bluuebunny/crossref_metadata_2025_split huggingface dataset:
P539 Unmet needs in advanced therapy-naïve (ATN) and advanced therapy-experienced (ATE) moderate-to-severe (mod-sev) ulcerative colitis (UC) patients in the United States (US)
Authors: Afzali A , Kakehi S , Lapensee K , Lukanova R , Hennessy F , Knight H , Singh K 
Published: May 2021

Abstract

Background
About a third of patients with mod-sev UC receiving advanced therapy (AT, i.e. biologics and tofacitinib) do not respond initially and another third lose response. We examined reasons for treatment choice and outcomes in ATN and ATE mod-sev UC patients.

Methods
A point-in-time survey of US gastroenterologists and their respective consulting UC patients was conducted from Jan 2020–Feb 2021 (ongoing) using the Adelphi Disease Specific Programme™ for Inflammatory Bowel Disease. Physicians completed patient record forms for UC patients with a history of mod-sev disease covering treatment history and clinical status. Patients were classified as ATN and ATE based on treatment. Response to treatment status was identified by factor and cluster analyses using flare, remission and change in symptoms. Descriptive and comparative statistics were calculated for reasons for initiating/switching therapy and patient-reported outcomes (satisfaction, pain/fatigue, and quality of life via the EuroQol-5 dimension questionnaire [EQ-5D]).

Results
Based on the interim sample, 66 physicians and 394 mod-sev UC patients were analysed. Of patients who were ATN (n=82) and ATE (n=312), 29% and 32% were classified as non-responders respectively. Comparing ATN vs ATE patients, mean age was directionally lower (38.4 vs 40.7 years), proportion of males was directionally higher (65% vs 55%), and mean time since diagnosis was similar (3.9 vs 3.8 years). In general, non-responders experienced gastrointestinal-related (90% vs 41%), anorectal (38% vs 6%), and fatigue-related symptoms (66% vs 23%) more frequently than responders. ATN patients eligible to receive AT (n=26) reported dislike of injections/infusions (46%) or unwillingness to go to infusion centres (31%) as reasons for not receiving AT. Most common reasons for switching therapy in ATN patients were disease progression (40%) and lack of tolerability (27%), and in ATE patients were loss of response over time (43%) and disease progression (35%). In the ATE group, patient and physician satisfaction rates were higher in responders vs non-responders (&gt;93% vs &lt;79%), pain and fatigue scores were lower (0.8 vs 2.3 and 1.1 vs 2.3, p&lt;0.0001), and EQ-5D scores higher (0.93 vs 0.81, p=0.005). In the ATN group, comparisons were not conducted due to small sample sizes.

Conclusion
In this point-in-time survey study with data collected during the COVID-19 pandemic period, about a third of mod-sev UC patients did not respond to current therapy. These results suggest an opportunity for new therapies that increase response rates, provide long-term disease control, provide alternatives to parenteral routes of administration, and enhance patient satisfaction.
P554 Does vitamin D level correlates with disease activity in inflammatory bowel disease patients?
Authors: Sina M , Pemaj X , Akshija I , Hysa A , Koçollari A , Prifti S 
Published: May 2021

Abstract

Background
Vitamin D exerts an important role in the immune regulation. Several studies from the Western countries showed low level of vitamin D among inflammatory bowel disease (IBD) patients. They also showed that vitamin D may have an influence on disease activity. Data from the Eastern Europe are scarce. The aim of this study was to evaluate vitamin D level and the association between vitamin D and disease activity in biologic naïve patients with IBD.

Methods
This is a prospective study carried out at a tertiary hospital center in Albania from 2016–2020 including consecutive biologics–naïve IBD patients. Demographic and clinical data [age, gender, body mass index (BMI), disease location, extent, activity and duration) were collected. All patients underwent ileocolonoscopy. Vitamin D level and C-reactive protein (CRP) were measured within 2 weeks of their ileocolonoscopy. Montreal classification was used to evaluate the disease extent, while total Mayo score and Crohn’s disease activity index (CDAI) were used to assess disease activity in patients with ulcerative colitis (UC) and Crohn’s disease (CD) respectively. Vitamin D levels were considered as: normal &gt;30ng/ml; insufficient 10–30 ng/ml; deficient &lt;10ng/ml.

