bluuebunny/crossref_metadata_2025_split huggingface dataset:
A80 SELF-COMPLETED QUESTIONNAIRES IDENTIFY SYMPTOMS IN A PROPORTION OF PATIENTS WITH CELIAC DISEASE CONSIDERED ASYMPTOMATIC DURING CLINICAL VISITS
Authors: Chang N , Khaouli M , Armstrong D , Pinto-Sanchez M 
Published: February 2024

Abstract

Background
Patients with celiac disease (CeD) often experience symptoms despite adhering strictly to a gluten-free diet, and novel therapies are under development to help symptom management. However, recruitment for clinical trials [DA1] can be challenging, as screening is often based on symptoms reported to the physician during a clinic visit. However, symptoms reported by patients during clinic visits may not be an accurate reflection of the true extent of the symptoms.

Aims
To assess whether gastrointestinal (GI) symptoms reported by patients to physicians during a clinic visit differ from those self-reported in questionnaires on the same day.

Methods
A retrospective chart review of patients enrolled in the celiac registry (HiREB #5415, #16758) was performed. We included adult patients enrolled in our celiac registry from January 2021 to August 2023. We collected data on demographics such as age, sex, gender, time since CeD diagnosis (early diagnosis defined as within 2 years versus late diagnosis as greater than 2 years), CeD serology (TTG, DGP, EmA), in addition to GI symptoms 1) reported to the physician during the clinic visit, and 2) recorded on a validated questionnaire (Gastrointestinal Symptoms Rating Scale - GSRS) completed on the same day. A GSRS score greater than 30 for overall GI symptoms and a score greater than 2 for any individual symptom was considered symptomatic.

Results
We reviewed a total of 174 patient charts that met the inclusion criteria during the defined time period. Overall, 107 patients reported symptoms during the clinic visit; of the remaining 67 patients who did not report symptoms at the clinic visit, 29 (43.2%) were identified as symptomatic by the GSRS. Compared to the clinical history, the GSRS identified higher rates of abdominal pain (77% vs 12.6%, p=0.0001), diarrhea (44.8% vs 11.4%, p=0.0001), bloating (87.3% vs 30.5%, p=0.0001), GERD (55.1% vs 5.1%, p=0.0001), constipation (57.4% vs 15.2%, p=0.0001) and nausea (56.3% vs 10.8, p=0.0001). There were no differences in responses between clinical visits and GSRS when subgrouped by gender, age, time since diagnosis or disease activity.

Conclusions
Self-reported questionnaires identify a subgroup of patients with celiac disease who reported GI symptoms when completing a validated questionnaire despite reporting no symptoms during a clinic visit. Screening patients for clinical research studies is often based on symptoms reported to the physician during the clinical visit, and therefore this has direct implications for research recruitment in gastroenterology clinical trials.

Funding Agencies
None
A82 A SURVEY-BASED ASSESSMENT OF RADIATION PROTECTION ATTITUDES AND PRACTICES IN ADVANCED THERAPEUTIC ENDOSCOPY TRAINING CURRICULUMS
Authors: Chin Koon Siw K , Sypkes C , Gozdzik M , Dhaliwal H , Kundra A 
Published: February 2024

Abstract

Background
Fluoroscopy-assisted endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) expose patients and physicians to the risks of ionizing radiation, including infertility, cataracts, skin hypersensitivity, hair loss and cancer. Radiation exposure from these procedures can have lasting adverse effects on the health and productivity of gastroenterologists. With attention to “as low as reasonably achievable” (ALARA) principles, recent efforts to minimize radiation use have emphasized the importance of formal radiation protection education, including during advanced therapeutic endoscopy (ATE) training. However, teaching of basic protective measures in radiation safety during ATE training remains often overlooked.

Aims
We aimed to learn how radiation safety training is delivered in ATE programs across Canada and the US. Identifying the existing training standards and knowledge will help us understand the current gaps in training curriculums and inform future curricular development.

Methods
Our study was reviewed by the Ottawa Health Science Network Research Ethics Board in September 2023. Surveys were designed and distributed with the REDCap software and sent to ATE trainees (current and recent graduates within the last 3 years) in Canada and Program Directors (PDs) of accredited ATE programs across Canada and the US.

