bluuebunny/crossref_metadata_2025_split huggingface dataset:
A107 EXAMINING FACTORS CONTRIBUTING TO GENDER PAY DIFFERENCES AMONG ONTARIO PHYSICIANS IN PROCEDURAL SUBSPECIALTIES OF INTERNAL MEDICINE, INCLUDING GASTROENTEROLOGY
Authors: Bushra M , Balderrama F , Sibley L , Bollegala N 
Published: February 2025

Abstract

Background
Prior research has shown that gender pay inequity exists among physicians, with little improvement in the last few years. A study examining the physician gender pay gap in Ontario showed that women physicians earned 13.5% less than men daily, even after correcting for factors such as practice characteristics, specialty and rurality.

Aims
We aimed to identify factors contributing to gender-based differential billing among physicians in Ontario, with a specific focus on providers in procedural sub-specialties of internal medicine including gastroenterology.

Methods
We performed a cross-sectional study using data from the Ontario Health Insurance Plan (OHIP) in the 2021 and 2022 fiscal years. OHIP billings were used to estimate differences in gross payments between male and female physicians in procedural subspecialties of internal medicine, including gastroenterology, cardiology and respirology. Physicians who submitted claims to OHIP were included. Pay gaps were calculated annually. Chi-square test was used to calculate differences between categorical variables, and t-test for continuous variables.

Results
A total of 3600 physicians were included in the study sample (1212 [33.7%] women and 2388 [66.3%] men). Male physicians in procedural subspecialties earned an average of $391,734.76 more than female physicians (p&lt;0.001) with male gastroenterologists earning an average of $154,698.86 more (p&lt;0.001). The total number of procedural days was higher for men (49 vs 25; p&lt;0.001), with male gastroenterologists having more endoscopy days as compared to their female counterparts (134 vs 108; p&lt;0.001). Male physicians in procedural subspecialties had higher percentage of days with after-hours billings (8.5 vs 5.4; p&lt; 0.001) and weekend billings (4.2 vs 3.5; p&lt;0.01) compared to female physicians, and were less likely to work part-time (343 men [14%] vs 334 women [28%]; p&lt;0.001).

Conclusions
Our study noted significant differences in gross payments between men and women physicians in procedural specialties of internal medicine including gastroenterology, which may be explained by total hours worked, after-hours work and number of procedural days.

Funding Agencies
None
A109 A SIMPLE METHOD TO CALCULATE ADENOMA DETECTION RATES
Authors: Sadowski D C , Min A , Byun P , Miller T 
Published: February 2025

Abstract

Background
The adenoma detection rate (ADR) is a key indicator of the effectiveness of colonoscopy, which remains the gold standard for colorectal cancer detection. Many centers in Canada are increasingly adopting EPIC as their electronic health record system. However, the ADR calculation tool in the EPIC foundation build is not well-suited for Canadian practices, as it fails to account for colonoscopies performed due to positive fecal immunochemical tests (FIT) and relies on synoptic reporting of polyp histology by pathologists. To address this, we developed a straightforward text-based search strategy to identify adenomas in dictated pathology reports.

Aims
This study aims to compare the accuracy of our new ADR metric against calculations based on manual reviews of pathology reports.

Methods
We analyzed all screening colonoscopies conducted in Alberta from January to August 2024. For cases with specimens submitted for pathology, we examined the reports using a text string search for the terms “adenoma,” “tubular adenoma,” and “tubulovillous or villous adenoma” in the Final Diagnosis section. Reports were excluded if they contained the phrases “no adenoma,” “history of adenoma,” or “serrated adenoma.” Our reference standard was a manual review of pathology reports performed by trained polyp reconciliation nurses.

