bluuebunny/crossref_metadata_2025_split huggingface dataset:
560 Bowel Preparation Quality Improvement Using Multimedia and Visual Aids in Hospitalized Patients
Authors: Tang Thinh , Gohar Hamza , Villano Svetlana , Sharma Vishvinder , Attri Priyanka , Carlson Brian 
Published: October 2019

INTRODUCTION:
Bowel preparation is one of the most important factors affecting diagnostic yield and reaching the cecum in colonoscopy. Poor bowel preparation is encountered in up to 25% of colonoscopies. Hospitalized patients typically have poorer bowel preparation compared to outpatients due to factors such as acute illness and narcotic use. In this study, a new bowel preparation process using multimedia and visual aids was introduced with the goal of decreasing suboptimal and incomplete colonoscopy in hospitalized patients.

METHODS:
The study was conducted at a single community hospital in Las Vegas, Nevada. Nurses and nursing assistants completed an online educational module consisting of interactive written and video materials. All patients scheduled for colonoscopy received a brochure and watched a short 10 minutes video detailing the colonoscopy process. This new process was implemented on February 1, 2019. Post-implementation data were collected from February 1, 2019 to March 31, 2019. This was retrospectively compared to pre-implementation timeframe from December 1, 2018 to January 31, 2019. In the post-implementation period, 46 patients were included while 13 patients were excluded due to colonoscopy aborted or not performed for reasons unrelated to bowel preparation. During the pre-implementation period, 48 patients were included and 10 patients were excluded.

RESULTS:
In the post-implementation period there was a decreased in the number of colonoscopies aborted due to poor bowel preparation (19% to 7%). Of the number of completed colonoscopies, the average Boston Bowel Preparation Score are comparable (6.00 versus 5.95). The percentage of adequate bowel preparation, defined as Boston bowel preparation score of 6 or greater, are also similar (58% versus 57%).

CONCLUSION:
There was a significant decline in the number of colonoscopies aborted due to poor bowel preparation after the new process was implemented. The educational materials likely benefited those patients with poor initial understanding of the bowel preparation who would have inadequate preparation for successful colonoscopy otherwise. In patients with adequate initial understanding, the educational materials are less likely to be beneficial or change the outcome of the colonoscopy. This is evidenced by similar average Boston Bowel Preparation Score and percentage of adequate bowel preparation in both timeframes. These findings emphasize the importance of patient advocacy and education.
568 Polyp Detection and Histology by Colon Cleansing Quality With a Ready-to-Drink Low Volume Bowel Preparation: Subgroup Analysis From a Randomized, Assessor-Blinded, Multicenter Study
Authors: Bertiger Gerald , Hookey Lawrence , Johnson Kenneth L. , Ando Masakazu , Stong Laura , Chacar Christelle , Dahdal David N. 
Published: October 2019

INTRODUCTION:
High-quality bowel preparations are essential for polyp detection. In a recent meta-analysis, patients with adequate bowel preparation by the Aronchick Scale (AS) (defined as those with “excellent,” “good,” or “fair” ratings) had sufficient adenoma detection rate (ADR) for follow-up at guideline-recommended intervals. Here, we examine polyp and adenoma detection, grouped by AS rating, from a study of a ready-to-drink preparation of sodium picosulfate, magnesium oxide, and citric acid (SPMC oral solution).

METHODS:
A phase 3, randomized, assessor-blinded, multicenter study compared the efficacy and safety of low volume, split-dose SPMC oral solution to a powder formulation for colon cleansing in adults undergoing elective colonoscopy for screening, surveillance, or diagnosis. The study protocol was approved by Schulman IRB (protocol #000253). The primary efficacy endpoint assessed overall colon cleansing quality using a modified AS. Any polyps found during the colonoscopy were removed, recorded as AEs, and all polyps were sent for histological analysis. A post-hoc analysis examined polyp detection and histology by AS rating group. Polyp detection rate (PDR) and ADR in this study were defined as the percentage of any participants who had ≥1 polyp or adenoma, respectively (NCT03017235).

RESULTS:
A total of 448 patients received SPMC oral solution. For patients with an “excellent” rating by AS (n = 241), the mean (standard deviation, SD) age was 56.5 (12.2) years. In this group, PDR was 46.1% (111/241), and ADR was 30.3% (73/241), with a total of 122 adenomas identified across all participants (Figure 1, Table 1). For patients with a “good” rating by AS (n = 152), the mean (SD) age was 57.3 (9.4) years. In this group, PDR was 46.7% (71/152), and ADR was 33.6% (51/152), with a total of 104 adenomas identified in the group. For patients with a “fair” rating by AS (n = 43), the mean (SD) age was 60.8 (9.5) years. In this group, PDR was 41.9% (18/43), and ADR was 34.9% (15/43), with a total of 23 adenomas identified across all participants in this group. There were 4 (0.9%) patients who received an “inadequate” rating by AS, with a mean (SD) age of 51.0 (10.7) years.

