bluuebunny/crossref_metadata_2025_split huggingface dataset:
2898 Factors Influencing the Length of Hospital Stay in Patients With Non-Variceal Upper Gastrointestinal Bleeding
Authors: Rassameehiran Supannee , Tetangco Eula Geralyn , Tan George , Rakvit Ariwan 
Published: October 2019

INTRODUCTION:
Upper gastrointestinal bleeding (UGIB) is one of the most common GIemergencies, which frequently requires hospitalization. This condition accounts for 400,000 hospital admissions per year and costs more than $2 billion annually. The purpose of our study was to identify risk factors associated with prolonged hospital stay in non-variceal UGIB patients.

METHODS:
We conducted a retrospective study through an electronic medical record review of patients admitted at University Medical Center, Lubbock, Texas between January 2012 and December 2015. Patients older than 18 years with UGIB identified by the ICD-9 diagnosis code 578.9 (hemorrhage of gastrointestinal tract, unspecified) were enrolled into the study. Admissions were excluded if patients did not undergo EGD or if they had documented underlying cirrhosis. Statistical Package for Social Sciences (SPSS™) version 22 was used for statistical analysis.

RESULTS:
143 patients met inclusion criteria. 83 were men (58.0%), 92 were Caucasian (64.3%), 33 were Hispanic (22.4%), and the mean age was 60.9 + 17.1 years. 33% of patients requiring FFP transfusion underwent endoscopic therapy. The mean length of stay (LOS) was significantly increased in patients requiring endoscopic therapy, FFP transfusion, and inthose who had underwent EGD after 24 hours. LOS was also significantly increased in patients that presented with acute kidney injury (AKI) or hypoalbuminemia. There was no correlation between prolonged hospital stay and Glasgow-Blatchford bleeding score, pre-endoscopic Rockall score, Rockall score, AIMS65 score, shock index score, PRBC transfusion, the use of NSAIDs, antiplatelet drugs, or anticoagulants.

CONCLUSION:
Our study demonstrates that delayed EGD (after 24 hours), endoscopic therapy, the need for FFP transfusion, and acute kidney injury are associated with prolonged hospital stay. Coagulopathy requiring FFP transfusion and AKI reflects the severity of UGIB. Urgent EGD and endoscopic intervention in these patients may decrease the LOS and improve outcomes.
2902 Using Data Aggregation to Determine Thematic Knowledge Transfer and Lasting Performance Change in Multiple Continuing Education Activities on IBD
Authors: Faler Whitney E. , Perez Jan S. , Tordoff Shari , Gross Tara , Salinas Gregory D. 
Published: October 2019

INTRODUCTION:
Often, implications of the effect of CME is difficult to determine due to reliance on single data points of pre-post knowledge questions. Using aggregation methodology, we were able to thematically combine the assessments of 3 similar educational activities to determine the immediate and lasting effect of education on IBD practice.

METHODS:
Surveys were designed based on learning objectives of 3 accredited CME activities on IBD. Outcomes measurements were taken directly before and after the activities, as well as 3-months after activity completion. This 3-month follow-up sample was matched at the same time to a control sample of clinicians who did not participate in the education.

RESULTS:
Based on the themes of the pre-post questions, we were able to aggregate the scores of the three activities and determine overall changes in understanding key risk factors, establishing appropriate goals, choice of guideline-based therapy, and knowledge of clinical trials. Compared to pre-activity, learners had significant improvements in each of these areas, showing effectiveness of the education. Hodge's g effect sizes were run on all pre-post data to better compare the effect of education across themes. The most robust effects were seen in recognizing risk factors (g = 0.75) and clinical trial results (g = 0.71) while more modest effects were seen in establishing goals of treatment (g = 0.40) and selecting treatment (g = 0.59). Some of this modest effect seen in establishing goals can be attributed to a high baseline level of knowledge (a pre-score of 70.8%). However, looking at the scores of learners compared to a control group of similar clinicians that did not attend the education, robust effects can be seen even 30 days after the activity. Assessment of risk had an effect of 0.67 while establishing goals (g = 0.81) and treatment choice (g = 0.85) had even higher effects.