Results
The survey was completed by 12 trainees and 4 PDs. These are preliminary results and further survey responses are being collected. The majority of trainees (75%) believed it would be very important for their program’s curriculum to include dedicated radiation safety teaching, but most trainees (83.3%) received no such training. Familiarity in optimizing modifiable fluoroscopy parameters to minimize radiation exposure (collimation, gain, magnification, frame rate modification or pulsed fluoroscopy) was variable among trainees (36.4%-81.8%). Seventy-five percent of trainees were unaware of the annual limit for radiation exposure and only 25% believed they were operating within a safe level. Most trainees (90.9%) felt they were given inadequate training to optimally reduce their risk of radiation exposure and 90.9% expressed a desire for further radiation safety training. Despite these findings, only 50% of PDs believed it would be beneficial to offer dedicated radiation safety training as part of their program’s curriculum. Among PDs, 75% did not feel their trainees had the knowledge required to reduce their risk of radiation exposure and all (100%) felt that dedicated training would be useful.

Conclusions
These findings indicate a need for more robust radiation safety training. Further studies are needed to understand the most effective way to deliver comprehensive radiation safety training to ATE trainees.

Funding Agencies
None
A83 GENDER-RELATED BARRIERS TO ADVANCEMENT ALONG THE GASTROENTEROLOGY CAREER PATHWAY: AN INTERNAL MEDICINE RESIDENT PERSPECTIVE
Authors: Cintosun A , Pattni C , Jawaid N , Lomonaco J , Bollegala N 
Published: February 2024

Abstract

Background
Women comprise approximately 31% of the Canadian and 19% of the American gastroenterology population. This gender disparity widens throughout training, with relative gender parity in medical school, slightly less female representation in internal medicine, then with the widest gender disparity in gastroenterology training and practice.

Aims
Our aim was to understand the gender-related barriers to advancement along the gastroenterology training pathway specifically among internal medicine residents.

Methods
A 72-question online survey was distributed by email to internal medicine residents from post-graduate years (PGY) 1, 2, and 3 at the University of Toronto. The initial email was followed by two reminder emails over 1 month. Questions pertained to demographic characteristics, social situation, career aspirations, academic pursuits, and career challenges. Data analysis was performed using SAS software. Continuous variables were compared using Wilcoxon (Mann Whitney U test) and categorical variables with chi-squared and Fisher’s exact test.

Results
40 residents completed the survey. 62.5% were female and most were PGY1 or 2 (n=18, 45% for each; PGY3 was n=4, 10%). Women were more likely to be single (44% vs. 27%, p = 0.0423). In terms of scholarly involvement, women more frequently had additional academic pursuits than their male counterparts (92% vs. 60%, p = 0.0195). For training-related challenges, women more often reported different expectations were put on them due to their due to their background, specifically related to gender (70% vs. 33%, p = 0.0356). Women described more challenges with support staff compared to their colleagues (36% vs. 0%, p = 0.0105), and stated that gender was the reason. Women were also more likely to report that their clinical competence was challenged compared to their peers (32% vs. 7%, p = 0.0384). Outside of work, women more often felt a work-life misbalance due to coordinating childcare (64% vs. 27%, p = 0.0085). Regarding career aspirations, men more often endorsed wanting a hospital leadership role (67% vs. 32%, p = 0.0201). They also rated renumeration as a driving motivation for applying to a subspecialty more often (47% vs. 12%, p = 0.0085) and rated their desired future personal income to over $70,000 more than women (p = 0.0402).

Conclusions
This study is the first to examine gender-related barriers to advancement in gastroenterology at the crucial internal medicine resident level. Women more often reported training-related challenges with others’ expectations and judgments of their clinical competence, as well as personal challenges with coordinating childcare. A deeper understanding of these differences may shape support interventions to help women meet their career goals.

Funding Agencies
None
A86 INFORMING MODERN CARE FOR CANADIAN IBD PATIENTS: A PROSPECTIVE RANDOMIZED TRIAL ON APPOINTMENT TYPES
Authors: Galts C , Siempelkamp B , Cade K , Wilson L , Loomes D 
Published: February 2024

Abstract

Background
There is now significant data supporting virtual care (telehealth or telephone) as a means to provide care to IBD patients with equivalent outcomes to in-person care. Many studies assessing virtual care lack a control group and suffer from recall bias. Further, there is a lack of understanding individual patient appointment style preferences and the reasons for these preferences.