CONCLUSION:
In patients receiving SPMC oral solution who had “excellent”, “good”, or “fair” ratings by AS, PDR and ADR were above guideline-recommended levels. Detection of sessile polyps was higher for those with “excellent” or “good” ratings by AS, compared to those with “fair” ratings.
570 Improving Endoscopy Staff Professional Satisfaction and Employment Retention Through Clinical Educational Didactic
Authors: Palmer William , Chris-Olaiya Abimbola , Hodge David , Lesser Elizabeth , Cangemi David , Lewis Michele 
Published: October 2019

INTRODUCTION:
High nursing turnover has long been recognized as a fiscally and emotionally costly phenomenon in gastrointestinal (GI) endoscopy units. Previous studies suggest high turnover may be partly attributed to job-related stress in GI endoscopy units and lack of educational opportunities. A retrospective review of nursing turnover rate in 2016 at Mayo Clinic Florida GI endoscopy unit found the turnover rate to be 25%, which is twice the average of other departments at the clinical site. We aimed to reduce endoscopy staff turnover rate to less than 25% and improve job satisfaction by improving knowledge of GI diseases through structured didactic sessions.

METHODS:
A descriptive correlational study of the impact of a six-month long optional educational curriculum on professional quality of life and employee turnover was performed. All endoscopy nurses and technicians employed at Mayo Clinic in Florida were recruited, but both study enrollment and participation were blinded and voluntary. Data on clinical gastroenterological knowledge and surveys on professional satisfaction and team cohesion were collected at the initiation of the curriculum and at one month after completion. Pre and post intervention knowledge scores were compared using the Wilcoxon signed rank test. The annual percentage of turnover was estimated by the Wilson score confidence interval.

RESULTS:
All available GI nurses and endoscopy technicians (n = 71) were invited to participate. 40 (56.3%) participants completed only the initial survey, 30 (42.3%) only the second survey, and 16 (22.9%) both surveys. Of those who completed both surveys, median quiz scores improved by 2 questions for those that attended 6 or more lectures (P = 0.017). There was a trend towards increased professional satisfaction on the modified perceived cohesion scale in participants who attended 6 or more lectures (P = 0.095). For participants who have worked in the unit for less than 1 year, the estimated turnover is 14% (6 – 38%, P > 0.05) and 24% (11 – 45%, P >0.05) for those who have worked longer than 1 year.

CONCLUSION:
Though limited by sample size, there is a trend towards improved job satisfaction for participants that completed all surveys and a reduction in turnover rate for staff who have worked in the unit for less than one year. This study suggests potential benefit in knowledge, professional satisfaction, and turnover for those offered voluntary education.
576 Comparing Electronic Consults versus Outpatient Referrals to Gastroenterology: Impact on Timespan to and Completion Rates of Recommended Procedures
Authors: Lindholm Christopher , Ramkissoon Resham , Cohen Emily , Anderson Joseph 
Published: October 2019

INTRODUCTION:
Electronic consults (econsults) are a valuable tool embedded in the electronic medical record. There have been a number of studies regarding econsults, however most are descriptive studies. There are currently few studies describing the impact of econsults on clinical practice. In this retrospective study we examined how econsults to gastroenterology compared to “standard consults” submitted via primary care practitioners (PCP) impacted 1) time to recommended procedure and 2) completion rate of recommended procedures.

METHODS:
A retrospective chart review of econsults and outpatient referrals made to the gastroenterology department at the Veteran's Affairs Medical Center in Vermont was performed from 2012 to 2014. Charts were analyzed and patient demographic information including age, gender, comorbidities (hypertension, coronary artery disease, diabetes mellitus) was collected. With regards to econsults and standard consults, the following information was collected: date of econsult/referral, referring PCP credentials, nature of question (clinical versus administrative), disease process in question, completion of econsult or referral, timespan to answer econsult, timespan to initial clinic visit for referrals, whether or not a procedure (EGD or colonoscopy) was recommended, whether or not recommended procedure was completed and time to completed procedure. Data collection and analyses were done in accordance with local IRB. Chi square and t-test were performed, and logistic regression model used to predict factors associated with time to procedure.

