bluuebunny/crossref_metadata_2025_split huggingface dataset:
1152 Financial Relationships of Gastroenterology Guideline Authors: Analysis of Sunshine Act CMS Open Payments Database
Authors: Shah Raj , Numan Laith , Chandar Apoorva K. , Maruggi Chiara , Alabdulwahhab Motib , Chauhan Mahak , Davitkov Perica , Falck-Ytter Yngve 
Published: October 2019

INTRODUCTION:
There is a lack of data in regards to industry financial relationship in gastroenterology. The Sunshine Act CMS Open Payment Database is a national program that increases the transparency of financial relationships between physicians and industry. Per the 2011 Institute of Medicine standards for guidelines, an increased effort is being placed on minimizing conflicts of guideline authors. We aimed to delineate the financial relationships between industry and guideline authors in gastroenterology using the Sunshine database.

METHODS:
Guidelines and guideline authors using GRADE methodology from American Association for the Study of Liver Disease, American College of Gastroenterology, American Gastroenterology Association, and American Society of Gastrointestinal Endoscopy societies from 2013 to October 15, 2018, were abstracted. We searched the Sunshine database for each author the year the guideline was published and the year before the guideline publication date, when available. Only general payments were examined. Authors who published many guidelines in the same year were only counted once when calculating general payments.

RESULTS:
562 authors were included. Of those, a total of 249 guideline authors were found on the open payment website with available data. 238 (95.5%) received general payments during the time of their publication, and 176 (73.9%) of them got more than $500. 238/562 (44.3%) of total authors received general payments. Payments made for consulting amounted to $2,279,469 (39.5%). A total of 5,883 payments were made. The total amount of general payments for all authors is $5,775,403. The average payment per author was $24,266.

CONCLUSION:
Collectively, guideline authors received at least $5,775,403 from industry relationships between 2013-2018 and three quarters received over the amount $500. The largest amount of money was spent on consulting fees. Less than half of Gastroenterology guideline authors receive payments from industry during the time they are working on guidelines, but as a scientific community, we can improve in minimizing external influences in the guideline development process.
1153 Conflict of Interest in Gastroenterology Guidelines: A Lack of Transparency
Authors: Shah Raj , Numan Laith , Chandar Apoorva K. , Maruggi Chiara , Alabdulwahhab Motib , Chauhan Mahak , Davitkov Perica , Falck-Ytter Yngve , Sultan Shahnaz 
Published: October 2019

INTRODUCTION:
In 2011, the Institute of Medicine (IOM), now the National Academy of Medicine (NAM) published standards for developing clinical practice guidelines, highlighting the necessity of transparency and the importance of minimizing conflict of interest (COI) in guideline authors. We aimed to assess the prevalence of COI and transparency of reporting COI in gastroenterology guidelines.

METHODS:
Guidelines using GRADE methodology from American Association for the Study of Liver Disease, American College of Gastroenterology, American Gastroenterology Association, and American Society of Gastrointestinal Endoscopy societies from 2013 to October 15, 2018, were abstracted. We reviewed each guideline to determine if COI information was provided and the prevalence of COI among guideline authors. We further categorized conflicts as “research/academic funding” (not directly paid to the individual) or “other.” This other category included disclosures such as speaker's bureau, stocks, consulting, advisory board, honoraria, non-research funding, and industry-sponsored continuing medical education activities. Funding from government or nonprofit organizations were excluded.

RESULTS:
A total of 78 guidelines were reviewed. Of these, only 11 (14.1%) provided no or vague information on COI; ten guidelines (12.8%) provided only general statements about COI without details informing the reader if they were present or not and one guideline did not report COI. Across the 78 guidelines, 823 authors were identified. When COI was examined at the individual guideline author level, 222/823 authors (27%) had reported COI. The total number of conflicts for all guidelines across all authors was 816 and the majority (79.5%) of them were reported as “other” conflicts such as speaker’s bureau, consulting, advisory boards and honoraria.

