent clinic appointment between April 1, 2020 to September 30, 2020.
Healthcare efficiency data was extracted through electronic record review with specific dates and times for referral receipt (a), triage completion (b), appointment wait-listing (c), and clinic appointment (d). The time to triage (TT), time to visit (TV), and total time to consult (TC) were calculated (TT = c - a; TV = d - c; TC = TT + TV) for each patient. The Mann–Whitney U test was used to compare TT, TV, CT between patient cohorts.

Results
A total of 429 patients were booked for urgent clinic consultation, 176 during the pre-implementation period and 253 in the post-implementation period. The mean TT for the pre-and post-implementation cohorts was 4.8 days and 3.3 days, respectively (U=18,149, p=0.001). Mean TV was decreased from 16.2 days for the pre-implementation cohort to 3.6 days for the post-implementation cohort (U=6095, p=0.000). The mean time from a referral being received to the patient being seen in consultation (TC) decreased by 67% from 21 days to 6.9 days, Figure 1 (U=6,419, p=0.000).

Conclusions
The COVID-19 pandemic has had a dramatic impact on healthcare delivery in Nova Scotia. One positive result is that it facilitated the motivation and alignment needed to make a large health system change that may not have otherwise been possible. This study demonstrates that a standardized pathway for urgent outpatient gastroenterology assessment improves the timeliness of care delivery.

Funding Agencies
None
A114 DEVELOPING AND VALIDATING A PATIENT RISK ASSESSMENT TOOL TO PREDICT POST-ERCP PANCREATITIS
Authors: MacMillan R A , Ponich T 
Published: March 2021

Abstract

Background
Post-ERCP pancreatitis (PEP), the most common complication of ERCP, can lead to significant patient morbidity and even mortality. Both American (ASGE) and European (ESGE) guidelines emphasize the importance of assessing PEP risk among patients about to undergo ERCP so appropriate preventative measures can be initiated. Though multiple PEP risk factors have been identified, an ideal risk assessment tool has not yet been developed that accurately predicts PEP risk among ERCP patients. An ideal PEP risk factor screening tool would be one that most sensitively identifies patients likely to benefit from PEP preventative measures. We have developed a patient PEP risk screening tool based on both ASGE and ESGE guidelines (Table 1) and analyzed its accuracy predicting PEP rates in our clinical practice.

Aims
We investigated whether the ERCP patient and procedural risk factors listed in the ASGE and ESGE guidelines were linked to PEP rates using a novel PEP risk screening tool in patients undergoing ERCP.

Methods
Retrospective chart reviews of patients undergoing ERCP were performed within a single clinician’s practice at the London Health Science Centre, Victoria Hospital, between January 2016 and October 2019 to: 1) assess the proportion of patients identified as high PEP risk using our novel PEP risk screening tool; 2) determine whether a high PEP risk score using this tool was linked to higher PEP rates following ERCP; and 3) identify the absolute score threshold that best delineates patients at higher risk. A chi-square test of independence was performed to examine the relationship between high PEP risk identified via screening and the actual PEP rate following ERCP.

Results
Five hundred sixty-one patients who underwent ERCP were assessed using the new PEP risk screening tool. Among those patients, 6.6% (37/561) developed post-ERCP pancreatitis. Using the screening tool, 79.5% (446/561) were identified as high risk, using a cut-off score of 1; the score with the highest sensitivity (95%) and specificity (22%) combination. Identifying high PEP risk patients at this cut-off was significantly linked to increased PEP rates in patients who underwent ERCP (X2 = 5.5; df = 1, p &lt; .05).

Conclusions
Using a cut-off score of 1, the PEP risk screening tool was very sensitive, but relatively non-specific at identifying patients who went on to develop post-ERCP pancreatitis. We hope that, based on these findings, high-risk patient identification can be improved, so more aggressive and appropriately-targeted prophylactic measures against PEP can be provided.

Funding Agencies
None
A133 GASTRIC ESD: PRELIMINARY EXPERIENCE IN A TERTIARY CENTER IN QUEBEC
Authors: Maillet D , Desilets E , Maniere T 
Published: March 2021

Abstract

Background
Endoscopic submucosal dissection (ESD) is an endoscopic procedure developed in Asian countries to treat early gastric cancer (EGC). Western countries have less experience with this challenging technique.

Aims
The goal of this study is to evaluate the effectiveness of ESD as a preliminary experience.