CONCLUSION:
Aggregating the outcomes of multiple educational activities allows us to understand effect by theme, providing opportunities to inform key stakeholders of the value of educational interventions. Further it allows educators opportunities to understand the continuing need of the community that has not attended these activities, and focus future interventions on improving areas where they are needed most.
2905 Adherence to the Crohn's and Colitis Foundation's IBD Anemia Care Pathway: Treatment of Iron Deficiency Anemia in IBD
Authors: Blaney Hanna , Mathew Antony , Snelling Robin , England Julie , Duong Camille , Shaver Courtney , Keum Yo Sup , Johnson Christopher 
Published: October 2019

INTRODUCTION:
Anemia is the most common systemic complication of inflammatory bowel disease (IBD), with reported prevalence up to 74%. Anemia is associated with worse disease outcome and quality of life. However, anemia in this population is often underdiagnosed and untreated. The Crohn's and Colitis Foundation (CCF) recently published a care pathway for anemia. Our aim was to assess adherence to the CCF's IBD Anemia Care Pathway in treatment of iron deficiency anemia (IDA) at a tertiary referral center in Texas.

METHODS:
A retrospective chart review including patients 18 years of age and older in our electronic record system with IBD who had a CBC, an outpatient encounter with gastroenterology, and no hospitalizations from 2014-2018. Demographic, laboratory, and anemia treatment was extracted from electronic records. IDA was defined per the CCF anemia care pathway. Active IBD was defined by elevated CRP and/or fecal calprotectin.

RESULTS:
341 patients were included in the analysis, 65 (19%) of which had IDA. Of these anemic patients, 43 (66%) had CD and 16 (32%) had UC, with 1 (2%) patients unspecified. 34 (52%) patients had evidence of active IBD, with 3 (9%) receiving IV iron and 10 (29%) receiving oral Fe. In the 31 patients with inactive IBD, 3 (10%) patients received IV iron and 5 (16%) received oral Fe.

CONCLUSION:
Active IBD is known to decrease enteral iron absorption and current recommendations encourage parenteral treatment of iron deficiency in patients with IDA and active IBD. In this study, we demonstrate that a limited number of patients with active IBD and IDA received recommended parenteral iron. These results demonstrate that system-wide education is needed regarding recommended IDA treatment based on IBD activity. Future studies at our institution aim to improve this trend.
2910 Immunization Rates in Inflammatory Bowel Disease Patients at the G.V. (Sonny) Montgomery VA Medical Center
Authors: Iqbal Sara , Paine Elizabeth 
Published: October 2019

INTRODUCTION:
Inflammatory bowel disease (IBD) patients are more prone to developing vaccine-preventable illnesses and therefore vaccinating these patients in our outpatient clinics needs to be a priority. In light of this crucial IBD patient care need, we conducted a quality improvement project centered on rates in the Gastrointestinal (GI) clinics at the G.V. (Sonny) Montgomery VA Medical Center.

METHODS:
We provided same educational session for both GI fellows and GI nurse practitioners and reviewed the rates in each group for two months before and after this session. During the four-month study period, 29 IBD patients were seen by fellows and 34 by nurse practitioners.

RESULTS:
During the four-month study period, 29 IBD patients were seen by fellows and 34 by nurse practitioners. For the fellow cohort, 19 IBD patients were seen before the educational intervention and 10 patients were seen after it. Nurse practitioners saw 12 patients before and 22 patients after the educational sessions. GI fellows' vaccine administration increased after the educational session for Zoster, pneumovax, Hepatitis A, and Hepatitis B. GI Nurse practitioners' vaccination of IBD patients increased after the session for Zoster, influenza, and pneumonia vaccines. Overall, the GI nurse practitioners had higher vaccination rates than the GI fellows before and after the educational sessions.

