bluuebunny/crossref_metadata_2025_split huggingface dataset:
2878 Assessment of Mobile APP for Constipation and Incontinence: Randomized Crossover Study in Healthy Subjects
Authors: Yan Yun , Jimenez Enoe , Karunaratne Tennekoon , Sharma Amol , Parr Rachael , Herekar Anam , Eubanks Audrey , Sanku Amalesh , Rao Satish 
Published: October 2019

INTRODUCTION:
An accurate history is important for diagnosis, treatment and clinical decision making but patients with bowel problems cannot accurately recall or quantify stool habit. We determined whether an electronic mobile phone APP can reliably and accurately records bowel symptoms of constipation and fecal incontinence (FI), when compared to paper form stool diary in healthy subjects.

METHODS:
Healthy subjects were randomly assigned to complete either a paper diary or 2 mobile phone APPs (separate for FI and constipation) for 2 weeks each, in a crossover study. The APP has approximately 10 questions each that assess severity of symptoms, bowel habit, stool consistency etc. Usability of APP versus paper form diary was assessed after 4 weeks. Intraclass correlation coefficients (ICC) assessed equivalence.

RESULTS:
Ten healthy subjects (34.7 ± 4.1 years, F/M = 6/4) participated. The number of BM, spontaneous (SBM), and complete spontaneous bowel movement (CSBM), over 2 weeks showed strong correlation between APP and paper form diaries, and for all questions related to either FI or constipation (ICC >0.79) (Table 1). Although mean stool consistency was strongly correlated with paper diary, the number of hard (BSFS1-2) and normal (BSFS3-4) stools were moderately significantly correlated with paper diary, possibly because of day to day variability in normal stool pattern. No leakage episodes were recorded in both FI APP and paper diary. The urgency of BM in FI APP was significantly associated with paper diary. The number of gas and bloating episodes ranged rom 0.8 to 2.5 in both APPs and paper diary. The VAS scores for functionality and usability for electronic APP were significantly higher (P < 0.027) compared to paper diary, and 90% of subjects preferred (P < 0/001) the APP (Table 2).

CONCLUSION:
The mobile APPs for FI and constipation were reliable, reproducible and useful and strongly correlated with paper diary. However they were strongly preferred by the subjects over paper form. These APPs could aid screening and assessment of bowel function in patients with FI and constipation but require validation for clinical or research use.
2885 Reducing Anxiety in Patients Undergoing First-Time Colonoscopy: A Pilot and Feasibility Study for a Randomized Controlled Trial
Authors: Albashir Siwar , Durepos Pamela , Causada-Calo Natalia S. , Mangat Ramandeep S. , Nowakowski Matilda E. , Kaasalanien Sharon , Anglin Rebecca , Moayyedi Paul , Armstrong David 
Published: October 2019

INTRODUCTION:
Patients undergoing colonoscopy may experience pre-procedure anxiety, which is associated with increased pain and might affect the willingness to undergo subsequent studies. We hypothesised that a brief psychological intervention would reduce anxiety before colonoscopy. The aim of the pilot study was to evaluate the feasibility of conducting a randomized, controlled trial (RCT) of the efficacy of a psychological intervention (PsI) in reducing anxiety levels in adult patients undergoing first-time colonoscopy under conscious sedation.

METHODS:
We performed a mixed method, double-blinded RCT of adult patients undergoing first-time colonoscopy. Eligible patients were randomized to a PsI vs. sham PsI. The primary outcome was feasibility, with success defined a priori as recruitment rate >50%. All participants had an anxiety assessment pre- and post-intervention using State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) score.Pre- and post-intervention scores were compared within and between groups. Secondary outcomes included sedation dose, patient comfort, cecal intubation rate and willingness to repeat colonoscopy.

RESULTS:
In total, 130 patients were recruited from 180 eligible participants (72%). Eighty were randomized and completed the study (44%).Failure to randomize recruited patients was due to logistical scheduling issues after patient arrival (26/50: 52%). Baseline characteristics were similar among groups (Table 1). In the PsI group, pre- and post-intervention median STICSA scores were 29 and 24 (P < 0.001), respectively. In the sham group, pre and post median scores were 31 and 25 (P < 0.001), respectively. There were no significant differences between the groups for any other secondary outcomes (Table 2). Although not statistically significant, the PsI group had fewer patients unwilling to repeat a colonoscopy and a higher cecal intubation rate than the sham PsI group.