Methods
This is an unicentric retrospective study of all consecutive gastric ESD for adenomas or EGC from 07/2017 to 08/2020. The primary endpoints were en bloc and R0 resection rates.

Results
Nineteen patients (mean age 74.2 (54–88), sex ratio 3F/16M) and 23 lesions were included. Mean diameter was 25 mm (10–90). Treatment was previously performed in 7 cases (30.4%), by ESD (5) or EMR (2). The procedure, performed under general anaesthesia, lasted on average 148 minutes (45–412). En bloc resections were performed in 16 cases (69.6%); 5 cases (21.7%) were converted to P-EMR and there was a failure to resect the lesion because of deep invasion or perforation in 2 cases (8.7%). Pathologic examination demonstrated 2 low-grade dysplasia, 4 high-grade dysplasia and 15 adenocarcinomas: intramucosal (8), sm1 (2), sm2 (2), sm3 (1) or sm deep (2). R0 and curative resection rates were 43.5% and 39.1% respectively. The complication rate related to the procedure was 30.4% including 5 perforations and 2 delayed bleeding: all were managed endoscopically. Five patients (21.7%) underwent subsequent gastrectomy for non-curative resection (4) or failed resection (1); 3 had no residual disease on final pathology, 1 had high grade dysplasia and 1 had intramucosal adenocarcinoma. One patient went to palliative care because he was unfit for surgery. Follow-up endoscopy was completed in all 17 patients who underwent endoscopic resection (mean 10 months (2–24)). Recurrence occurred in 23.5% (4/17); all were successfully treated by another ESD.

Conclusions
In our preliminary experience, the rate of en bloc and R0 resection were 70% and 44%. Compared to other studies, these low en bloc and curative resection rates may be explained by technically difficult lesions during the learning curve and might improve with experience. Nevertheless, surgery has been avoided in 13/19 patients (68%) with endoscopic intervention.

Funding Agencies
None
A140 OUTCOMES OF ENDOSCOPIC ABLATIVE THERAPY AND SURGICAL MANAGEMENT IN BARRETT’S ESOPHAGUS: DEVELOPMENT OF A MULTIDISCIPLINARY DATABASE
Authors: Wilson H A , Blakely P , Sun W , Dang J , Karmali S , Wong C 
Published: March 2021

Abstract

Background
Barrett’s Esophagus (BE) is a precancerous condition in which epithelial cells of the esophagus undergo metaplasia from stratified squamous to simple columnar. This metaplasia predisposes the epithelial cells to a stepwise progression of dysplasia, and ultimately esophageal adenocarcinoma. The risk for developing malignancy increases with greater degrees of dysplasia; therefore, current intervention is focused on reducing the incidence and progression of dysplasia. There is good evidence that endoscopic therapies, such as resection and ablation, are effective at treating dysplasia in BE; however, the optimal modality to reduce recurrence is unclear. While proton pump inhibitors (PPI) remain the mainstay of medical treatment, fundoplication may be indicated for failure of medical therapy and patients with anatomical defects such as hiatal hernias. There is currently a lack of guidelines for optimal combined medical and surgical treatment for patients with BE who have received endoscopic treatment.

Aims
Our aim is to create a novel multidisciplinary database of endoscopically treated patients with BE that will allow us to monitor long-term outcomes and disease progression.

Methods
A systematic review on the impact of fundoplication on the progression of BE to dysphagia and adenocarcinoma is underway. Using an existing database as a foundation, we developed a prospective database of patients with BE using RedCAP, a secure cloud-based database. Feedback from specialists in both Gastroenterology and General Surgery contributed to a database that is to our knowledge, the first to combine medicine and surgery.

Results
As proof of concept, we entered seven participants’ information into the database. The majority of participants had risk factors for BE, including caucasian ethnicity, male gender, age &gt; 50 years, and elevated BMI. Five came from the endoscopic ablation program and two were referred by surgery. Four patients underwent laparoscopic Nissen fundoplication, of which three had concurrent hiatal hernia repairs. Two have been seen for post-surgical surveillance. One remained dysplasia free PPI dose was reduced. The other demonstrated a reduction of BE, but continued the same dose of PPI and is scheduled to receive ablation therapy.

Conclusions
Our preliminary results indicate our database can successfully monitor both medical and surgical parameters of patients with BE. With additional participants and longitudinal data, we are positioned to provide evidence-based guidelines to treat and monitor endoscopically treated patients with BE from both a medical and surgical perspective.

Funding Agencies
None