CONCLUSION:
Our study showed that GI fellows who rotated in the VA GI Clinic on alternate months had more difficulty in making sure that IBD patients were current on their vaccinations as compared to the GI nurse practitioners who regularly follow their IBD patients in continuity. This study also showed that a one-time educational session can improve vaccination rates but is unlikely to result in complete compliance with vaccine guidelines. Periodic reinforcement and monitoring of these vaccine rates will need to be done. Other observations made during the study included that the nurse practitioners have a clinic note template addressing vaccine status in their treatments plans; however, GI fellows have not incorporated this template. This template was felt to make a great difference in terms of the documentation, reminder about vaccines during the next clinic visit and simple inquiry about the vaccinations. In light of this, moving forward, incorporation of this note template into all IBD clinic visits is recommended.
2921 Correlation Between the Cumulative Risk of Surgery and Timing of Anti-TNF Initiation in Crohn's Disease
Authors: Jahandar Donya R. , Young Chase K. , Hamdeh Shadi , Kalot Mohamad , Makki Maha , Olyaee Mojtaba 
Published: October 2019

INTRODUCTION:
Despite their effectiveness in the management of Crohn's disease (CD), anti-tumor necrosis factor medications' use is often delayed until patients fail conventional therapy. There is more evidence in the literature that the early use of anti-TNF in the disease course may improve the long-term outcomes and decrease the risk of complications. However, the optimal time to start these agents is not well defined. In our study, using patient data at the University of Kansas Medical Center, we aimed to determine the cumulative risk of surgery based on the use of anti-TNF agents during the disease course.

METHODS:
A retrospective cohort study was conducted evaluating CD patients on anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) seen at the University of Kansas Medical Center until May 2018. The primary outcome was the cumulative risk of surgery based on anti-TNF initiating time.

RESULTS:
A total of 229 patients with CD were enrolled, 143 in the early anti-TNF alpha group and 86 in the late group. Total of 128/229 required surgery. Our analysis demonstrated a positive correlation between the cumulative incidence of surgery and the duration between diagnosis and initiating anti-TNF alpha therapy. In fact, initiating anti TNF at the time of diagnosis prevented the need for surgery for 80-100% of patients. Whereas initiating anti TNF within 10 years of diagnosis prevented the need for surgery in 50% of the patients and more than 80% of patients who started anti-TNF alpha therapy after 20 years of diagnosis had a need for surgery.

CONCLUSION:
Our study suggests an increased risk of surgery in Crohn's disease patients with the late use of anti-TNF. Early initiation of anti-TNF alpha therapy at the time of diagnosis was associated with the least risk of the need for surgery.
2942 Cenicriviroc (CVC) for the Treatment of Liver Fibrosis in Adults With Nonalcoholic Steatohepatitis (NASH): AURORA Phase 3 Study Design
Authors: Anstee Quentin M. , Neuschwander-Tetri Brent A. , Wai-Sun Wong Vincent , Abdelmalek Manal F. , Younossi Zobair , Alkhouri Naim , Yuan Jiacheng , Pecoraro Maria Lucia , Seyedkazemi Star , Fischer Laurent , Bedossa Pierre , Goodman Zachary , Sanyal Arun 
Published: October 2019

INTRODUCTION:
CVC, a novel, oral, and potent inhibitor of C-C chemokine receptor types 2 and 5, was well tolerated and demonstrated clinically meaningful antifibrotic activity in a 2-year Phase 2b study. The AURORA Phase 3 study will assess the efficacy and safety of CVC for the treatment of liver fibrosis in adults with NASH.

METHODS:
AURORA is a global, multicenter, randomized, double-blind, placebo-controlled study (NCT03028740) which will enroll 2000 subjects to evaluate a surrogate histology endpoint in the first 1200 subjects and clinical outcomes in the totality of enrolled subjects (∼2000 subjects) (Figure 1). Subjects will be randomized 2:1 to receive CVC 150 mg or placebo orally once daily with food. Adults aged 18–75 years with histologic diagnosis of NASH and Stage 2 or 3 liver fibrosis per NASH Clinical Research Network classification will be enrolled (≥60% with Stage 3). Subjects with cirrhosis or other known causes of chronic liver disease will be excluded. Liver biopsies will be performed at screening and Months 12 and 60 and will be evaluated by a central pathologist. An online tool (AURORA Toolbox) was developed to help assess the individual risk of fibrotic NASH (low, intermediate, or high) to inform pre-screening and whether to conduct a new liver biopsy during screening.