Results
A total of 96 patients were included in this study; mean age was 43.5±15.8 years, 52% females; 85.4% UC, mean disease duration 6.5±5 years. Vitamin D levels ranged from 3–58 ng/mL, with a mean level of 18 ±9.9 ng/ml (CD:17.5±12.4 ng/mL, UC:18.1±9.5, p=0.826). 63/96 patients (66%) had vitamin D deficiency (73.2% UC and 21.4% CD, p&lt;0.001), while 21/96 (22%) had vitamin D insufficiency. There was no significant difference in vitamin D insufficiency and IBD type (p&gt;0.05), although the insufficiency was found higher among CD that UC patients [7/14 (50%) vs 14/82 (17%) respectively]. No statistically significant association was found between vitamin D level and age, gender, BMI, disease type, activity, location, extent and duration. There was a negative correlation between CRP and vitamin D level (r=−0.178, p=0.054).

Conclusion
Low vitamin D levels are common in biologic-naïve patients with IBD. These levels are not associated with clinical data such as disease type, extent, duration or severity in IBD patients, but it seems that vitamin D influences the presence of inflammation in these patients.
P588 Steroid sparing effect of adalimumab in cortisone–depended ulcerative colitis patients
Authors: Sina M , Pengili E , Pemaj X , Osmanaj D , Bibolli I , Prifti S 
Published: May 2021

Abstract

Background
Corticosteroids are indicated for induction of remission in moderate to severe ulcerative colitis (UC) patients. However, due to their adverse effects associated with long-term use, steroids are not indicated as a maintenance therapy. The aim of this study was to assess the steroid sparing effect of adalimumab (ADA) in steroid-dependent UC patients.

Methods
This is a prospective study carried out at a tertiary hospital center in Albania from 2016–2020, including consecutive moderate-to-severe UC patients. All patients received biologic therapy with subcutaneous ADA 160/80mg at weeks 0/2 followed by 40mg every 2 weeks. We evaluated the steroid-sparing effect of ADA measuring the number of steroid–free patients and the average steroid dose at baseline before initiating biologic treatment and at week 8, 24, 52, 104, 156. Clinical remission was defined as total Mayo score ≤ 2 points.

Results
We enrolled 26 UC patients, mean age 47.3 ± 16.1 (24–85) years, 55.6% were females. The average disease duration before starting ADA was 7.3 ± 7.0 years (range 1–33); 44.4% had pancolitis and 55.6% left side colitis. 8(29.6%) patients were on combination therapy with azathioprine. 17/26 (65.4%) patients were taking prednisone at the time of the first ADA injection with an average dose of 17.7mg. The number of steroid-free patients at week 8, 24, 52, 104 and 156 was 12/26 (46.2%), 16/26 (61.5%), 15/21 (71.4%), 11/14 (78.6%), 8/9 (88.9%) respectively. At the end of the follow-up (week 156), the proportion of steroid free patient was significantly higher than at baseline [88.9% (8/9) vs 34.6% (7/26), p=0.005]. The reduction of the average dose of prednisone (8.8 mg, 4 mg, 6.8mg, 3.8mg and 3,8mg at week 8, 24, 52, 104 and 156 respectively), was also statistically significant (p&lt;0.01). Clinical remission rates were 7.7% (2/26) at week 8, 47.6% (10/21) at week 52, 42.9% (6/14) at week 104 and 44.4 % (4/9) at week 156.

Conclusion
In our cohort, ADA administration to moderate–to severe UC significantly reduced the steroid dose and the proportion of patients taking cortisone during 3 years follow-up.
P595 Finding predictors of azathioprine-induced pancreatitis in patients with inflammatory bowel disease
Authors: Freitas M , Capela T , Macedo Silva V , Arieira C , Cúrdia Gonçalves T , Dias de Castro F , Moreira M J , Cotter J 
Published: May 2021

Abstract

Background
Azathioprine (AZA)-induced pancreatitis (AIP) is a common, idiosyncratic side effect, whose incidence, clinical course and risk factors data in inflammatory bowel disease (IBD) patients are scarce. We aimed to establish the incidence, describe the clinical course and identify risk factors for AIP.