CONCLUSION:
During 2013-2018, approximately 14% of Gastroenterology guidelines did not fully inform their readers about COI and about 1 in 4 gastroenterology guideline authors self-reported as having potential conflicts. As this is based on self-report, underreporting could possibly inflate this issue. We suggest that societies producing guidelines consider a more rigorous COI management process to mitigate the perceived risk of biased guidelines and be more transparent about reporting COI.
1156 Trends in Matching in GI Fellowship: Data From NRMP
Authors: Kesar Varun , Lakhani Komal , Taylor Savannah , Kanth Rajan , Mouchli Mohammad , Kesar Vivek 
Published: October 2019

INTRODUCTION:
Gastroenterology (GI) fellowships continue to be highly sought after by internal medicine residents interested in pursuing subspecialty training. A recent study reported that GI fellowships had the highest number of applicants per available position among the major subspecialties. The National Resident Matching Program (NRMP) Specialties Matching Service® (SMS®) conducts Matches for fellowship positions. NRMP identified ten applicant characteristics that contribute to Match success: number of contiguous ranks, number of specialties ranked, USMLE scores, number of research, work, and volunteer experiences, number of publications, and Alpha Omega Alpha Honor Medical Society membership. We aim to compare the temporal trends in these characteristics by comparing data in 2011 and 2018.

METHODS:
Data was collected from the NRMP booklet: charting outcomes in the match in 2011 and 2018. Four applicant groups are included in the report: U.S. allopathic medical school graduates (USMG), U.S. citizen international medical school graduates (US-IMG), Non-U.S. citizen international medical school graduates (Non-US-IMG), and U.S. osteopathic medical school graduates (DO) We compared various variables from 2011 and 2018 including the number of applicants and positions offered, type of applicants, USMLE mean scores, research experiences.

RESULTS:
The total number of positions offered in 2011 was 383 and the number of applicants were 648; making 1.7 application per position, the most per any other IM subspecialties. In comparison, the total number of positions offered in 2018 was 496 and the number of applicants were 758; making 1.5 applicants per position. Percentage of matched USMG, US-IMG, Non-US-IMG and DOs in 2011 and 2018 were as follows: 65 vs 61%, 7 vs 9%, 18 vs 23%, 4 vs 5 %. The mean step 1, step 2, step 3 for USMG has increased as follows 223 to 235, 230 to 248, 221 to 235. A similar trend is observed in other groups. The mean number of scholarly activity have increased significantly in USMG (3 to 11), US-IMG (6 to 13) Non-US-MG (9 to 21) and in DOs 5 to 10.9.

CONCLUSION:
The total number of fellowship positions has increased, however positions per candidate have been relatively stable. There has been a slight increase in the proportion of Non-US-IMG (∼5%), US-IMG (2%), and DOs (1%) in GI fellowship match in the year 2018 as compared to 2011. However, a slight decrease in USMG (4%) was noted. There has been increase in USMLE step scores and scholarly activity in all groups.
1157 Given the Offer of GI EConsultation, PCPs Decline: A Prospective Study
Authors: Moore Danielle , Hays R. Ann , Dowdell Kimberly 
Published: October 2019

INTRODUCTION:
eConsult is an asynchronous communication using an electronic chart by primary care physicians (PCP) to specialists that involves sharing of patient-specific information and for clarification or guidance regarding clinical care. It can provide the PCP with timely access to specialist consultation for evaluation, treatment and management of the PCPs patients. It could benefit patients by saving time and costs of travel to and copays of unnecessary clinic visits. Subspecialities at our institution provide eConsults whereby the PCP asks specific questions of the specialist through Epic; only the PCP has a face to face (F2F) visit with the patient but the chart is available to the specialist. We aimed to determine whether eConsultation would improve the satisfaction and outcomes for PCPs and their patients if the PCP was offered an eConsult immediately after their patient was scheduled with a F2F visit with gastroenterology (GE).

METHODS:
Prospective study offering eConsults for all referrals made to GE at a single U.S. based tertiary care academic medical center from Nov 1,2018 to May 1,2019 evaluating 4 segments of eConsultation (query, response, action, resolution) for 6 high frequency topics (abdominal pain, GERD, chronic constipation, diarrhea, iron deficiency anemia and Barretts esophagus). Scheduling notified us when an appointment was made for these indications; the PCP was then offered an eConsult by Epic staff message and email.

RESULTS:
43 consults met study criteria. The mean time after a F2F referral was scheduled to eConsult offer was 42 hours. PCPs placed eConsult order following 6.9% of eConsult offer. The average response time for eConsult completion was 56 hours as compared to 109.1 days wait for a F2F consultation in digestive health clinic.