RESULTS:
The primary endpoint of improvement in fibrosis by ≥1 stage (NASH Clinical Research Network) AND no worsening of NASH (lobular inflammation or hepatocellular ballooning) on liver histology at Month 12 relative to screening biopsy will be evaluated in the first 1200 enrolled subjects. The key secondary endpoint will be improvement in fibrosis by ≥2 stages AND no worsening of NASH. Another primary endpoint to be evaluated in all 2000 enrolled subjects will be time to first occurrence of any adjudicated events of mortality (all causes), progression to cirrhosis (defined by NASH fibrosis Stage 4), liver transplant, Model for End-Stage Liver Disease score ≥15, ascites, or liver decompensation. The study will be terminated when adjudicated events have been accrued in 367 unique subjects overall. Safety, patient-reported outcome measures, serum hepatic fibrosis indices, liver stiffness measure, and biomarkers of systemic inflammation will also be evaluated.

CONCLUSION:
The AURORA Phase 3 study aims to confirm the efficacy and safety of CVC for the treatment of liver fibrosis in adults with NASH.
2956 The Utility of Repeating Paracentesis in Patients With Cirrhosis and Low SAAG Ascites
Authors: Salazar Miguel , El-Khider Faris , Mbachi Chimezie , Elkhouly Mohamed A. , Mathew Madhu , Vohra Ishaan , Kumapley Rudolf , Paintsil Isaac , Simons-Linares C. Roberto 
Published: October 2019

INTRODUCTION:
The use of serum-ascites albumin gradient (SAAG) is widely stablish and a key part for the workup of ascites. It can differentiate portal hypertension (cirrhosis) from non-portal hypertension causes (malignancy, tuberculosis, nephrotic syndrome, pancreatic ascites), however literature on the interpretation and value of a low SAAG ascites in patients with cirrhosis is very limited and its clinical significance is unclear. Our aim was to investigate patients with cirrhosis who had low SAAG ascites, the presence of a causative factor not related to portal hypertension and the value of repeating paracentesis for SAAG re-assessment.

METHODS:
We conducted a retrospective designed study in which we obtained a cohort of patients with low SAAG ascites defined as <1.1 g/dl, between the years of 2008 to 2017 in a single large tertiary community Hospital in Chicago, IL. Cirrhosis was defined by clinical, histopathological and radiological findings. Non-portal hypertension causes were reviewed including bacterial peritonitis, peritoneal carcinomatosis, nephrogenous ascites, tuberculous peritonitis, chylous ascites and pancreatic ascites. Receiver operating curve and multivariable logistic regression models using SAS software version 9.4 were performed.

RESULTS:
A total of 77 patients were evaluated, of whom 53 (69%) were patients with cirrhosis and 24 (31%) without cirrhosis. Patients with cirrhosis were more likely to be males, smokers, alcoholics (Table 1). 47 (89%) patients had a repeat paracentesis that allowed re-calculation of the SAAG. 13 (28%) patients had persistent low SAAG ascites: 3 cardiac, 2 tuberculosis, 1 pancreatic, 1 malignancy and 6 idiopathic. 7 (53%) out of the 13 had identifiable secondary etiology that explained the low SAAG and in 1 (7.7%) case, malignant ascites was diagnosed. Importantly, in 34 (72%) patients the SAAG changed to high SAAG. Of note, the repeat SAAG in those with low SAAG was not difference from the initial one (mean 0.71 vs. 0.84, P = NS).

CONCLUSION:
High SAAG >1.1 g/dl is specific for cirrhosis as shown in previous studies. However, in patients with known cirrhosis and a low SAAG <1.1 g/dl further evaluation with a repeat paracentesis is recommended; in patients with a persistent low SAAG value up to 53% a secondary etiology of the ascites was identified, including malignancy, in these cases we recommend further investigation to clarify the cause of the ascites.
2962 Pre-Operative Treatment of Hepatitis C Infection Decreases Post-Operative Complications in Patients Undergoing Knee and Hip Arthroplasty
Authors: Patel Harish , Abbas Hafsa , Baiomi Ahmed , Shehi Elona , Miranda Jeirym , Kirschenbaum Ira , Makker Jasbir , Meftah Morteza , Tariq Hassan , Bhandari Peter , Hanumanthu Siddarth , Balar Bhavna , Chilimuri Sridhar 
Published: October 2019

INTRODUCTION:
Large joint surgeries, hip and knee arthroplasties, are often performed in individuals with hepatitis C infection. Hepatitis C has been identified as one of risk factors for the post-operative complications. There is scarcity of the data about the role of pre-operative hepatitis C treatment in decreasing the post-operative complications for patients undergoing hip and knee arthroplasties.

