bluuebunny/crossref_metadata_2025_split huggingface dataset:
A87 HEALTHCARE PROVIDER SATISFACTION WITH VIRTUAL CARE DELIVERY IN ALBERTA DURING THE COVID-19 PANDEMIC.
Authors: Olayinka L , Kaplan G G , Reeb L , Panaccione R , Kroeker K 
Published: March 2021

Abstract

Background
In light of the COVID-19 pandemic, gastroenterologists in Alberta moved to virtual care for many clinic visits. As the public health situation evolves, it is important to evaluate provider satisfaction with virtual care during these unprecedented times.

Aims
To assess healthcare provider (HCP) satisfaction with virtual care during the COVID-19 pandemic.

Methods
We administered a 20-item satisfaction survey that assessed the usefulness, ease of use, interface qualities, reliability, and overall satisfaction with virtual care tools for the delivery of care to patients with gastrointestinal diseases. One hundred and twenty-five gastroenterologists in Alberta were invited to participate via email. We used a modified Telehealth Usability Questionnaire (TUQ) which was open for response from June 19-August 30, 2020.

Results
The overall response rate was 19% (24/125) with 46% female respondents. Most respondents worked in an academic facility (63%) and had been in practice for a mean duration of 12.3 years. Respondents were from seven facilities within the South, Calgary, Central and Edmonton health zones. Virtual care reported was a hybrid model consisting of telephone and in-person (54%) or telephone and video consults (42%). Although 90% indicated that virtual care tools improved access to healthcare, provided location flexibility and were appropriate to meet healthcare needs, only 42% agreed that it saved time. Inconclusive virtual consultations due to the absence of physical examination and missing lab values was reported by 75% and 33% of HCPs, respectively. Ninety-five percent of HCPs who used video conferencing found it simple, easy to learn and were able to become productive quickly with it. Over 60% of HCPs reported that virtual care (irrespective of the platform used) was not the same as in-person visits. The mean overall satisfaction for HCPs who rarely or never had virtual care prior to the pandemic, was 0.57 points higher than those who often provided virtual care (4.36 vs 3.79; 95% CI: 0.26–0.88, p=0.001). Overall, 88% of providers were satisfied with virtual care and all respondents were willing to use it again (Figure 1). Identified areas of concern included patient safety, patient education on best practices, adequate remuneration, additional administrative duties, and challenges with providing care for new patients on virtual platforms.

Conclusions
This survey of GI providers in Alberta showed high satisfaction and acceptance with virtual care. However, the majority reported it to be less reliable than in-person visits. Access to Alberta Netcare to view investigations was deemed valuable. Areas of concern that needs to be addressed include patient education on virtual care best practices and provider resources to assist with new consultations on virtual platforms.

Funding Agencies
None
A90 A PROPENSITY SCORE-MATCHED, STATE-LEVEL COMPARISON OF INPATIENT CIRRHOSIS OUTCOMES IN ENGLISH VS NON-ENGLISH SPEAKING PATIENTS
Authors: Sedarous M , Alayo Q , Subramanian K , Nwaiwu O , Okafor P N 
Published: March 2021

Abstract

Background
United States (US) citizens speaking a foreign language at home has increased by 192% from 1980 to 2018.

Aims
With the increase in multiculturalism and ongoing concerns for health disparities in the US, we sought to compare inpatient outcomes between non-English speaking and English-speaking patients with cirrhosis.

Methods
The 2013–14 Maryland State inpatient databases were used to compare inpatient outcomes in adult patients with cirrhosis. The analysis cohort was identified using a validated algorithm of ICD-9 codes. Cirrhosis patients were stratified based on primary language into non-English-speaking patients [NESP] vs English-speaking patients [ESP]. A 1:3 propensity score matching analysis based on possible confounders was used to finalize the analysis cohort. The primary outcome (all-cause in-hospital mortality) and secondary outcomes including 30-day all-cause readmission rates, length of stay, total hospitalization charges were then compared between groups.