Methods
Retrospective study including all IBD patients on AZA between January 2013 and July 2020. Patients with AIP were considered. Demographic, clinical, biochemical and imaging data were collected.

Results
AIP occurred in 33 patients (7.5%; 442 patients on AZA): 81.8% had Crohn’s disease, 54.5% were male, and the mean age was 35±13 years. The mean time under AZA till AIP was 25±11 days, with a mean dosage of 88±44mg. Eighteen patients (54.4%) were hospitalized, with a mean hospital stay of 4±2days. All patients had a mild course of disease which resolved with suspension of AZA, and with no complications or need of invasive interventions or complications. Smoking (p=0.02), single daily dose of AZA (p&lt;0.001) and concomitant treatment with budesonide (p=0.001) were risk factors for AIP. In multivariate analysis, concomitant treatment with budesonide (OR: 5.3; p=0.002) and single daily dose of AZA (OR: 4.8; p=0.002) were the only predictors of AIP.

Conclusion
Although AIP was a relatively common side effect, it presented a mild course in all patients. Smoking, concomitant treatment with budesonide and single daily dose of AZA were risk factors for AIP. This study suggests that smoking, concomitant use of budesonide and single dose regimen of AZA should be avoided in IBD patients treated with AZA.
P613 Social Media Analytics for Inflammatory Bowel Disease – What Are We Missing?
Authors: Kumar L , Kiely L , O’Riordan A , Barry P 
Published: May 2021

Abstract

Background
Increasingly, Inflammatory Bowel Disease (IBD) patients are using social media to disseminate information, share experiences and address queries. Gastroenterologists can play an important role in IBD care by better understanding trends in patients’ perception of their disease. This study aimed to identify trending topics and misconceptions of disease for early targeted education based off patients’ interactions and activity on social media.

Methods
Utilising an established social media analytics program, we extracted social media posts relating to IBD over a 30-day period between 11/05/2020 and 10/06/2020. The most common hashtags and frequently used words were retrieved from these posts, analysed and qualitatively coded. Additional analysis was performed to evaluate user mentions for specific key words identified from the ECCO consensus for Complementary and Alternative Medicine (CAM) and psychotherapy.

Results
22,375 social media posts were reviewed. Twitter was the most common platform with 12,977 posts (58%). Most posts originated from North America and Europe (81%).
Amongst common hashtags and words, patients most frequently referenced community groups (n=8094) for example “#crohnswarrior”, followed by terms related to treatment (n=3256), and lifestyle (n=2446). Symptom-related terms were less frequently referenced (n=2031). Of mentions relating to diet and nutrition, ‘gluten free’ was mentioned most frequently (466/2911, 16.0%), followed by ‘vegan’ (374/2911, 12.8%), and ‘plant based’ (342/2911, 11.7%).
There was a temporal association with these posts which was demonstrated by hashtags (n=1397) and mentions (n=485) referencing ‘World IBD Day’ which occurred on the 19th of May as well as hashtags (n=391) and mentions (n=1475) referencing the COVID 19 pandemic.
Analysis of CAM mentions highlighted patients’ interest in “exercise” as a manipulative and body-based intervention (2015/2088, 96.5%), “cannabinoids” as a herbal and dietary intervention (816/2144, 38.1%) and “yoga” as a mind-body intervention (175/415, 42.2%). 3435 mentions were generated from our psychological key word search. These included terms such as fatigue (28.2%), anxiety (20.1%), depression (13.8%) and suicide (2.2%).

Conclusion
Our study identified areas where patients’ needs, concerns and queries may be unmet by current clinical practices. Further development of our analytical model can aid gastroenterologists in bridging this gap and providing more holistic patient care.
P639 Epidemiology and patient burden of rectovaginal and anovaginal fistulas in patients with Crohn’s disease: A systematic review
Authors: Iglay K , Bennett D , Kappelman M , Thai S , Aldridge M , Karki C , Cook S 
Published: May 2021

Abstract

Background
Rectovaginal fistulas (RVF) and anovaginal fistulas (AVF) in Crohn’s disease (CD) are rare, debilitating conditions that present substantial disease and treatment burdens for women. In this systematic literature review (SLR), articles relating to the epidemiology and burden of CD-related RVF and AVF were assessed in order to summarize evidence from observational studies and highlight knowledge gaps.