METHODS:
The retrospective review of the patient with hepatitis C infection who have undergone hip and knee arthroplasties from 2008 to 2015. Diagnosis of Hepatitis C was made based on the positive viral load. The study population is divided into two groups based on the sustained virologic response (SVR) after the hepatitis C treatment prior to the hip and knee arthroplasty surgery and those who did not have treatment prior to surgery. The baseline demographic data, laboratory parameters (Table 1) and post-operative course were reviewed from electronic medical records. AIM: To compare the post-operative outcomes for hip and knee arthroplasties, in patients with hepatitis C infection, based on prior hepatitis C treatment status (Table 2).

RESULTS:
There were 1187 hip and knee arthroplasties performed during study period. 11% of patients (n = 129) were positive for hepatitis C infection. In our study population hepatitis C infection is identified as the risk factor for post-operative infections. Among the patients with the hepatitis C infection 18.6% (n = 24) had received treatment with SVR prior to surgery. All patients were treated with the direct acting anti-viral agents (DAA). The mean age of the patients was 55 years and they were predominantly males (75%). The base line demographic and laboratory parameters were comparable between the two groups, except for serum albumin level, which was lower in patients with no prior hepatitis C treatment. The patients with liver cirrhosis were equally distributed in both groups. The patients with prior hepatitis C infection consistently demonstrated higher rates for post-operative complications including infection, bleeding and impaired would healing, whereas “zero” post-operative complications (infections, joint bleeding or wound dehiscence) were noted for the patients who had prior hepatitis C treatment with SVR.

CONCLUSION:
This retrospective review of patients with hepatitis C undergoing the hip and knee arthroplasties demonstrates a protective effect for post-operative complications in patients with prior hepatitis C treatment and SVR.
2965 Utilizing Fracture Risk Assessment Tool (FRAX) in Patients With Osteopenia Listed for Liver Transplant to Guide Treatment for Fracture Prophylaxis
Authors: Mushtaq Asim , Sood Gagan , Victor David W. 
Published: October 2019

INTRODUCTION:
Low bone mineral density (BMD) is common in chronic liver disease and predisposes to fracture. FRAX score is a widely used web-based algorithm used to estimate fracture risk with or without dual-emission x-ray absorptiometry (DEXA). FRAX score has not been studied in patients listed for liver transplant. Aim of this study was to determine if FRAX score with DEXA is effective in patients with osteopenia listed for liver transplant to guide treatment for fracture prophylaxis.

METHODS:
104 consecutive patients who were actively listed for liver transplant at Baylor St. Luke's medical center were included. Clinical and demographic patient information was collected retrospectively. FRAX scores calculated with BMD data.

RESULTS:
104 patients (29 ALD, 26 HCV, 22 NASH, 27 others) were studied (mean age 56 ± 10, 59% male, 41% female, mean BMI 28 ± 5, mean MELD 17+8). All patients had bone mineral density assessed (13 [12%] were osteoporotic and 42 [40%] were osteopenic at the spine and/or hip. 4 [3.8%] had a previous osteoporotic fracture. Mean FRAX score for a 10-year probability of a hip fracture was 1.7% and a 10-year probability of a major osteoporosis-related fracture was 6.2% based on the US-adapted WHO algorithm. Among 40% osteopenic and 13% osteoporotic patients, only 3% and 8% of patients had significantly high FRAX score respectively.

CONCLUSION:
BMD FRAX score underestimated fracture risk in actively listed liver transplant patients. We believe this could be related to small sample size of the study and strict selection criteria for liver transplant listing. Majority of our study population was non-smoker, non-drinker and with a higher BMI. Therefore, future studies with bigger sample size would be helpful to utilize FRAX score to guide treatment in osteopenic patients for fracture prophylaxis.