CONCLUSION:
We found that when offered the opportunity for eConsultation, PCPs did not place an eConsult order 93% of the time. The literature and studies at our institution indicate eConsult has the potential to improve timely access to specialty care, save costs for the patient and optimize appropriate testing prior to F2F consultations. The poor response to our offer for eConsult could be attributed to lack of marketing, high PCP patient volumes, excess email and/or epic staff messages; or lack of PCP familiarity with the eConsult model. Additionally, patients may prefer F2F visits. With rising demand for GI consultation anticipated in the next decade, further research and/or modification of the eConsult model is needed.
1159 Tweeting the Meeting: Analysis of Twitter Use During the Digestive Disease Week DDW 2019
Authors: Azawi Muaataz , Vijayasekar Kavitha , Homsi Maher , Alwan Manar , Syed Umer , Walfish Aaron 
Published: October 2019

INTRODUCTION:
The DDW is an international gathering of physicians around the globe in the fields of GI. Collectively sponsored by few of the largest GI societies. Nowadays, social media is widely used to deliver information and business marketing. Twitter is a social network site that rapidly gained worldwide popularity. With over 300 million users, and over 500 million Tweets sent daily, there is a great opportunity to spread ideas to a global audience. In this study, we are aiming to analyze the use of Twitter during DDW.

METHODS:
The Symplur Signals, a specialized healthcare social media analytics platform was used to analyse the hashtag #DDW19, the official hashtag of the DDW 2019 meeting. The analysis was conducted on tweets during the meeting days between May 18-21, 2019. The number of tweets, participants, impressions, average tweets per hour and average tweets per participant was determined. Advanced search on Twitter was also conducted using the hashtag #DDW19 with time frame between May 18-21. The resulted tweets were sorted by category “top tweets”. The top 50 tweets were categorized by content to scientific, social, administrative, industry promotion, or irrelevant.

RESULTS:
DDW 2019 had over 14,000 attendees from around the world. The number of people who participated in the hashtag #DDW was 3,924 (28% of the attendees) sending 15,350 tweets during the meeting days, with an average of 4 tweets per participant and 160 tweets/hour, leaving 71.594 million impression. The hashtag activity reached a peak of 4,815 tweets on the 2nd day of the meeting, May 19th. 60% of the top tweets were from physicians, 10% by medical journalist, and 30% by medical society/organizations. 42% of the top 50 tweets had social content such as group photos or appreciation of other presenters. Whereas 40% were scientific content. However administrative tweets were 10%. Only 8% of content was industrial promotions. There were no irrelevant tweets.

CONCLUSION:
Social Media has become the most effective medium to reach an enormous audience. With over 71 Million impressions produced during the recent DDW. Twitter has successfully promoted the event worldwide and disseminated medical information in a quick and cost-effective method. It has communicated to millions of individuals, including non-medical professionals, in a way that is difficult for traditional media sources to achieve. In order to create a more informative and influential post, it is encouraged that users tweet more on scientific and medical contents.
1167 Internal Medicine Residents’ Perspective on Gastroenterology Rotation: An Insight From a Survey
Authors: Gboluaje Temitayo , Pantangi Pramod 
Published: October 2019

INTRODUCTION:
Studies evaluating the Internal Medicine (IM) residents’ perspective on the attributes of Gastroenterology (GI) rotation are lacking. Inadequate knowledge of residents’ perspective can create a disconnect between residents’ expectations and experience during the rotation, leaving some residents on GI rotation disenchanted. We surveyed IM residents in our residency program and present our findings.

METHODS:
A paper questionnaire was distributed to IM residents at Morehouse School of Medicine Internal Medicine Residency program. The questions included in the survey gauged residents’ years in training, prior experience in GI rotation, the best and least desired aspects of the GI rotation and additional opinions as mentioned in the survey. The survey responses were analyzed for significant findings.

RESULTS:
We distributed the survey to 63 residents and received 51 responses. Of those that responded, 41% are in 1st, 31% in 2nd and 28% in 3rd year of training. 51% already completed GI rotation. Of those that already completed GI rotation: the statistical mode showed favorability rating of their experience was 9 on a scale of 1-10 with 10 being the most favorable; 62% rated case based learning as the best aspect of their experience; 42% rated didactics as the least desired aspect; 85% considered a length of 1 month to be about right for the rotation; 65% believed they had enough subspecialty training during their GI rotation; 35% and 39% considered 1-2 hours daily adequate for watching endoscopy and didactics respectively; 42% preferred 2-3 hours daily for case based learning; 31% believed the rotation increased their interest in GI but only 19% were considering a career in GI; 85% would like to rotate again. Of those that have not rotated through GI: using statistical mode, 72% would like the opportunity to rotate; 44% anticipate experiencing GI case-based learning the most and 44% anticipate watching endoscopy; 44% and 28% consider 1-2 hours daily adequate for didactics and case-based learning respectively; 16% are considering a career in GI.

