bluuebunny/crossref_metadata_2025_split huggingface dataset:
2805 Targeted Interventions Improving Compliance With Guideline-Based Care in Acute Pancreatitis
Authors: Sydor Michael , Roark Russell , Samuel Ronald , Chatila Ahmed , Nguyen Bao , Dayah Rawan , Marcondes Felippe O. , Khowaja Tehmina , Kaushik Chandni , Faruqi Jordana , Garza Rigoberto , Agarwal Mayank , Biggs Sarah , Tambra Sarah , Kline Kevin , Bilal Mohammad , Olino Kelly , Parupudi Sreeram , Sonstein Lindsay 
Published: October 2019

INTRODUCTION:
Acute pancreatitis (AP) is the 3rd leading cause of GI related hospitalizations nationwide. In an effort to improve guideline-based care at our institution, we acquired retrospective data from 247 patients admitted to our institution between April 1, 2015 to September 30, 2017 with AP. We identified multiple areas in which to improve care based on the American College of Gastroenterology (ACG) Guidelines: intravenous fluid (IVF) resuscitation, right upper quadrant ultrasound (RUQ-US) use, and antibiotic stewardship in patients admitted with AP. We aimed to increase the percentage of AP patients who receive adequate IVF resuscitation in the first 24 hours from 6.4% to 50%, increase the RUQ-US rate from 59.5% to 80%, and decrease the rate of inappropriate antibiotic use from 24% to 10%, by April 1, 2019.

METHODS:
Within the internal medicine department, a quality improvement group was assembled. Barriers to implementing guideline-based care within our target areas were identified. We then implemented interventions aimed at improving performance in our three focus areas. The interventions included: house staff education, development and implementation of an AP admission order set within the electronic medical record (EMR), meeting with the emergency department to encourage early fluid resuscitation, distribution of a management flowsheet to house staff work rooms, and the antimicrobial stewardship program (ASP) including patients with AP who meet criteria for inappropriate use (on antibiotics for >48 hours without evidence of intrapancreatic or extrapancreatic infection) in their EMR based communication. We tracked our progress utilizing a real-time patient monitoring software.

RESULTS:
On April 1, 2019, a total of 35 patients were captured after the start of our interventions. Appropriate IVF resuscitation [defined as >250cc/hr of normal saline or lactated ringers (6L in the 1st 24 hours)] improved from 6.4% to 20%. RUQ-US obtained on admission improved from 59.5% to 71.4%. Inappropriate antibiotic use decreased from 24% to 11.4%.

CONCLUSION:
While improvements in appropriate IVF resuscitation, RUQ-US rate, and antibiotic stewardship were noted, we have not yet met our goals. We aim to build on this progress through increased utilization of the AP order set, and the ASP will continue to monitor and intervene for inappropriate antibiotic use in AP patients. We intend to evaluate pre and post intervention 30-day readmission rates and length of stay.
2806 Viral-Induced Acute Pancreatitis: A Systematic Review
Authors: Imam Zaid , Simons-Linares Roberto , Chahal Prabhleen 
Published: October 2019

INTRODUCTION:
Infectious (viral, bacterial, and fungal) etiologies are rare causes of acute pancreatitis (AP). We sought to investigate the frequency of viral-induced AP (VIAP), describe its natural course, and clinical features.

METHODS:
A comprehensive review of PubMed’s database of English language from the time of its inception and until April 12th,2019 was performed using all relevant MeSH (medical subject headings) keywords. AP diagnosis and severity were defined as per the Revised Atlanta Classification (RAC). Viral infections were diagnosed by serology and/or histology. A diagnosis of viral infection, with a concurrent AP diagnosis, a temporal resolution of both entities and the attempt to exclude the most common etiologies of AP defined VIAP. Graft pancreatitis studies and non-English publications were excluded. Two independent blinded reviewers (Z.I, C.R.S.L.) reviewed the publications. Bias risk was assessed with the Murad tool derived from the Newcastle-Ottawa scale.