Methods
Articles published in the past 10 years in PubMed and Embase that provide data on incidence, prevalence and insight into the patient experience and disease burden of CD-related RVF and AVF (PROSPERO registration number CRD42020177732) were identified. Two trained reviewers used pre-specified eligibility criteria to identify studies for inclusion and evaluate risk of bias using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for observational studies. Data were extracted for a range of variables, including study type and design, population, outcomes and limitations.

Results
Of the 582 records identified, 316 full-text articles were assessed, and 16 studies that met a priori eligibility criteria were included (Figure). Three epidemiology studies were identified, with one study estimating the prevalence of RVF to be 2.3% in women with CD. No studies relating to the incidence or prevalence of AVF were identified. Seven of 12 treatment-pattern studies reported that patients had or required additional procedures before and/or after the intervention of interest, demonstrating substantial treatment burden. Of the nine studies that reported healing/success across multiple surgical types, rates ranged from 14.4% to 81.0%. In the seven studies that assessed clinical outcomes, healing rates were in the range 50–75%, with varying estimates dependent on population and intervention. Two studies reported recurrence rates of 13.3–55.8% across multiple surgical interventions. Patient-reported outcomes obtained using standardized measures were reported in only one of the 16 studies and were limited to overall health related quality of life, faecal incontinence-related quality of life and female sexual function index. None of the 16 studies included reported healthcare-resource utilization in this patient population.

Conclusion
This SLR shows the high disease and treatment burdens of RVF and AVF in patients with CD and identifies multiple evidence gaps in this field. The published literature lacks robust, generalizable data and demonstrates a compelling need for substantial novel research into these rare and debilitating sequelae of CD.
Sponsor: Takeda Pharmaceuticals USA, Inc.
Outcome of patients with different clinical presentations of high-risk pulmonary embolism
Authors: Ebner Matthias , Sentler Carmen , Harjola Veli-Pekka , Bueno Héctor , Lerchbaumer Markus H , Hasenfuß Gerd , Eckardt Kai-Uwe , Konstantinides Stavros V , Lankeit Mareike 
Published: May 2021

AbstractAimsThe 2019 European Society of Cardiology (ESC) guidelines provide a revised definition of high-risk pulmonary embolism (PE) encompassing three clinical presentations: Cardiac arrest, obstructive shock, and persistent hypotension. This study investigated the prognostic implications of this new definition.Methods and resultsData from 784 consecutive PE patients prospectively enrolled in a single-centre registry were analysed. Study outcomes include an in-hospital adverse outcome (PE-related death or cardiopulmonary resuscitation) and in-hospital all-cause mortality. Overall, 86 patients (11.0%) presented with high-risk PE and more often had an adverse outcome (43.0%) compared to intermediate-high-risk patients (6.1%; P &lt; 0.001). Patients with cardiac arrest had the highest rate of an in-hospital adverse outcome (78.4%) and mortality (59.5%; both P &lt; 0.001 compared to intermediate-high-risk patients). Obstructive shock and persistent hypotension had similar rates of adverse outcomes (15.8% and 18.2%, respectively; P = 0.46), but the only obstructive shock was associated with an increased all-cause mortality risk. Use of an optimised venous lactate cut-off value (3.8 mmol/L) to diagnose obstructive shock allowed differentiation of adverse outcome risk between patients with shock (21.4%) and persistent hypotension (9.5%), resulting in a net reclassification improvement (0.24 ± 0.08; P = 0.002).ConclusionThe revised ESC 2019 guidelines definition of high-risk PE stratifies subgroups at different risk of in-hospital adverse outcomes and all-cause mortality. Risk prediction can be improved by using an optimised venous lactate cut-off value to diagnose obstructive shock, which might help to better assess the risk-to-benefit ratio of systemic thrombolysis in different subgroups of high-risk patients.
Evaluation of transport-related outcomes for neonatal transport teams with and without physicians
Authors: Abdelmawla Mohamed , Hansen Gregory , Narvey Michael , Whyte Hilary , Ilodigwe Don , Lee Kyong-Soon ,   Canadian Neonatal Transport Network, Singh Avash , Ting Joseph , Tierney Anne , Thomas Sumesh , Phillips Ernesto , Byrne Paul , Toye Jennifer , Bingham William , Daspal Sibasis , Kalapesi Zarin , Murthy Poornima , Caces Rebecca , Roukema Henry , Marrin Michael , Redpath Stephanie , Beaumier Louis , Perrault Thérèse , Piuze Geneviève , Massé Edith , Jangaard Krista , Deshpandey Akhil 
Published: May 2021