RESULTS:
Overall 253 econsults and 171 outpatient referrals were included in our study with 253 (100%) and 98 (57.3%) completed respectively. Sixty-four procedures were recommended via econsults and 53 procedures were recommended via referrals with 36 (56.2%) and 30 (56.6%) (P = 0.89) completed respectively. Of the completed consults, 25.3% of econsults versus 54.1% (P < 0.0001) of standard consults had a recommended procedure. The mean timespan to procedures was 82 days for econsults and 87.3 days (P = 0.21) for referrals.

CONCLUSION:
Gastroenterologists were more likely to recommend a procedure after a face to face encounter with patients compared to econsults. There was no difference found between rates of completed procedures or the timespan to completion for econsults versus standard outpatient referrals.
577 Randomized Controlled Trial (RCT) of Over-the-Scope Clip (OTSC) as Initial Endoscopic Treatment of Severe Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB)
Authors: Jensen Dennis M. , Kovacs Thomas , Ghassemi Kevin , Kaneshiro Marc , Gornbein Jeffrey 
Published: October 2019

INTRODUCTION:
Recurrent GI bleeding from peptic ulcers (PUB's) & Dieulafoy's lesions is common in high risk patients. In our recent RCT, patients treated with Standard Hemostasis- RX (e.g. hemoclips &/or multipolar probe with epinephrine pre-injection) for severe NVUGIB had a 30 day rebleed rate of 26.3 % (Gastro 2017;152:1310). OTSC obliterates arterial flow underneath stigmata of hemorrhage (SRH) of PUB's more effectively than Standard RX & residual blood flow correlates with rebleed risk (DDW 2019). No one has reported an RCT of OTSC as primary, initial treatment compared to current Standard RX. Therefore, we performed this RCT.

METHODS:
The RCT was conducted at 2 academic medical centers after IRB approvals & Clinicaltrials.gov registration (NCT03065465). After informed consent for emergency endoscopy (EGD), patients & their caregivers (general GI, ICU & primary care) were blinded as to EGD Rx & the latter MD's made all management decisions about medical treatment, RBC transfusions, or ordering repeat EGD or angiography (IR) for rebleeding. Patients who met clinical & EGD criteria for PUB's or UGI Dieulafoy's lesions (with major SRH or spots with arterial blood flow) were randomized in a 1:1 allocation to either Standard RX (as described in above RCT) or OTSC. All patients received high dose PPI's after randomization & were followed prospectively for 30 days. Clinical outcomes data were collected on standard forms, de-identified, entered onto computer files, managed with SAS, & analyzed by a biostatistician (JG).

RESULTS:
49 RCT patients were well matched in demographics, risk factors, lesion type & SRH (Table 1). In contrast, the proportion of patients with 30 day rebleeding was significantly higher with Standard RX - 28% (7/25) - compared to OTSC Rx – 4.2% (1/24) - P = 0.0285 by Chi square (P = 0.022 by log rank test – See Figure 1). The OTSC rebleed rate was 85% lower than Standard group (Relative Risk 0.149 with 95% confidence intervals of 0.006, 0.863). The number needed to treat (NNT) was 4.2. See Table 2 for other outcomes.

CONCLUSION:
In patients with severe UGI bleeding from PUB's or Dieulafoy's lesions, primary endoscopic treatment with a large over the scope hemoclip resulted in significantly lower rates of rebleeding & severe complications, & fewer RBC transfusions than standard endoscopic hemostasis. Results appear to relate OTSC's superior ability to obliterate arterial blood flow underneath SRH & thereby reduce lesion rebleeding.
578 Resuming Anticoagulation Following Hospitalization for Gastrointestinal Bleeding Is Associated With Reduced Thromboembolic Events and Improved Mortality: Results From a Systematic Review and Meta-Analysis
Authors: Tapaskar Natalie , Pang Alice , Sengupta Neil 
Published: October 2019

INTRODUCTION:
Systemic anticoagulants are widely prescribed for prevention and treatment of thromboembolism, but are commonly complicated by gastrointestinal bleeding (GIB). There is limited data on the management of anticoagulation after hospitalization for GIB and the subsequent risks of recurrent GIB, thromboembolism, and mortality.