RESULTS:
209 cases were identified in 128 publications meeting criteria for VIAP and were reviewed (2 case control, 120 case reports, 6 case series) (Figure 1). Most studies 101 (78.3%) were at high risk of bias. Mean age was 38.9 ± 1.28 yrs for 170 patients. Male to female ratio was 2.2:1, and 52 (28.0%) of 186 patients were immunocompromised. Mean lipase was 1590 (range: 61-16879) and mean amylase was 1237 (range: 33-14800) in 103 and 156 patients. Viral hepatitis (A,B,C,D and E) was the most common virus and accounted for 34.4% of reported cases, followed by coxsackie and echoviruses at 14.8%, hemorrhagic fever viruses at 12.4%, CMV at 12.0%, VZV at 10.5%, mumps and measles at 3.8%, primary HIV infection at 3.8%, HSV at 1.9%, EBV at 1.9% and the remainder of cases (1.9%) attributed to adenovirus, influenza H1N1, and multiple viruses were implicated in 1% of cases. Severity of AP was: 43.1% mild, 11.7% moderately severe, 32.4% severe. Death was reported in 42 (20.1%) patients. Patient characteristics are summarized in Table 1.

CONCLUSION:
Although majority of patients were not immunocompromised (72%), a significant portion were immunocompromised (28.0%). Importantly, among those who died, 71.4% were immunocompromised. Mortality rate was higher than that reported for AP from other etiologies in the literature. Cholangiopathy and obstruction, direct acinar injury by viral replication are suggested pathogenesis mechanisms for virus attributed AP.
2823 Spleen Rupture Secondary Colonoscopy Is a Rising Epidemic
Authors: Ullah Waqas , Mehmood Asif , Rashid Mamoon Ur , Zafar Yousaf , Ahmed Ishtiaq , Hurairah Abu 
Published: October 2019

INTRODUCTION:
Colonoscopy is a safe and routine procedure to evaluate large bowel for diagnostic and therapeutic purposes. Common post procedure complications include bleeding and perforation of gut but rarely splenic Injury.

METHODS:
A structured search on four databases was done and 68 articles were selected. Three reviewers extracted data into the excel sheet identifying the reason of colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcome of all patients with spleen injury.

RESULTS:
The mean age of all the patients was 62.7 SD 15.7 years, 36% male and 64% female. About 22% had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason was screening colonoscopy (46%) followed by diagnostic colonoscopy (28%). About 87% patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%). While minor spleen hematomas and lacerations were managed conservatively (38%). Interestingly, 6% patients were managed with proximal splenic artery splenic embolization (PSAE) and 4% were managed with laparoscopy. The overall mortality was about 10% while 77% had successful recovery. The reason of colonoscopy against presentation specifically abdominal pain showed no statistical significance P = 0.69. Spleen rupture and injury were the most common reason was screening colonoscopy followed by colonoscopy done for bleeding evaluation (not statistically significant). There was no significant association found between the reason of colonoscopy and type of spleen injury management (P 0.89). It is interesting to note that significantly high (74%) of the spleen rupture patients were managed with splenectomy while the rest were managed with conservative management in spleen injury group (P value 0.04) (Figure 1). The strength of association between the management and spleen injury was moderately strong at at a cramer’s V 0.34. The Fisher exact test for the type of spleen injury with the outcome was significant (P = 0.028) indicating a high mortality with spleen rupture.

CONCLUSION:
Spleen rupture due to colonoscopy is an increasing concern and should physicians should be aware of it as it has been associated with a high mortality. The management of the patients can be individualized based on clinical settings.
2841 Sex, Educational Status, and Compliance With Scheduled Out-Patient Screening Colonoscopy Among Under-Served Urban Blacks
Authors: Laiyemo Adeyinka , Kwagyan John , Williams Carla , McKie Charmaine , Castor Chimene , Brim Hassan , Lee Edward , Ashktorab Hassan 
Published: October 2019

INTRODUCTION:
Black men suffer the highest burden from colorectal cancer in the United States. It is generally believed that women are more health conscious than men, but it is unknown if educational status influence compliance by sex among underserved minorities. Aim: To evaluate sex differences in compliance with scheduled screening colonoscopy appointments among underserved urban blacks and investigate the effect of the highest education attained.