AbstractObjectiveThe aim of this study was to evaluate if the presence of a physician in the neonatal transport team (NTT) affects transport-related outcomes and procedural success.DesignRetrospective cohort study with propensity score matching.SettingCanadian national study.PatientsNeonatal transports from nontertiary centres between January 2014 and December 2017.InterventionsComparison of transports conducted by NTTs with physicians (MD Group) and without physicians (noMD Group).Main outcome measuresThe primary outcome was the change in patient acuity as measured by the transport risk index of physiologic severity (TRIPS) score. Secondary outcomes included mortality within 24 hours of NICU admission, clinical complications during transport, procedural success, and stabilization time.ResultsAmong 9,703 eligible cases, 899 neonatal transports attended by NTTs with physicians were compared to 899 neonatal transports without physicians using propensity score matching. No differences were seen in the improvement of TRIPS score or mortality ≤24 hours of NICU admission. The MD Group had more clinical complications (7.7% versus 5.0%, P=0.02). No differences were seen in success rates of invasive procedures. The MD Group had shorter stabilization times. In multivariable analysis, the MD Group was not a significant predictor for the improvement in TRIPS score after adjustment for covariates.ConclusionsNeonatal transports conducted by teams including physicians compared to teams without physicians, did not have higher improvement in TRIPS scores and had similar success rates for procedures. These results provide insights for the planning of the structure and training of specialized interfacility neonatal transport programs.
Time to reopen schools: COVID-19, health disparity and education
Authors: Kahambing Jan Gresil S 
Published: May 2021

Abstract
Weighing the dilemma of reopening schools during the pandemic is no longer a matter of self-determination but harm. Coronavirus disease 2019 has shown gross health inequality and, by extension, the inequality of society per se. The assertion that ‘education continues despite the pandemic’ using access to technological means is a privileged position.
Rapid Transition to a Virtual Multiple Mini-Interview Admissions Process: A New Medical School’s Experience During the COVID-19 Pandemic
Authors: Carroll Turpin Michelle A. , Steele Kenya , Matuk-Villazon Omar , Rowland Kevin , Dayton Catherine B. , Horn Kathryn V. 
Published: May 2021

Problem
The University of Houston College of Medicine (UH COM) began its first admissions cycle after receiving preliminary accreditation in February 2020. With the advent of remote learning in response to the COVID-19 pandemic, the school moved its admissions process, including multiple mini-interview (MMI), from an in-person to online format in mid-March 2020.

Approach
The UH COM selected Zoom as the video conferencing platform for its virtual admissions process, including MMI. On each interview day (3–4 hours), 14–16 applicants joined administrators, faculty, and staff in a virtual meeting room. Applicants were divided into 2 groups: one viewed short presentations about the school, curriculum, and departments, while the other participated in 7 MMI stations (one-on-one interactions with interviewers) via virtual breakout rooms; the groups then switched. The MMI stations were the same as those used in-person in early March. Applicants were able to ask questions at multiple points during the day. Technical support was provided for participants with connectivity issues or unfamiliar with Zoom.

Outcomes
Of the 180 applicants interviewed in March–April 2020, 134 (74%) participated in the virtual process and 46 (26%) in the on-site process. Twenty-five (83%) of the 30 members of the inaugural class of 2024 interviewed virtually. Advantages of the virtual format included ease of access for faculty and more flexibility and less expense for applicants. Challenges included the need for applicants to decide whether to accept an offer of admission from a new school without visiting and missed opportunities for faculty to have relatively unstructured interactions with applicants.

Next Steps
This virtual admissions process was a feasible alternative for the inaugural class but is not sustainable. UH COM plans to leverage lessons learned to refine the virtual format for use in future admissions cycles, even when in-person interviews are possible.