Results
From January to August 2024, a total of 46,364 screening colonoscopies were conducted, with 45% of the patients being female. Manual record reviews revealed that 56% of cases had at least one adenoma, 20% had at least one sessile serrated lesion, 171 cases included at least one traditional serrated adenoma, and 345 cases of colorectal cancer were detected. Using manual chart review as the reference standard, our text-based ADR metric demonstrated a sensitivity of 81% and a specificity of 70%.

Conclusions
The text search-based ADR metric shows promise in simplifying the calculation of ADR, especially for centers that lack synoptic pathology reporting or the capacity for manual pathology report reviews. Further research is necessary to enhance the accuracy of this metric.

Funding Agencies
None
A110 SUSTAINABILITY IN EVERYDAY GI PRACTICE: QUANTIFYING TRAVEL RELATED CARBON EMISSIONS FOR IN-PERSON APPOINTMENTS AND MODELS FOR REDUCTION THROUGH USE OF TELEHEALTH
Authors: Galts C , Anvari S , Leontiadis G 
Published: February 2025

Abstract

Background
The health care industry alone contributes to approximately 5% of annual carbon emissions and gastroenterology represent a more resource intensive subspecialty so much so that multiple societies have begun initiatives with aims to reduce the environmental impact of gastroenterology practice. After COVID-19 there was a large adoption of telehealth across many disciplines including gastroenterology. This had the benefit of reducing viral transmission but also significantly reduced travel related emissions for routine appointments. Since that time there has been a varied continuation of virtual care.

Aims
We aimed to quantify the average carbon emissions associated with travel to non-endscopic gastroenterology appointments. We also aimed to develop models for emission reductions based on possible changes to practice (e.g. conversion of follow-up appointments to telehealth).

Methods
Over a 2-week period, we conducted a cross-sectional analysis evaluating carbon emissions associated with travel to gastroenterology appointments. The average number of appointments per day was determined and by using postal codes we were able to estimate travel distances for patients. Carbon emissions were based on these travel distances using standard estimates (including average emissions by car, percentage of patients using alternate transportation, non-tail pipe emissions) and we assessed various estimated of emissions related to telehealth. We then used variable practice models to determine the potential emissions reductions.

Results
We assessed 975 appointments, of which 71 were excluded (e.g. insufficient data, non-physician appointments), leaving 904 included appointments of which 75% were follow-up (678) and the remained were new consultations (226). Sixteen different gastroenterologists had an average of 22.7 patients per day. The mean return distance travelled per appointment was 57.3 km which translates to 14.9 kg CO2 per patient visit. An average day at in clinic would then equate to 337.3 kg CO2 per day, equivalent to 146.6 L gasoline or 15.5 trees’ annual carbon capture. By converting only appointments with a return distance over 100 km or follow-up appointments, we found that a 77% emissions reduction could be achieved.

Conclusions
There can be significant emissions savings with conversion of in-person visits to telehealth while still allowing for some visits to be in-person. Given the unique nature of gastroenterology requiring in-person visits for endoscopy, this may serve as one mechanism by which the collective group of Canadian gastroenterologists can substantilally reduce carbon emissions related to their practice.

Impact on carbon emissions from conversion of in-person appointments to telehealth for gastroenterology

Funding Agencies
None
A112 OUTCOMES OF PATIENTS AT INCREASED RISK FOR GASTRIC NEOPLASIA: A RETROSPECTIVE COHORT STUDY
Authors: Koerber D , Roda C , Pang S , Tavakoli P , Ten-Pow M , Walia A , Lam E , Motomura D , Xiong W , Shahidi N 
Published: February 2025

Abstract

Background
Gastric cancer is the third most common cause of cancer-related deaths, with 784,000 deaths annually and a 26% five-year overall survival. In contrast, the five-year survival in Japan exceeds 70%, which is in part attributed to increased awareness and surveillance for patients and increased risk of gastric cancer.

Aims
We aimed to evaluate outcomes of patients at increased risk of gastric cancer in a North American tertiary referral center.