METHODS:
We performed a systematic review and meta-analysis to determine the risk of recurrent GIB, thromboembolism and mortality after resuming anticoagulation following GIB. PubMed, Embase and Scopus were searched for randomized controlled trials and cohort studies in patients with atrial fibrillation, venous thromboembolism or valvular heart disease who received long-term warfarin or direct oral anticoagulants before experiencing GIB. Studies were included if data were available on anticoagulation management and outcomes of recurrent GIB, thromboembolism and mortality following initial hospitalization for GIB.

RESULTS:
A total of 5,354 studies were reviewed of which 10 were included in the meta-analysis (Figure 1). There were 2,080 patients who resumed anticoagulation and 2,296 patients who stopped their anticoagulation post index GIB (Table 1). Resumption of anticoagulation was associated with a significant increase in recurrent GIB (OR 1.646, 95% CI 1.035-2.617, P = 0.035, I2 = 55.5%) though recurrent GIB leading to death was rare (Figure 2). There was a significant decrease in thromboembolic events in patients who resumed anticoagulation compared to those who did not (OR 0.340, 95% CI 0.178-0.652, P = 0.001, I2 = 62.7%) and a significant reduction in all-cause mortality (OR 0.499, 95% CI 0.419-0.595, P = 0.000, I2 = 14.2%) (Figure 2). Optimal timing of re-initiation of anticoagulation varied, but as early as 2 weeks from index GIB or hospital discharge may be ideal.

CONCLUSION:
While resumption of anticoagulation following index GIB was associated with a significant increase in recurrent GIB, it was also associated with a significant decrease in thromboembolic events and all-cause mortality. Re-initiation of anticoagulation as early as 2 weeks post-GIB may be optimal.
582 CRP and BUN as Risk Factor for Complications in Patients With Upper Gastrointestinal Bleeding
Authors: Mariadi I. Ketut , Sudjana Karismayusa , Nyoman Wibawa I Dewa 
Published: October 2019

INTRODUCTION:
Rebleeding and mortality were serious complications following upper gastrointestinal bleeding. We need to identify the risk factor of the complication for prevention and prompt treatment. This study aims to know the risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding.

METHODS:
A prospective analytic observational study was made in patients with upper gastrointestinal bleeding, who admitted to Sanglah General Hospital. Data of CRP and BUN was collected when the patients admitted to the hospital, and follow up was done in 6 weeks to see the complication. The data were analysed using the chi-square test.

RESULTS:
Sixty-eight patients admitted to the hospital with upper gastrointestinal bleeding were involved in this study. 2 patients loss of follow up, and the rest 66 patients were involved in the analysis. Range age of patients was 18-68 years old. Forty-six (69.7%) patients were male, and the rest 20 (30.3%) were female. Both variceal and nonvariceal upper gastrointestinal bleeding patients were involved in this study. Median of CRP was 4.61 (0.30-65.80) mg/L and CRP level >5 mg/L was defined as high risk for complication. Mean BUN 35.65 ± 34.45 mg/dL, and BUN >20 mg/dL was defined as high risk for complication. During follow up, 41 patients have a complication. Rebleeding occurred in 27 patient and mortality in 14 patients. The results of Chi-square test for CRP:X

2
= 16.0; P < 0.001; OR=9.67 (2.95-31.73); for BUN: X

2
= 6.70; P = 0.01; OR = 3.95 (1.36-11.43).

CONCLUSION:
Rebleeding and death is the major complication in a patient with upper gastrointestinal bleeding, both variceal and nonvariceal. It is crucial to identify the risk factor of complication to predict the outcome of the patients. In this study, we found CRP level > 5 mg/L and BUN level >20 mg/dL was a significant risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding. This result is supported by the previous study, that found the serum CRP was an independent risk factor for 30-day rebleeding in patients with acute nonvariceal upper gastrointestinal bleeding and study by Wu et al., observed BUN/Creatinine ratio of >30 was an independent risk factor for mortality. Identifying the risk factor for a bad outcome will guide us to manage and treat the patients. In conclusion, In this study CRP level >5 mg/L and BUN level >20 mg/dL was a significant risk factor for rebleeding and mortality in patient with upper gastrointestinal bleeding.
583 Rebleeding After Hemoclip versus Argon Plasma Coagulation Use for Bleeding Gastrointestinal Angiodysplasias in Patients Receiving Antithrombotics: A Retrospective Multi-Center Study
Authors: Ismail Bahaaeldeen , Alayoubi Mhd Suhaib , Abdelwadoud Moaz , Castro Fernando 
Published: October 2019

INTRODUCTION:
Endoclips have been used for treating bleeding gastrointestinal angiodysplasias (GIAD), but the supporting evidence in the literature has been limited. We previously presented a retrospective study that showed a significantly lower rebleeding rate with clips compared to argon plasma photocoagulation (APC); however, the sample size was small particularly the number of patients receiving antithrombotics (ATs). Aim of the current study is to compare the rebleeding rate with the use of clips versus APC in patients with bleeding GIAD receiving ATs.