Results
In the study period, 3,035 NESP vs 21,212 ESP discharges were identified. We matched 1,659 NESP with 4,928 ESP using a 1:3 algorithm. Table 1 highlights demographic data. In the unmatched analysis, all-cause mortality was higher in the ESP cohort compared to NESP (6.71% vs 5.73%, p=0.046). However, after propensity-matching, inpatient mortality rate became comparable between both groups (6.45% vs 6.51%, p=0.9). Thirty day all-cause readmission rates were also similar between ESP vs NESP (4.87% vs 4.28%, p=0.18). Median length of stay in the ESP group was 4 days (IQR 3–8) vs 5 days (IQR 3–7) in the NESP group, while median total charges in ESP were $55,984 (IQR $33,897-$98,679) compared to $61,262 (IQR $36,228-$$108,369) in NESP.

Conclusions
While significant differences in socioeconomic status and payer type exist between non-English and English speaking cirrhosis patients, these do not appear to negatively impact inpatient outcomes including all-cause inpatient mortality, 30-day readmission rates, length of stay, total hospital charges.

Funding Agencies
None
A105 RAPID INTERDISCIPLINARY IBD CLINIC RESULTS IN TIMELY IBD WAIT TIMES, IMPROVED PATIENT SATISFACTION & PATIENT REPORTED OUTCOMES
Authors: Buffone E , Jogendran R , Broni E , O’Connor K , Panayotova K , Kennedy E , Steiman A , Maxwell C , Alavi A , Weizman A V , Huang V W 
Published: March 2021

Abstract

Background
Inflammatory Bowel Disease (IBD) patients often have disease flares and extraintestinal manifestations such as rashes, arthralgias & perianal fistulas that require timely assessments. We implemented a Rapid Interdisciplinary IBD program at Mount Sinai Hospital with expedited consultation by an IBD specialist and referral with clinical need to collaborative colorectal surgeon, dermatologist, rheumatologist, and/or high-risk obstetrician. The RAPID program includes an online IBD Dashboard for patients to respond to questionnaires which is closely monitored 90 days post-enrolment by the IBD nurse.

Aims
To assess the implementation of an Interdisciplinary IBD Clinic & online IBD Dashboard monitoring system on the ability to increase patient satisfaction regarding their IBD care.

Methods
Upon consent into the RAPID IBD program, patients are enrolled to the IBD Dashboard and complete a Patient Satisfaction (CACHE) questionnaire at baseline, 3, 6, 12 months follow up and clinical disease activity scores at baseline, 1, 2, 3 months post enrollment; the Modified Harvey Bradshaw Index (mHBI) for Crohn’s disease (CD); partial Mayo score and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC) and IBD unclassified (IBDU) patients. Results were compared pre/post enrollment with changes in median and interquartile ranges (IQR).

Results
109 patients were referred to RAPID, 88 (49 CD, 33 UC, 6 IBDU) enrolled & 62 consented to IBD Dashboard monitoring. Of those enrolled, 40 patients were referred based on flaring of clinical scores, 23 with potential flare or complication, 17 with acute extraintestinal manifestations, 4 pregnant and 4 with perianal disease. Median 4 (2–7) days to first GI IBD clinic. 15 patients were referred to dermatology, 12 to colorectal surgery, 8 to rheumatology and 3 to obstetrics. 6 patients visited the ER within the first 90 days after enrollment, with 1 (1–2) ER visits. Patient satisfaction improved from baseline 73.5% (68.4%-77.4%) (n=53) to 82.3% (75.5% - 84.0%) at 3 months (n=28). Clinical responses were seen post enrollment with a decrease in mHBI of 3.0 at 2 months, 1.5 on the 6-point Mayo (SF + RB) at 1 & 3 months and patient defined significant improvement in SCCAI greater than 1.5 after 1 month.

Conclusions
Preliminary results with RAPID IBD program demonstrate a short time to be seen by an IBD specialist, improvement in patient satisfaction and clinical responses in mHBI, pMayo and SCCAI scores 1–3 months post enrollment.