METHODS:
Methods: A total of 399 black patients participated in a clinical trial (NCT02464618) designed to evaluate the efficacy of self-selected social contact person in improving compliance to scheduled outpatient screening colonoscopy. The primary outcome of our present study was compliance with the scheduled outpatient screening colonoscopy among attendees by sex and highest education attained. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS:
There were 188 (47.1%) black men and 211 (52.9%) black women. Overall, there was no sex difference in compliance with the scheduled colonoscopy appointments (77.3% versus 77.1%; OR = 1.01; 95% CI: 0.63-1.61). However, participants with some college education were more compliant (84.1% versus 73.1%; OR = 1.95; 95% CI: 1.15-3.30). This improvement in compliance was more evident among men (Table 1).

CONCLUSION:
Conclusion: Efforts to improve general and cancer specific education of black men are needed to reduce the burden of colon cancer among this vulnerable population.
2843 Lack of Knowledge About Follow-Up Colonoscopy in Patients With Biopsy Proven Advanced Colorectal Polyps: A Major Clinical and Medicolegal Challenge
Authors: Rothschild Evin , Fiedler Benjamin , Fiedler Lawrence , DeDonno Michael , Fiedler Lawrence , Cruz Leonie de la , Fiedler Lawrence , Hennekens Charles H. 
Published: October 2019

INTRODUCTION:
The most recent guidelines from the American College of Gastroenterology recommend that patients with biopsy proven advanced colorectal polyps undergo repeat surveillance colonoscopy at a minimum of three years following resection. The rationale is based on rates of recurrence and progression to colorectal cancer. In this report we quantitate the knowledge of patients with biopsy proven advanced colorectal polyps about if, and when, they need a repeat colonoscopy.

METHODS:
Methods: Written informed consents were obtained and brief telephone interviews conducted by trained interviewers among 84 patients with biopsy proven advanced colorectal polyps. In semi-structured questionnaires that included eleven questions the patients provided self-reports about their awareness of the need to have a repeat colonoscopy as well as the proper surveillance interval.

RESULTS:
Among the 84 patients, who ranged in age from 41-91 years, 24 (28.6%) were unaware of either the need for a repeat colonoscopy or the proper surveillance interval. These included 10 (12.0%) who were not even aware that they required a follow up colonoscopy and 14 (16.6%) who were unaware of the proper three year interval.

CONCLUSION:
Discussion: These data pose medical and legal challenges to clinicians to educate patients with biopsy proven advanced colorectal polyps about their need for repeat colonoscopy as well as the proper surveillance interval to reduce their risks of colorectal cancer. Specifically, without proper knowledge of the advanced colorectal polyp three year surveillance protocol, 28.6% of these high risk patients would have forgone or delayed the colonoscopy. With advances in technology and digitized medical records, clinicians may need to rely on a more objective and reproducible centralized database of past colonoscopy findings rather than self-reports. These clinical and medicolegal challenges may also be addressed, at least in part, by automated recalls that ensure there is a safety net to remind patients of their subsequent colonoscopy appointment. The success of these strategies will depend on meticulous attention by the clinician to ensure accurate data pertaining to guideline based appropriate surveillance intervals for colonoscopy. These strategies may also reduce any overutilization of colonoscopies. Of far greater import, the achievement of this goal may reduce morbidity and mortality from colorectal cancer in high risk patients with advanced colorectal polyps.
2849 An Initiative to Optimize Bowel Preparation Quality
Authors: Jacob Bobby , Cusano Elizabeth , Yeroushalmi Kevin , Karim Syed , Wankhade Charudatta , Khan Nausheer , Rizvon Kaleem , Mustacchia Paul 
Published: October 2019

INTRODUCTION:
Colonoscopies are an imperfect screening tool with a miss rate of approximately 2-6% of pre-cancerous and/or cancerous lesion. Variations occur amongst endoscopists in performance of colonoscopies; therefore, quality indicators are established in order to provide consistent high quality health care. Bowel preparation quality affects the completeness of the examination, procedure duration and need to cancel or repeat procedures at earlier dates than would be otherwise be needed. Inadequate preparation is a major contributor of missed lesions leading to decreased adenoma detection rates (ADR) and medical costs.