METHODS:
We retrospectively included adults with bleeding GIAD that received either APC, clips monotherapy or in combination, at any of the Cleveland Clinic hospitals between 1/1/2009 to 11/1/2016. Only patients who resumed ATs after the intervention were included. Charts were reviewed to collect baseline and outcome characteristics.

RESULTS:
178 patients were included, 92 received APC, 28 received clips monotherapy and 58 received clips combined with a second modality. At baseline, the clips group had more single GIADs, more actively bleeding lesions on index endoscopy and a tendency towards more overt bleeding. Baseline characteristics were otherwise similar [Table 1]. Median follow up duration was 18.5 months [IQR 9.9-27.3]. Rebleeding was significantly lower in the clips group (34.9% compared to 51.1% for APC, P = 0.03). The probability of remaining free of rebleeding was also higher in the clips group compared to APC (P = 0.037) [Figure 1a] but not significantly different when patients were classified into 3 groups [Figure 1b]. On a multivariate hazards regression model [Table 2], receiving clips combined with a second modality was predictive of lower rebleeding (HR 0.46 (0.25-0.84)). Other significant factors were having a smaller sized GIAD and having higher hemoglobin nadir at the initial bleed.

CONCLUSION:
Clips were associated with a lower probability of rebleeding in patients with GIADs receiving ATs compared to APC. After accounting for potential confounders, using clips in combination with a second modality remained significant, suggesting a role for combined intervention in patients that will resume ATs after endoscopic therapy.
585 Risks of Recurrent Bleeding in Patients Hospitalized With Gastrointestinal Bleeding While on Warfarin vs Direct Oral Anticoagulants
Authors: Tapaskar Natalie , Ham Sandra A. , Sengupta Neil 
Published: October 2019

INTRODUCTION:
There is limited data on the management of anticoagulation following hospitalization for gastrointestinal bleeding (GIB) and the subsequent risks of recurrent GIB and thromboembolism in patients who are on warfarin compared to direct oral anticoagulants (DOACs).

METHODS:
We conducted a retrospective analysis of medical claims data from the IBM®MarketScan® Research Databases from January 1, 2008 through December 31, 2017. We collected data on adults with atrial fibrillation treated with warfarin or DOACs and subsequently hospitalized for GIB. Post discharge readmissions for recurrent GIB and thromboembolism within 180 days of initial discharge were reviewed. Univariable and multivariable cox regression were used to determine risks of recurrent GIB and thromboembolism.

RESULTS:
There were 2,991 patients hospitalized for GIB while on anticoagulants (warfarin, n = 1872; rivaroxaban, n = 676; dabigatran, n = 293; apixaban, n = 250). Differences between warfarin and DOAC users are reported in Table 1. Twenty-nine percent (n = 869) of warfarin users had warfarin resumed following discharge with a median time to resumption of 27 days (IQR 10-63), compared to 16% percent (n = 485) of DOAC users who had DOAC resumed (median time to resumption of 32 days (IQR 16-69). Discharge on warfarin was associated with the highest risk of recurrent GIB (HR 1.69, 95% CI 1.23-2.31) whereas discharge on dabigatran (HR 0.13, 95% CI 0.02-0.90) and apixaban (HR 0.38, 95% CI 0.14-1.01) had the lowest risk of recurrent GIB (Table 2). In a multivariable model adjusting for demographics, comorbidities, in-hospital management, source of bleeding, and post-discharge anticoagulant resumption, resumption of warfarin was associated with an increased risk of recurrent GIB (HR 1.53, 95% CI 1.07-2.18) compared to resumption of DOAC (HR 0.85, 95% CI 0.51-1.42). Variables associated with thromboembolism on multivariable regression included preceding venous thromboembolism (HR 2.42, 95% CI 1.66-3.51) and history of left ventricular assist device (HR 7.84, 95% CI 3.20-19.2). Survival analysis showed a significant association between type of anticoagulant on discharge and risk of recurrent GIB (log-rank, P = 0.001) (Figure 1).

CONCLUSION:
Resumption of warfarin following hospitalization for gastrointestinal bleeding was associated with an increased risk of recurrent GIB when compared to DOACs.