Funding Agencies
AMO
A106 BENZOCAINE-INDUCED METHEMOGLOBINEMIA: A RARE BUT POTENTIALLY FATAL COMPLICATION OF TOPICAL ANESTHETIC USE IN ESOPHAGOGASTRODUODENOSCOPY
Authors: Ricci M , Gillis C 
Published: March 2021

Abstract

Background
Methemoglobinemia is an uncommon and potentially lethal condition arising when the iron moiety of heme is oxidized from the ferrous (Fe2+) to ferric (Fe3+) state, causing a disruption of O2 binding and impairment of O2 delivery to tissue. There are two forms of methemoglobinemia: inherited and acquired. Acquired methemoglobinemia is caused by medications, including topical anesthetics (TAs) used in esophagogastroduodenoscopy (EGD).

Aims
To raise awareness of this serious complication of TA use.

Methods
A 66-year old woman underwent EGD for dysphagia and globus sensation. Her past medical history included gastroesophageal reflux disease, paraoesophageal hernia, coronary artery disease, and hypertension. Prior to EGD, her oropharynx was anesthetized with benzocaine spray and she was sedated with fentanyl 100 mcg and midazolam 3 mg. EGD was unremarkable. At completion she required no supplemental oxygen (SpO2 96%). In recovery, she became drowsy and cyanotic. Vital signs revealed an SpO2 of 86% that did not improve with 4L supplementary O2 via nasal prongs. Aside from cyanosis, physical examination was normal. ECG, chest X-ray, and CT scan with pulmonary embolism protocol did not identify a cause for hypoxia. Arterial blood gas (ABG) revealed dark brown blood with an PaO2 of 397 mmHg. Methemoglobinemia was suspected and confirmed with a serum methemoglobin (MHg) level of 18% (ref &lt;3%).

Results
Intravenous methylene blue (1g/kg) was administered with complete resolution of symptoms. She was admitted for monitoring and discharged the next day with no sequelae.

Conclusions
Methemoglobinemia is a rare condition (incidence 1/7000 procedures) of increased MHg due to the oxidation of iron in heme, compromising oxygen binding/offloading and delivery to tissues. Normal MHg levels are &lt;3%, which is maintained by NADH-MHg reductase. This enzyme reduces Fe3+ to Fe2+. TAs cause elevated methemoglobinemia by oxidizing iron (Fe2+ to Fe3+) at a rate 100-1000x faster than NADH-MHg reductase can reduce it. Benzocaine has been associated with a 3.7- fold higher risk of methemoglobinemia than other topical anesthetics, and the risk is not dose-dependent. Presentation varies with degree of MHg. Hallmark signs of cyanosis, impaired SpO2 with normal ABG, and “chocolate-colored” blood occur at levels&gt;10%. Death/coma occurs at levels &gt;50%. Incidence is idiosyncratic; however, those with smoking history or underlying cardiac/lung disease are at elevated risk for poor outcomes. The activity of NADH-MHg reductase is increased by methylene blue. When administered at doses of 1-2g/kg, it rapidly reduces MHg, restoring the physiological equilibrium. TAs are used routinely in EGD. Gastroenterologists who use TAs in procedures need to be aware of the association between TAs and methemoglobinemia. Prompt recognition/treatment will prevent morbidity/mortality.

Funding Agencies
None
A111 THE CANADA-GLOBAL RATING SCALE: USE OF AN INNOVATION LEARNING COLLABORATIVE METHODOLOGY TO GUIDE PROVINCIAL IMPLEMENTATION IN ALBERTA
Authors: Sadowski D , Oilund C , Moysey B , Greenaway M , Jelinski S , Morrin L , McInnis N , Nemecek N , Snider J , Underwood F , Wong C , Veldhuyzen Van Zanten S 
Published: March 2021

Abstract

Background
The Canada-Global Rating Scale (C-GRS) is a web-based, patient centered endoscopy quality improvement tool. It assesses the quality of the services an endoscopy unit provides in two dimensions: clinical quality and the quality of the patient experience. It also allows each endoscopy unit to choose priority areas for future QI activities. Scores are submitted twice a year to a centralized website by the local endoscopy site’s C-GRS working group.
Uptake of the C-GRS in Alberta has been historically poor with only 22/50 sites submitting a C-GRS survey in 2016. A provincial C-GRS project team was formed in 2018 to spearhead provincial implementation of the C-GRS. Alberta Health Services approved a C-GRS policy in 2020 mandating regular use of the C-GRS in all provincial endoscopy units.