CONCLUSION:
We have shown that it is feasible to recruit patients to an RCT evaluating PsI in colonoscopy and identified potentially remediable administrative challenges that reduced study completion rates. In addition, anxiety scores in both groups improved following colonoscopy although we did not observe a significant difference between treatment arms. Both findings are key to adjust future study design (e.g. a third arm that receives usual care). Currently, a qualitative assessment is underway to evaluate participant and staff acceptance of the study design and intervention.
2886 A Quality Improvement Curriculum for First Year Gastroenterology Fellows Associated With Improved Efficiency in the Endoscopy Unit
Authors: Kaminsky Thomas J. , Bank Jeffrey S. , Gawron Andrew J. , Iriana Sentia , Voaklander Rebecca , Johnson Jessica , Byrne Kathryn R. 
Published: October 2019

INTRODUCTION:
A teaching endoscopy unit is a dynamic setting, with many interrelated parts. Its fundamental mission is to provide quality care to patients while facilitating the development of physician learners. This requires that teaching cases be safe and effective, but also timely. We implemented a Quality Improvement (QI) curriculum in the Salt Lake City Veterans Affairs GI Endoscopy Unit with a focus on workflow efficiency.

METHODS:
We implemented a year-long quality improvement curriculum in the Endoscopy Unit. This was carried out by rotating first-year fellows and faculty mentors with input from technical and nursing staff. Initial efforts were aimed at identifying areas of inefficiency. Pre-intervention data was collected from fifty eight appointments over three months using recording sheets. Time points were noted as patients underwent each phase of their GI procedures with moderate sedation (e.g. appointment, check-in, intake, consent, in-room, scope in). Forty three appointments were analyzed, while fifteen were incomplete and were omitted. Our primary measure was patient check-in time to patient in-room time. Procedures were defined as “on-time,” only if this interval was thirty minutes or less. After data collection confirmed our perceived area of inefficiency, we made formal modifications to process inputs and quantified their effect over two months. A total of thirty six appointments were included in the post-intervention analysis. Eight appointments were incomplete and were omitted.

RESULTS:
At the time of initial data collection, a total of 14% of procedures began “on-time.” We considered multiple changes to workflow inputs. These included modifications to the check-in process, variations in the order and location of consent, utilization of workstations-on-wheels as well as novel communication methods between Unit staff. However, the chosen intervention was a formal posting which detailed the roles and responsibilities of each member of the Endoscopy Unit. This was communicated with the support of departmental leadership. Post-intervention, a total of 61% procedures began “on-time.” Overall, the initiative was associated with a 47% improvement over a five-month period.

CONCLUSION:
Increasing emphasis is being placed on healthcare efficiency and productivity, even in the academic setting. In this collaborative initiative, we demonstrate that implementation of a first year fellows QI curriculum is associated with a significant improvement in the timeliness of endoscopic procedures.
2903 Does Onset of Cancer Suppresses the Disease Activity in Patients With Pre-Existing Inflammatory Bowel Disease?
Authors: Dhaliwal Amaninder , Lamb Bernie , Cormier Ian , Sayles Harlan , Eichele Derrick , Young Renee , Hewlett Alexander 
Published: October 2019

INTRODUCTION:
Limited data is available regarding the impact of cancer on the disease activity in patients with pre-existing inflammatory bowel disease (IBD) especially in relation to chemotherapy. The aim of our study was to see the effect of cancer and chemotherapy on the IBD activity in our patient population.

METHODS:
A retrospective chart review of the patients was conducted who had prior diagnosis of IBD (UC/Crohn's) followed by any cancer between 01/01/2010 to 09/30/2018. Exclusion criteria: Age < 19 years, patients who had total colectomy and pregnant patients. Primary outcome was to evaluate if onset of cancer had any overall impact on the UC/Crohn's activity. Secondary outcome was to evaluate whether chemotherapy or cancer related surgery had any impact on UC/Crohn's activity. Statistical analysis was conducted using McNemar's test.