CONCLUSION:
Gastroenterology rotation continues to be well coveted amongst IM residents. According to our findings, residents rotating through GI most favored case-based learning with didactics being least favored. We recommend that more emphasis be placed on case-based learning during GI rotation with an approximate daily time limit of 2-3 hours and allot an approximate 1-2 hours for other aspects of daily learning like didactics and watching endoscopy.
1168 Time Spent on Ambulatory Electronic Health Records Outside of Scheduled Work Hours by Gastroenterology Physicians
Authors: Ramrakhiani Nathan S. , Shetler Katerina 
Published: October 2019

INTRODUCTION:
The introduction of electronic health records (EHR) has been linked to physician burnout. This study aims to quantify the time gastroenterology physicians spend on ambulatory EHR outside of scheduled work hours.

METHODS:
Data was collected for time spent in ambulatory EHR for the eight-week period 02/03/2019 - 03/30/2019. Cumulative scheduled time was calculated for each physician. Hospital-based clinical encounters and time spent in hospital-based EHR were excluded from analysis. Ratios of ambulatory EHR time to scheduled time were calculated. We also analyzed data on physician FTE status, post-fellowship experience, new patient visit time interval, and correlated these data with the aforementioned ratio. P-values < 0.05 were considered significant. This study was reviewed by our Institutional Review Board, and a waiver was obtained.

RESULTS:
Data was available for 41 providers; 18 providers were excluded (5 non-physicians, 3 with FTE status < 0.2, 2 pediatric gastroenterologists, 8 without available scheduled time data). Data were analyzed for 23 gastroenterology physicians with 7,373 ambulatory encounters (3465 office visits, 310 office-based procedures, and 3598 ASC) across 4 sites. The average weekly time spent in EHR was 41.30 ± 11.73 hours, and the average weekly scheduled time was 24.48 ± 7.64 hours. Correspondingly, the average ratio of EHR time to scheduled time was determined to be 1.78 ± 0.70. Part-time and full-time physicians were also compared. There was a greater proportion of males in the full-time group rather than the part-time group (90.91% vs. 58.33%, P = 0.076). In addition, there was a trend towards a higher ratio of EHR time to scheduled time for part-time physicians (1.99 ± 0.88 vs. 1.56 ± 0.36), although this was not statistically significant (P = 0.15). The only statistically significant predictor of ratio was FTE status, treated as a continuous variable; the slope of the linear regression model was -3.06 ± 0.83 (P = 0.001) and the corresponding R2 was 0.39. Neither experience, in years after fellowship, nor new patient visit interval, were correlated with ratio.

CONCLUSION:
Our data show that gastroenterology physicians spend significant time outside of their scheduled time on EHR-related tasks. More studies are needed to better understand the distribution of time across different tasks; targeted countermeasures, such automation and utilization of non-physician staff, may help reduce the burden of EHR time and, correspondingly, the risk for physician burnout.
1169 Travelers' Diarrhea, Single Dose Antibiotics, Acquisition of Multi-Drug Resistance and Associations With Functional Microbiome Characterization: Is There Any There There?
Authors: Johnson Ryan C. , Van Nostrand Joy D. , Tisdale Michele , Swierczewski Brett E. , Simons Mark P. , Connor Patrick , Fraser Jamie , Melton-Celsa Angela R. , Tribble David R. , Riddle Mark S. 
Published: October 2019

INTRODUCTION:
Travelers’ diarrhea (TD) is a commonly diagnosed acute illness among those visiting tropical and sub-tropical regions with substantial consequences. While antibiotic treatment (with lopermaide) substantially reduces TD symptoms and duration, a growth in concerns about the off-target effects of TD treatment on the impact of resident microflora and the potential adverse effects associated with acquisition of multi-drug resistant organisms (MDRO). To date, most microbiome analyses have studied microbial structure/composition, while the functional capabilities of the gut microbiota remain largely unstudied. We set out to understand the functional properties of the gut microflora in response to TD acquired in diverse geographic regions, associations with different single-dose therapies, MDRO acquisition.