Aims
The purpose of this project is to describe a process of focused C-GRS implementation using Innovation Learning Collaborative (ILC) methodology.

Methods
An ILC is a process meant to drive clinical pathway practice changes to achieve system-wide improvements. Inter-professional teams meet at least three times over a 12–18 month period at Learning Sessions to share successes, learnings, resources and data. A balanced scorecard (Figure 1) is used to track C-GRS progression and regression. Action Period meetings are held in between the Learning Sessions to help build collaboration and support the teams.

Results
The first of three in-person ILC Learning Sessions was successfully held on November 29, 2019. 37 out of 50 sites in Alberta attended. Each site committed to working on up to 6 C-GRS descriptors during the course of the ILC. An updated scorecard is provided after each C-GRS cycle. An average of 25 sites attended Action Period meetings to report on progress and to share learnings with other sites. 44 endoscopy sites submitted a follow-up C-GRS survey in the spring 2020 cycle (an increase of 22 from 2016). 84% of sites demonstrated improvement with the average number of items improved at 5.1

Conclusions
Use of ILC methodology with a balanced scorecard approach can achieve system level improvement within a relatively short time frame.

Funding Agencies
None
A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT
Authors: Sey M , Siddiqi O , McDonald C , cocco S , Hindi Z , Rahman H , Chakraborti D , French K , Alsager M , Blier M , makandey b , Al-obaid S , Wong A , Siebring V , Brahmania M , Gregor J C , Khanna N , Teriaky A , Wilson A , Guizzetti L , Yan B , Jairath V 
Published: March 2021

Abstract

Background
Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence.

Aims
The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics.

Methods
A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation.

Results
A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1).

Conclusions
Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate.
Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes.

Funding Agencies
None
A115 A SYSTEMATIC REVIEW AND META-ANALYSIS OF LOWER GASTROINTESTINAL BLEEDING RISK SCORES TO PREDICT ADVERSE OUTCOMES
Authors: Almaghrabi M M , Gandhi M , Guizzetti L , Iansavitchene A , Oakland K , Jairath V , Sey M 
Published: March 2021

Abstract

Background
Acute lower gastrointestinal bleeding (LGIB) is a common reason for emergency hospitalization. In most patients, bleeding resolves spontaneously but some cases can be fatal. Risk prediction scores can be useful in risk stratifying patients with LGIB at the time of presentation although the most discriminative LGIB risk score is unknown.

Aims
To perform a systematic review and meta-analysis comparing LGIB risk prediction scores.

Methods
Following the PRISMA statement, a systematic search for relevant publications after 1990 was conducted in Ovid Medline, EMBASE, Web of Science and CENTRAL electronic databases. We also searched published conference abstracts over the past 5 years. Studies with a primary aim of deriving or validating a LGIB risk score were included. Title and abstracts were reviewed by two independent reviewers followed by full text review and data extraction by both reviewers. Diagnostic classification data for combinations of risk score and clinical outcome were meta-analyzed using a hierarchical summary receiver operator characteristic curve (ROC) model, allowing for random-effects by study, and fixed-effect of the risk score thresholds to influence both sensitivity and specificity. Area under the summary ROC were estimated from model parameters for the pre-specified LGIB risk score thresholds-of-interest.