RESULTS:
51 patients (UC 23/Crohn's 28) were included, 26 males: 25 females, mean age 61 years. 98% were Caucasians with mean BMI 28. The mean age at IBD diagnosis and duration of IBD before the diagnosis of cancer were 34 years and 20 years respectively. Overall, 30 patients who had active disease before the cancer, 57% remained active and 43% had remission after the onset of cancer as compared to 21 patients who were in remission before the cancer, only 5% developed active disease while 95% stayed in remission after the onset of cancer with P value = 0.002 (Table 1). In Crohn's group, out of 20 patients, who had active disease before the cancer, 55% remained active and 45% had remission after the onset of cancer as compared to 8 patients who were in remission before the cancer, only 12% developed active disease while 88% stayed in remission after the onset of cancer with p value = 0.02 (Table 2). In UC group, no statistical difference was noted in the overall disease activity in relation to the cancer. In the subgroup analysis, out of 22 patients who only had cancer related surgery, 32% remained active, 18% had remission and 50% stayed in remission as compared to 12 patients who only received cytotoxic drugs, 50% remained active, 42% had remission and 8% stayed in remission with p value = 0.04 (Table 3).

CONCLUSION:
Our limited study showed that onset of cancer suppressed the overall disease activity in patients with pre-existing IBD (P = 0.002). In the subgroup analysis, patients who had cancer related surgery had higher chance of going into or staying in remission as compared to patients who received cytotoxic drugs (P = 0.04).
2909 Vedolizumab Safety Profile in Treatment of Elderly IBD Patients
Authors: Marnoy Zachary , Grossberg Laurie , Hartwell Nathan 
Published: October 2019

INTRODUCTION:
Vedolizumab is an anti-integrin therapy for IBD. It is a monoclonal antibody that selectively inhibits the interaction between the MAdCAM-1 receptor and α4β7 integrin in the gut. Vedolizumab, in comparison to other biologics, has a smaller pool of literature designating it's safety profile, specifically in the elderly (age >65 years of age) population of IBD patients. The GEMINI post-hoc trials have indicated an acceptable rate of infections, adverse reactions leading to hospitalization, and rate of malignancy in patients older than 55 years of age. The elderly subset of patients, designated as those 60-65 years of age or older by prior literature, is a growing population in need of effective and safe treatment of their IBD.

METHODS:
We searched the Epic database for Lahey patients with a diagnosis of inflammatory bowel disease, searching for patients who had been prescribed vedolizumab for this diagnosis. Of the compiled list of patients collected with these criteria, we searched the patient charts for the occurrence of flares, infections, development of malignancy, and death. Reasons for exclusion from the study include discontinuation of vedolizumab before completion of induction dosing, not being on vedolizumab, and lack of gastroenterology follow-up at Lahey Medical Center by a Lahey gastroenterologist.

RESULTS:
Of a total of 86 patients with IBD, ages ranging from 23-81 years of age, there was no significant difference found in the time to flare, time to remission from flare, incidence of infections, arthralgias, or malignancy in patients with IBD >65 after starting vedolizumab. Non-melanomatous skin cancer was the most common malignancy diagnosed after starting vedolizumab in both groups.

CONCLUSION:
Our data indicated no statistical difference between the adverse reactions leading to hospitalization, time to flare, and malignancy between the elderly and non-elderly IBD patients undergoing treatment with vedolizumab. However, our current data is primarily limited by small sample size and unequal study arm size. Also, our sample is primarily Caucasian, limiting our data's application to non-white IBD patient populations. We are currently working to combine our data with that of other hospital populations to overcome this limitation.
2916 Social Media and Inflammatory Bowel Disease
Authors: Chowdhary Tarika , Naqvi Syeda Fatima , Thompson Jesse M. , Gayam Swapna 
Published: October 2019

INTRODUCTION:
Social media has become so prevalent in our society today and it has become more widely used in the healthcare community. Inflammatory bowel disease (IBD) patients are one of the many patient populations that benefit from social media use to obtain further information on their diseases. West Virginia (WV) is a rural state and we wanted to see what role social media played in the lives of those living there. We conducted a study in the state of WV to determine how IBD patients used social media, which sources they used, and their opinions on these resources.

METHODS:
Our patient population consisted of patients 18-65 years old who live in WV with a diagnosis of IBD. Surveys were sent to patients over a course of four weeks through an application called REDCap. Our survey included 17 questions and was sent to a total of 2131 patients. We used descriptive statistics to better understand social media use in our IBD population.