Methods
Between 01/2012 to 07/2024, consecutive patients with gastric atrophy, intestinal metaplasia, and low-grade or high-grade gastric dysplasia were identified using a validated histopathology registry at St. Paul’s Hospital (Vancouver, BC, Canada). Full chart review was then completed, including demographic and outcome variables. Continuous variables were summarised using median (IQR) and categorical variables were summarised as frequencies (%).

Results
Preliminary analysis from 01/2012 to 5/2014 identified 127 patients: 8 (6%) gastric atrophy, 114 (90%) gastric intestinal metaplasia, 5 (4%) low- or high-grade dysplasia. Median patient age was 65 (56-75) years, with 61 (48%) being female. Concomitant Helicobacter pylori was identified in 34 (27%) with 12 (9%) receiving eradication therapy and confirmation of eradication. Follow-up data was available for a median of 5.7 (0.4-10.3) years. Endoscopic surveillance was performed in 38 (30%) patients. Gastric cancer was not identified during surveillance, with 1 (1%) patient developing dysplasia.

Conclusions
Patients at increased risk of gastric cancer represent a significant clinical burden within tertiary gastroenterology centers. Gastric cancer risk commonly goes unrecognized leading to low rates of endoscopic surveillance. Programmatic management may lead to optimized outcomes and resource utilization.

Funding Agencies
None
A113 FACILITATORS FOR EVIDENCE-BASED INTERVENTIONS FOR PSYCHOLOGICAL DISTRESS IN PERSONS LIVING WITH IBS: A ROADMAP FOR HUMAN-CENTERED DESIGN AND IMPLENTATION
Authors: MacDonald M C , Heisler C , Willett N , Rohatinsky N , Farina S , Stewart M , Vallis M , Shepherd T , Currie B , Robar J , Huard T , Neil E , Jones J 
Published: February 2025

Abstract

Background
IBD-related psychological distress (IBD-PD) refers to the emotional impact of IBD and has been associated with increased disease severity, co-morbid mental health disorders (i.e., anxiety and depression), and increased mortality. Ensuring high-quality, patient-centered care for IBD-PD that is proportionate to the level of distress severity will address a key evidence-practice gap in our healthcare system.

Aims
This study aims to identify the facilitators for accessing evidence-based interventions for IBD-PD to inform the design and implementation of patient-centered models for IBD mental health support in the future.

Methods
This was a qualitative research study in which a semi-structured interview script was developed by a multi-disciplinary team guided by the domains of the COM-B Behaviour Change Wheel framework. Participants were asked about facilitators and preferences related to psychological support services throughout their disease course. Using thematic analysis, codes were generated to identify themes using an inductive approach.

Results
Fourteen participants were successfully recruited (n=14). Thematic analyses identified the following major themes: 1) Mental health should be treated as an integrated component of specialty IBD care; 2) Use of self-help strategies alongside existing supports is feasible, acceptable, and accessible; 3) Accessing support for IBD-PD through virtual care is often acceptable; 4) Flexible, multifaceted delivery models for IBD-PD are needed. All participants felt that mental health should be discussed at IBD clinic visits. Preferences for a range of psychological support formats were clear. Half of the participants said that they did not access formal psychological support services. Instead, this group preferred informal support networks or self-help strategies they already had in place. Most participants felt it was important for psychological support persons to also have IBD knowledge, but there were concerns regarding access to these services. Overall, participants felt strongly that a more qualified psychologist, even in the absence of IBD knowledge, was their top priority. No single approach or setting seemed to be acceptable for everyone. This illustrated that offering hybrid formats for IBD care would provide the greatest benefit to patients.

Conclusions
Facilitators to accessing care start with the IBD healthcare provider, but it is important to recognize that other facilitators such as informal support through family and friends can also have an impact on care. Structural health system changes that support the delivery of integrated care still need to occur to improve overall access to multidisciplinary care.