Results
Our search identified 2,331 citations for review, of which 100 remained after the title and abstract screen, and 18 ultimately met criteria for inclusion in the meta-analysis after full text review. From these, we identified 21 risk prediction scores for LGIB, although only four had sufficient number of papers to meta-analyze (Oakland, Strate, NOBLADS, and BLEED score). For the outcome safe discharge from hospital, the Oakland score had an area under the receiver operating characteristics curve (AUROC) of 85.5% (95% CI: 82.1%, 88.3%). For the outcome major bleeding, the Oakland score had an AUROC of 78.9% (95% CI: 75.1%, 82.2%); the Strate score had an AUROC of 74.4% (95% CI: 70.4%, 78.0%); the NOBLADS score had an AUROC of 60.3% (95% CI: 55.9%, 64.5%); and the BLEED score had an AUROC of 65.6% (95% CI: 61.4%, 69.7%). For the outcome, need for hemostasis, the Oakland had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the Strate score had an AUROC of 82.1% (95% CI: 78.5%, 85.2%); the NOBLADS score had an AUROC of 23.9% (95% CI: 20.3%, 27.8%). For the outcome, need for transfusion, the Oakland score had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the NOBLADS score had an AUROC of 87.7% (95% CI: 84.5%, 90.3%).

Conclusions
The Oakland score was the most discriminative risk prediction model for safe discharge from hospital, major bleeding, need for hemostasis, and need for transfusion.

Funding Agencies
None
A116 PROPHYLACTIC CLIPPING TO PREVENT DELAYED COLONIC POST-POLYPECTOMY BLEEDING: META-ANALYSIS OF RANDOMIZED AND OBSERVATIONAL STUDIES
Authors: Bishay K , Meng Z , Frehlich L , James M T , Kaplan G G , Bourke M J , Hilsden R J , Heitman S , Forbes N 
Published: March 2021

Abstract

Background
Delayed post-polypectomy bleeding (DPPB) is a commonly described adverse event following polypectomy. Prophylactic clipping may prevent DPPB in some patient subgroups. We performed a meta-analysis to assess both the efficacy and real-world effectiveness of prophylactic clipping.

Aims
We performed a meta-analysis to assess both the efficacy and real-world effectiveness of prophylactic clipping.

Methods
We performed a database search through March 2020 for clinical trials or observational studies assessing prophylactic clipping and DPPB. Pooled risk ratios (RR) were calculated using random effects models. Subgroup, sensitivity and meta-regression analyses were performed to elucidate clinical or methodological factors associated with effects on outcomes.

Results
A total of 2,771 citations were screened, with 11 randomized controlled trials (RCTs) and 9 observational studies included, representing 24,670 colonoscopies. DPPB occurred in 2.0% of patients overall. The pooled RR of DPPB was 0.47 (95% CI 0.29 – 0.77) from RCTs enrolling only patients with polyps ≥ 20 mm. Remaining pooled RCT data did not demonstrate a benefit for clipping. The pooled RR of DPPB was 0.96 (95% CI 0.61 – 1.51) from observational studies including all polyp sizes. For patients with proximal polyps of any size, the RR was 0.73 (95% CI 0.33 - 1.62) from RCTs. Meta-regression confirmed that polyp size ≥ 20 mm significantly influenced the effect of clipping on DPPB.

Conclusions
Pooled evidence demonstrates a benefit when clipping polyps measuring ≥ 20 mm, especially in the proximal colon. In lower-risk subgroups, prophylactic clipping should not be performed.

Funding Agencies
None
A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY
Authors: Taghiakbari M , Pohl H , Djinbachian R , Barkun A N , Marques P , Bouin M , Deslandres E , Panzini B , Bouchard S , Weber A , von Renteln D 
Published: March 2021

Abstract

Background
Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance.

Aims
This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent.

Methods
The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment.

Results
Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p &lt;0.0001), and were inferior to the location-based strategy. The location-based resect and discard strategy allowed a 69.7% (95% CI = 0.67 - 0.72) reduction in pathology examinations compared with 55.3% (95% CI = 0.52 - 0.58) (NICE and Sano) and 41.9% (95% CI = 0.39 - 0.45) (WASP) with optical diagnosis.

Conclusions
The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.

Funding Agencies
None