RESULTS:
We received 624 responses with a 30% response rate. When asked about using social media for medical purposes, 29.6% of patients noted that they used Facebook for information related to their IBD, while 4.3% used Instagram. All other sites were used by less than 2% of participants. The majority of patients ranked reliability of the information as neutral (44.9%) or reliable (39.3%). When comparing information obtained through social media versus from physicians, 92% of patients did not prefer information obtained through social media over their physicians and there was no difference among patients with different education levels regarding this preference (chi square P value >.05%). Most patients stated that social media had a neutral impact on their disease management (67%), while 30.3% believed it had a positive impact. Almost 55% of patients stated they wished their physician had a social media account for IBD. The most common topic of interest was treatment options.

CONCLUSION:
IBD patients in WV represent a rural population with more barriers to social media use, so it was interesting to see how social media was used specifically for IBD. Even in this population, patients have been able to use social media to be involved in support groups, obtain information about treatments, and hear other patient's stories. Many patients were neutral about the impact that social media had on their lives, but there were also many others that were positively affected. This stresses the importance of social media in today's world among all different populations and locations.
2918 Reader's Digestion: An Assessment of Health Literacy in IBD Patients on Biologic and Immunomodulator Therapies
Authors: Baumgartner Scott , Szvarca Daniel , Clarke Lindsay , Tabbara Nadeem , Borum Marie 
Published: October 2019

INTRODUCTION:
Management of Inflammatory Bowel Disease (IBD) can include immunomodulators and biologics therapy. While these medications can have significant risks, patients may be inconsistently assessed for health literacy prior to initiating medications. Evaluation of health literacy is recommended to optimize patient understanding of clinical circumstances and management plans. This study assessed the rates of health literacy documentation in patients with IBD who are maintained on immunomodulators and biologics at a university medical center.

METHODS:
A retrospective chart review evaluating all IBD patients at a university medical center during a 5 year period was performed. Patient age, gender, IBD diagnosis, medication record (biologics, immunomodulators), and documented health literacy assessment with regard to medications and procedures were recorded. A database was generated using Microsoft Excel. Statistical analysis was performed using two-tailed Fisher's Exact Test with significance set at P < 0.05. The study was approved by the institutional IRB.

RESULTS:
Medical records of 392 IBD patients (175 men, 217 women) with mean age 44.3 (range 20-82; 259 <50 years old) were reviewed. 278 (70.9%) had ulcerative colitis, 96 (24.5%) Crohn's disease, 11 (2.8%) microscopic colitis and 7 (1.8%) with unspecified colitis. 295 were on immunomodulators (224 on immunomodulators alone, 31 also on a biologic). 78 were on biologics alone. Of those on biologics, 32 (41%) had documented health literacy assessment. Patients on biologics were more often assessed for health literacy compared to those not on biologics (P < 0.0001) or on immunomodulators alone (P = 0.0334). With respect to age, patients <50 were assessed for health literacy more frequently than patients >50 years (P = 0.0008).

CONCLUSION:
As physicians discuss therapeutic options with their IBD patients, it is important that physicians assess health literacy when initiating medications. This study demonstrates that there is insufficient documentation of health literacy in patients on biologic and other immunomodulatory therapies, especially in those older than 50. While this study was limited by retrospective design, small sample size and reliance on documentation, it identifies a potential opportunity for physicians to enhance quality of care and improve clinical outcomes in IBD patients.
2931 Lumen-Apposing Metal Stent for Treating Pancreatic Fluid Collections in Patients at Sarasota Memorial Hospital: A Quality Improvement Initiative to Compare Outcomes With Meta-Analysis Benchmarks
Authors: Alkayali Talal , Ricardo Juan , Salem Ahmed I. , Smith Robert , Harris Cynthia L. 
Published: October 2019

INTRODUCTION:
Acute pancreatitis can result in four different subtypes of fluid collections including acute peri-pancreatic fluid collection, pseudocyst, acute necrotic collection, and walled-off necrosis (WON). Complications including symptoms due to large size and infection may occur and warrant intervention. Endoscopic ultrasound (EUS)-guided drainage with a lumen-apposing metal stent (LAMS) is now commonly performed for cases where certain parameters are met. Evidence from academic centers reveals comparable or even superior technical and clinical outcomes over traditional drainage. The primary aim of our study is to evaluate technical and clinical outcomes of EUS-guided LAMS at a community-based hospital.