METHODS:
Fecal samples from USA & UK military service members in 3 continents that presented with acute watery TD were collected at acute presentation (day 1, prior to antibiotics), as well as 7 and/or 21 days following a single-dose of antibiotics (azithromycin (500 mg), levofloxacin (500 mg), or rifaximin (1650 mg) with loperamide). Each sample underwent culture and TaqMan RT-PCR analyses for pathogen detection and a limited set of ESBL-PE genetic probes. Purified DNA from each sample was analyzed using the HumiChip v2.0 microarray which contains over 150,000 DNA probes specific for genes involved in various functional processes including antibiotic resistance, virulence, stress responses, and nutrient metabolism.

RESULTS:
In total, 125 Day 1 samples, 64 Day 7 samples, and 105 Day 21 samples were available for analysis from 135 subjects. Ordination analysis revealed that subjects enrolled in each country had distinct functional profiles. While we did not observe overt differences in functional profiles between treatment groups, we observed an increase in functional diversity from day 1 to day 21 in the levofloxacin treatment group, relative to azithromycin and rifaximin groups. Additionally, we noted distinct geographical patterns of resistome patterns at baseline and post-illness, but lesser influence of antibiotic effects on post-treatment functional genomic composition.

CONCLUSION:
A thorough understanding of how antibiotics impact the functional properties of the gut microbiota will help inform future treatment options, antibiotic stewardship in TD patients, and the reduction of potential post-infective complications due to MDRO pathobionts.
1177 Multi-Drug Immunosuppression Post-Solid Organ Transplantation Is Associated With Increased Enteric Infection on Multiplex Gastrointestinal Pathogen PCR Testing
Authors: Hine Ashley M. , Joelson Andrew , Lebwohl Benjamin , Axelrad Jordan E. 
Published: October 2019

INTRODUCTION:
Diarrhea is a common sequela of solid organ transplantation. Post-transplant diarrhea may be attributed to non-infectious causes including medications, however the contribution of infectious etiology is unclear. The objective of our study was to evaluate the relationship between post-transplant immunosuppression and enteric infection as detected by multiplex gastrointestinal PCR stool testing in solid organ transplant (SOT) recipients.

METHODS:
We performed a multicenter cross-sectional analysis of inpatient and outpatient SOT recipients who underwent stool testing with a FilmArray multiplex gastrointestinal pathogen PCR panel (GI PCR panel) during an acute episode of diarrhea from April 2016 to May 2019. The primary endpoint was the detection of any enteric pathogen. Patients were stratified by the number of major classes of immunosuppressive agents, including calcineurin inhibitors, anti-proliferative agents, and corticosteroids, at time of stool testing.

RESULTS:
We identified 232 SOT patients who underwent a GI PCR panel comprising 52 (23%) lung, 84 (36%) kidney, 41 (18%) heart, and 55 (24%) liver transplants. 92 (40%) tested positive for an enteric pathogen. Patients whose immunosuppressive regimen included 3 medications (n = 139) were more likely to have a gastrointestinal pathogen detected (63, 45%) compared to patients on 2 immunosuppressive medications (P = 0.02; Figure 1) Renal transplant patients were more likely to have an enteric pathogen detected (60%; P < 0.0001) compared to other organ types, and more likely to be on 3 immunosuppressive medications (P < 0.01). Viruses, specifically norovirus and sapovirus, and bacteria, including C. difficile and E. coli subtypes, were common in transplant recipients on 2 immunosuppressive agents (Table 1). Of 139 patients on 3 immunosuppressive agents, 89 (59%) were more likely to be on opportunistic infection prophylaxis for CMV and P. jiroveciipneumonia compared to those patients on 2 drugs (P < 0.001). In the 30 days following stool testing, all SOT recipients, regardless of the number of immunosuppressive drugs, were as likely to visit an emergency room (P = 0.57), require hospitalization (P = 0.66), or undergo endoscopic procedures for persistent GI symptoms (P = 0.78).

CONCLUSION:
Gastrointestinal infections, particularly enteric viruses, were common in SOT recipients who underwent a GI PCR panel for an episode of post-transplant diarrhea, with the highest proportion of positive results in patients maintained on 3 or more immunosuppressive agents.