METHODS:
We performed a retrospective review of all colonoscopies preformed from May 1, 2018 to September 30, 2018 to assess our baseline rates of poor bowel preparation quality using the Aronchick bowel preparation scale. An initiative to improve the quality of our bowel preparation rates through re-designing the educational material distributed to patients undergoing colonoscopies and implementing a two-day call reminder system. We then performed another retrospective analysis from October 1, 2018 to February 28, 2019 with the above changes to our practice. We then compared the rates of poor preparation before and after the implemented modifications of counseling patients, as well as the rates of adequate preparation in the subset of patients undergoing colonoscopy for the indication of screening for colorectal cancer.

RESULTS:
We assessed our baseline rates of adequate preparation of all colonoscopies to be 86% pre-intervention. Post-intervention with re-designed education material and two-day call reminder system has improved our adequate preparation rate to 93.3%. Of all the colonoscopies preformed with the indication as screening colonoscopies the pre-intervention adequate preparation rate was 84.3% and post-intervention adequate preparation rate was 86%.

CONCLUSION:
Healthcare professionals involved with colorectal cancer screening should focus on improving patients understanding and compliance with appropriate bowel preparation prior to screening colonoscopy through effective communication, phone call reminders and educational material, which can be easily comprehendible. Socioeconomic factors and language barriers in some patient populations may require increased educational efforts before the colonoscopy to achieve this level of success. Compliance with quality measures will allow for effective and safe CRC prevention, better patient outcomes and decreased medical costs.
2858 Effervescent Granules Are an Effective, and Cost-Saving Strategy in Acute Esophageal Food Impaction
Authors: Al-Jashaami Layth , Narang Aneesh T. , Baron Robert L. , Gerkin Richard D. , David Joseph 
Published: October 2019

INTRODUCTION:
Acute esophageal food impactions (AEFI) are common. Effervescent granules (EG) consist of sodium bicarbonate and citric acid and create carbon dioxide (CO2) gas in the esophagus, which can raise the intraluminal pressure and force the bolus into the stomach. There are little published data describing EG in the treatment of AEFI. The primary purpose of this study was to evaluate the effectiveness and safety of EG in the emergency department (ED) setting in adult patients presenting with AEFI. Secondary objectives are to determine cost associated with EG, and to see if there are any patient characteristics that may predict successful response.

METHODS:
A prospective chart review of patients presenting to the ED with AEFI in a large tertiary referral teaching hospital, as well as from 2 sister community hospitals in the same metropolitan area from January 1, 2016 to December 31, 2018 was performed. Inclusion criteria were age 18 and older and clinical diagnosis of AEFI. Data collected included patient demographics, outcomes, cost and complications. Mann-Whitney testing was used to compare groups. Logistic regression was used to determine predictors of effectiveness. Successful response was defined as clearance of the food impaction avoiding the need for emergent endoscopy.

RESULTS:
Sixty AEFI presentations met inclusion criteria with mean age of 51.0 years (+/- 18.4) and mean BMI 29.1 kg/m2 (+/- 6.6). Other demographic variables are shown in Table 1. A total of 33 patients (55.0%) who received EG responded successfully. The median hospitalization cost associated with EG success was $1,743 (IQR $976-$2,427). For patients who failed to respond to EG, the median cost was $13,224 (IQR $10.563-$18,933) (P < 0.001). Of concern, there were 2 cases of esophageal perforation that both occurred in patients who failed to respond to EG but were only noted after EGD. One healed with conservative therapy (NPO, antibiotics) and the other with placement of a covered esophageal stent. Both made a full recovery.

CONCLUSION:
Effervescent granules are an effective and cost-saving initial strategy in the treatment of acute esophageal food impaction. Further study of the safety and effectiveness of effervescent granules is warranted.
2860 Safety of Esophageal Dilation in Patients With Eosinophilic Esophagitis in a Single Center Cohort
Authors: Zhao Weidan , Ali Asad , Rosenstengle Craig , Shan Kuangda , Dayan Yehudith Assouline 
Published: October 2019

INTRODUCTION:
Eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, is a leading cause of food impaction due to fibrotic formation of rings, narrowing, and strictures. Historically, esophageal dilation (ED) was reserved as second-line therapy for EoE after failure of medical management, due to concern of complications, mainly perforation. Now, ED is recognized as an effective treatment for symptomatic relief. The aim of this study is to assess the safety of ED in a large cohort of EoE cases in a single center.