METHODS:
The Sarasota Memorial Hospital (SMH) Institutional Review Board (IRB) deemed this a quality improvement initiative, exempt from IRB review. Data was retrospectively collected from the SMH electronic medical records of 31 patients who underwent EUS-guided LAMS between April 2016 to October 2018. Contrast benchmarks were derived from a meta-analysis of eleven studies that evaluated efficacy of LAMS in the management in 688 patients.

RESULTS:
EUS-guided LAMS was performed by two endoscopists in 24 males and 7 females with median age of 55 years. Technical success was defined as correct placement of the stent with immediate drainage and occurred in 29 cases. Technical failure occurred in 2 cases, one due to solid debris preventing deployment of stent, and the other due to numerous varices surrounding the PFC resulting in limited access. Clinical success was defined as decrease of symptoms as well as decrease in size of the PFC and occurred in 25 cases. Four cases were considered a clinical failure: 3 patients required surgery, and one patient died due to complications from pancreatitis. Overall complications of LAMS placement included one pneumothorax, one infected WON in previously sterile WON, and one stent migration; Tables 1 and 2.

CONCLUSION:
EUS-guided LAMS for the treatment of pseudocyst or WON performed in a community hospital setting has equivalent technical and clinical outcomes and rate of complications compared to benchmarks established in an academic medical center.
2934 Thermal Ablation Is Effective for Recurrent Papillary Adenomas After Endoscopic Resection
Authors: Lee Jun Su , Kwon Hyeonwoo , Kim Seongmin , Cho Byungha , Choi Jongwook , Kim Ki Bae , Kim Hyoung Woo , Han Joung-Ho , Yoon Soon Man , Chae Hee Bok , Park Seon Mee , Youn Sei Jin 
Published: October 2019

INTRODUCTION:
Endoscopic papillectomy (EP) has been regarded as a safe and effective treatment for benign or premalignant ampullary tumors. There were many studies about indications, techniques, short-term and long-term complications, and prognosis. However, 5%-24% of cases of complete resection by EP have been recurred within 6-24 months. Proper treatment for recurrent cases depends on the individual features. Because papilla changed to flat fibrous scar after EP, 2nd EP is usually impossible or induces severe complications. Thermal ablation with electrocautery or argon plasma coagulation, approved as an effective and safe procedure for recurrent papillary adenomas. However, there were few data about long-term effects of thermal ablation for recurred ampullary neoplasm. We retrospectively analyzed the cases of papillary tumors treated by conventional EP and followed for more than 5 years. For recurrent papillary adenomas, we treated with thermal ablation with bipolar electrocautery and followed for more than 3 years.

METHODS:
Twenty cases with papillary mass who underwent EP over a 10 year were reviewed. Endoscopic papillectomy was performed for benign or premalignant papillary tumors. Surveillance after EP was performed at 3, 9 months and yearly thereafter with side-viewing endoscopy. During follow-up, recurrent cases were treated depending on pathological diagnosis and long-term outcomes were analyzed. Mean duration of follow-up was 52 months.

RESULTS:
Pathologic diagnosis were low grade dysplasia (n = 11), high grade dysplasia (n = 3), adenomyoma (n = 3), inflammatory lesion (n = 2), and paraganglioma (n = 1). Complete resection achieved in 19 cases by en block in 18 cases (90%) and additional endoscopic thermal ablation in one case with low grade dysplasia. One case of incomplete resection revealed high grade dysplasia and was treated with surgical ampullectomy. Three sporadic cases and one familial colonic polyposis recurred at 16, 18, 24, and 36 months after surgery, respectively. Three low grade dysplasia and one high grade dysplasia diagnosed by papillectomy pathology revealed low grade dysplasia by surveillance biopsy. Four cases were treated with one or multiple sessions of electrocoagulation. During follow up period after 2nd treatment, recurrence did not occurred.

CONCLUSION:
Recurrence occurred frequently in ampullary adenomas after complete resection. However, they can be safely treated with thermal ablation. Careful surveillance more than 3 years is needed after EP for ampullary adenomas.