Funding Agencies
None
A114 INTERRATER RELIABILITY BETWEEN ENDOSCOPISTS USING LOW-COST SIMULATED POLYPS
Authors: Almneni A , Lisondra J , Gimpaya N , Zhao A Y , Tham D , Pattni C , Jugnundan S , Brar G S , Gupta S , Sabrie N , Grover S 
Published: February 2025

Abstract

Background
The identification and removal of polyps are essential skills as they remove premalignant lesions found ad hoc during colonoscopy. Simulation training helps with trainee learning curves and help train novices in polyp identification and polypectomy skills acquisition. The cost of simulators, however, limits trainee access to simulation-based training.

Aims
To determine the interrater reliability between endoscopists in identifying the Paris Classification of low-cost simulated polyps.

Methods
Using the Paris classification, novel simulated polyps with various morphologies were developed. 5 endoscopists of varying experience levels (1 expert (&gt;1000 endoscopies), 2 intermediates (500-1000 endoscopies), and 2 novices (&lt;500 endoscopies)) completed a knowledge test. The knowledge test showed images of simulated polyps and the endoscopists identified the Paris classification (Figure 1). The primary outcome measure was the interrater reliability between endoscopists during the knowledge test. A two-way random effects intraclass correlation coefficient (ICC), with absolute agreement between the raters was used to estimate the interrater reliability. Another outcome measure was content validity which was assessed via survey completed by 3 experts and 21 novice endoscopists during a previous simulation course.

Results
The raters correctly identified all 1p polyps. The Average Measures ICC between all 5 raters was 0.961 (95% CI: 0.93-0.98) indicating excellent reliability. One rater correctly identified all 1s polyp and was removed from ICC analysis due to lack of variance. The Average Measures ICC for 1s polyps was 0.524 (95%CI: 0.15-0.76) indicating moderate reliability. All errors were misidentification of 1s for 2a polyps. The survey showed content validity in terms of setup, usefulness in trainee programs, realism, and perceived trainee improvement.

Conclusions
Excellent reliability for 1p polyps suggests its usefulness for training polypectomy. Further work is needed to differentiate 1s polyps from 2a polyps. A limitation to interrater reliability is the use of images instead of videos in the knowledge test. The content validity of the polyps suggests practicality for low-cost training to achieve trainee improvement. Further studies are needed to assess other polyp classifications and correlate endoscopist experience level with ability to identify the simulated polyps.
Knowledge Test Scores of 5 Endoscopists

ICC, intraclass correlation coefficient. (*)excluded from ICC analysis due to lack of variance.

Figure 1. Simulated gel polyps based on Paris classification A-B) 1p, C-D) 1s.

Funding Agencies
None
A115 IMPROVING ENDOSCOPY ROOM EFFICIENCY: EVALUATION OF A VIDEO AS A SUPPLEMENTARY TOOL FOR INFORMED CONSENT
Authors: Kyei A , esenwa O , Tan C , Llovet D , Bernstein M , Mannino B , Cohen L , Griller N , Saibil F , Tartaro P , Yong E , Tinmouth J 
Published: February 2025

Abstract

Background
Endoscopy unit efficiency is critical because of the need to provide timely and quality care, despite limited resources. In previous work, obtaining informed consent negatively impacted efficiency. We developed a 3-minute animated video to facilitate the consent process, including describing colonoscopy, its purpose and potential risks/benefits.

Aims
1) Assess the ability of the video to support the informed consent process; 2) Determine the effectiveness of the video as a communication tool.

Methods
Using a critical case sample design with maximum variation, 12 participants completed pre- and post-colonoscopy 1:1 semi-structured interviews after viewing the video. Questions evaluated whether key components of informed consent were conveyed and assessed the video using principles of learner verification (attractiveness, usability, comprehension, impact on self-efficacy, acceptability). Interviews were recorded and transcribed. The data were coded inductively and deductively.