METHODS:
A retrospective review of patients with biopsy confirmed EoE at University of Iowa Hospitals and Clinics between the years 2006 – 2018 was conducted. All subjects met diagnostic criteria for EoE; presence of esophageal dysfunction and mucosal eosinophilic infiltration (≥15 eos/hpf). Histologic and clinical features, ED characteristics and related complications, and self-reported symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed.

RESULTS:
A total of 160 patients were dilated 295 times, ranging from 1-12 dilations per patient, with an average of 1.91 dilations per patient. 67 patients (41.88%) required >1 dilation. Procedures were generally tolerated well, with no major bleeds or perforations. The overall complication rate was 6.1%, primarily due to post-procedural chest pain (4.8%). Three patients had sedation related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Clinical improvement was documented in 87% of dilations on follow up. Table 1 and Figure 1 and 2.

CONCLUSION:
The prevalence of EoE is increasing with rates of 0.5 – 1 cases per 1000 individuals, with 25-35% of these patients requiring ED for symptomatic management. In the early 2000s, many reports suggested an increased procedure-related risk, including esophageal perforation. Recent systematic review and meta-analysis have shown otherwise. Present published rate of perforation in dilation in EoE occurs in < 0.3% of procedures, which approximates that of dilation for other benign esophageal indications. Our study is consistent with current data. Taking the above safety data of ED into account along with the rising incidence of EoE, lends evidence to the acceptance of ED as a safe and effective treatment. ED should therefore be considered a safe procedure in EoE patients for symptomatic management in addition to dietary and pharmacological interventions.
2876 YouTube Videos on Irritable Bowel Disease: A Qualitative Analysis of Views and Content
Authors: Azawi Muaataz , Homsi Maher , Syed Umer , Walfish Aaron 
Published: October 2019

INTRODUCTION:
IBS is a functional disorder of the GI tract. It accounts for 25-50% of all referrals to gastroenterologists in the US, ranking it as the second highest cause of work absenteeism. Patients tend to use the internet, and particularly social media sites, to learn more about their medical condition. YouTube being one of the largest search engines, has grown its popularity as a go-to health-related source of information. This study aims to evaluate the quality of material available for IBS patients.

METHODS:
Youtube.com main page was queried for the search term “Irritable Bowel Disease”. The resulting videos were evaluated for content, duration, source, and audience interaction: number of views, likes, and dislikes. Content was classified as useful, misleading or patient’s views/experience. Useful videos were further analyzed for content using the published DISCERN instrument with 16 questions each consists of 5-point scale for assessing the quality of health information.

RESULTS:
The search phrase “Irritable Bowel Disease” recaptured thousands of videos sorted by default filter of “relevance.” The top 20 videos were analyzed as these are the videos that patients were likely to view by visitor statistics. On average, videos had 5:41 minutes duration, 184892 views, 1471 likes, and 81 dislikes. 50% of videos were from health care professionals, 30% from health care organizations, 10% from individuals/patients, 5% clips from TV shows, and 5% non-professional educational groups. 60% of the videos were classified as useful. Wheres 25% were misleading, 10% were irrelevant, and 5% were patient experience. Useful videos scored an average of 2.8 out of 5 on the DISCERN scale indicating fair quality. 66% of the useful videos were from health care professionals with average DISCERN score of 2.6 out of 5. 33% were from health care organizations with an average score of 3.3 out of 5.

CONCLUSION:
Despite YouTube being the fastest growing shared videos website, it lacks qualitative videos about a very common disease such IBS. As one of the largest online references for many patients, healthcare organizations can utilize this platform to correct misconceptions about the disease. Although the majority of the top 20 videos were created by healthcare professionals, it is advisable to improve their content quality and given the prevalence of misleading videos, patients should exercise extra caution towards these information and verify it directly from a healthcare provider.