Results
Regarding components of informed consent, most participants understood the purpose and nature of a colonoscopy, but alternatives, including the right to refuse, were less effectively communicated. As a communication tool, the animations engaged participants and aided comprehension of complex material. The language was accessible, however, some participants found the video too fast and the font too small. Most participants found the video acceptable and characters relatable. Some identified information gaps included sedation level and procedure duration.

Conclusions
Endoscopy unit efficiency may be improved by providing consent information via video to patients scheduled for colonoscopy to supplement current approaches to informed consent. Our findings will inform revisions of the video and subsequent implementation into clinical practice.

Funding Agencies
This study is being funded by the principal investigator’s own funds (Jill Tinmouth)
A119 CLINICAL MANAGEMENT OF PATIENTS WITH COLORECTAL INTRAMUCOSAL CARCINOMA COMPARED TO HIGH-GRADE DYSPLASIA AND T1 COLORECTAL CANCER
Authors: Medawar E , Djinbachian R , Rex D , Vieth M , Pohl H , Popescu Crainic I , Taghiakbari M , Marques P , Kaufman D , Huang F , von Renteln D 
Published: February 2025

Abstract

Background
In the colorectum, intramucosal carcinoma (IMC), like high-grade dysplasia (HGD), should be resected endoscopically.

Aims
We were interested to understand how real-world treatment of IMC cases compares to the management of HGD and T1 colorectal cancer (CRC).

Methods
A multicenter retrospective cohort study was conducted. Through pathology databases, all patients diagnosed between 2010 and 2019 with HGD, IMC or T1 CRC were identified. Pathology and endoscopy reports were verified for HGD, IMC or T1 CRC polyps. The primary outcome was the proportion of surgical management of IMC compared to HGD and T1 cancer. Secondary outcomes were the adjusted odds ratios (OR) for surgical management, proportions of synchronous advanced neoplasia, and adjusted hazard ratios (HR) for metachronous advanced neoplasia.

Results
We identified 455 patients with follow-up endoscopy and pathology (mean age 67.1y, 42.2% female, median follow-up 3.4y): 269 with HGD, 60 with IMC, 126 with T1 CRC. Compared to patients with HGD, patients with IMC were significantly more likely to receive a CT of the abdomen despite a complete endoscopic resection (52.6% vs 13.2%, p&lt;0.001). Surgery rates were 15.2% for HGD, 36.7% for IMC and 84.1% for T1 CRC (p&lt;0.001). When evaluating reasons for surgery, patients with IMC were more likely to undergo unnecessary surgery after a complete endoscopic resection compared to patients with HGD (22.7% of surgical resection reasons in IMC group vs 0% in HGD group, p&lt;0.001). After adjusting for select factors potentially affecting the decision for surgical management and that differed between groups (age, family history of CRC, lesion location, size and morphology, multiplicity of synchronous lesions, colonoscopy indication/context), the adjusted odds of surgery remained significantly higher in patients with IMC compared to HGD (OR 2.62 [1.18-5.85]). Proportions of synchronous advanced neoplasia were 24.2% for HGD, 26.7% for IMC and 25.4% for T1 CRC (p=0.908). The proportion of metachronous advanced neoplasia was 26.8% in the HGD group, 18.3% in the IMC group and 20.6% in the T1 CRC group (p=0.227). Compared to HGD, patients with IMC and T1 CRC had similar adjusted metachronous advanced neoplasia risks (respectively, HR 0.82 [0.43-1.59] and HR 1.16 [0.66-2.05]). No lymph nodes were positive (0/363) and no metastasis occurred among patients with IMC.

Conclusions
Patients diagnosed with colorectal IMC are more likely to receive imaging and surgery than when HGD is diagnosed, although they are not at increased risk of synchronous advanced neoplasia, metachronous advanced neoplasia, lymph node involvement or metastasis. Labeling colorectal lesions as IMC is associated with unnecessary surgical resections.

Funding Agencies
TRIANGLE