Aims
We aimed to determine patient’s preferred appointment styles and to inform these preferences by assessing demographic factors and other appointment related factors (e.g. cost, time required, communication, privacy etc). We hypothesize that this information may help to inform decisions regarding choosing the optimal appointment for patients.

Methods
In this single centre randomized trial we assigned IBD patients to in-person, telehealth (with video), or telephone appointments in a sequential manner. To minimize recall bias, surveys were completed after each appointment style. All participants had demographic data collected and survey data was compiled using UBC redcap. Standard regression analyses and T-scores were used for assessment of statistical significance.

Results
After exclusion of surveys with incomplete data, a total of 81 surveys were included, 27 in-person, 28 telephone, and 26 telehealth. The overall scores (out of ten) were 9.1 ±1.0, 7.8 ±2.1, and 8.0 ±2.6 for in-person, telephone and telehealth appointments respectively. With exclusion of telehealth appointments which suffered technical difficulties (n=6) the overall score improved and range was comparable to in-person appointments (8.9 ±1.2). In-person appointments were associated with a higher cost and longer time commitment but had the highest scores across all appointment features (e.g. perceived privacy, physician engagement etc.). Among patients who would have preferred an in-person appointment optimal communication (80.0%) and interaction with care provider (83.3%) were prioritized. Conversely, among participants who would have preferred telehealth appointments, time savings (71.4%) and cost savings (42.9%) were prioritized. Age, gender, number of dependents, and perceived privacy were not associated with any appointment style preference.

Conclusions
This study concludes that all appointment styles have certain benefits and drawbacks that individual patients may variably prioritize. In-person appointments had a higher cost and time requirement but still remained the highest rated appointment style. As virtual care continues to be part of the standard of care for patients with IBD, we suggest that providers individualize the style of patient appointment to their patients and the expected nature of that encounter.

Funding Agencies
None
A87 A SURVEY-BASED ASSESSMENT OF ENDOSCOPY CURRICULUM AND EDUCATION IN CANADIAN TRAINING PROGRAMS
Authors: Gozdzik M , Kundra A , Snelgrove R , Kroeker K 
Published: February 2024

Abstract

Background
Endoscopic training within Canada occurs in programs accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). Beyond national accreditation, there are no standardized endoscopic training curriculums and each program is responsible for ensuring its trainees achieve competency. There is debate in the literature regarding the minimum number of endoscopic procedures and the role of objective assessment tools in the assessment of trainee competence with no specific recommendations for these by the RCPSC.

Aims
The goal of our study was to characterize endoscopic training curriculums within Canadian training programs while determining the usage and perceived importance of procedure volume tracking and objective assessment tools.

Methods
Online surveys were sent to program directors (PD) and trainees within Adult Gastroenterology, Pediatric Gastroenterology, General Surgery and Colorectal Surgery programs within Canada. Surveys contained questions meant to characterize endoscopy training curriculums and perceived effectiveness of the curriculum while highlighting the factors important for feedback and competency assessment.

Results
Survey responses were obtained from 20 PDs and 83 trainees. Of all programs surveyed 53% (44/83) of trainees reported that they had a formal endoscopy curriculum compared with 75% (15/20) of PDs. PDs assessed endoscopic competence predominantly by EPAs (95%) and verbal feedback (65%) with minimal usage of objective tools (30%). Trainees reported fewer objective tool usage at 2.4% (2/83). When assessed on a 5-point Likert scale, both PDs and trainees felt that verbal feedback was the most important for assessment of competence (3.58 and 4.39 respectively). Seventy-seven percent of trainees report using a procedure log and when asked about procedure volume 37% of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training. Eighty-three percent of PDs felt that all their trainees achieved endoscopic competency with only 50% of adult GI PDs reporting the same. Most PDs and trainees felt that national recommendations for objective tool usage (65% and 57% respectively) and minimum procedure volume (65% and 63% respectively) would be helpful to standardize endoscopic training. Additional results are reported in Figure 1.

Conclusions
Most training programs reported a standardized curriculum with a majority of trainees tracking their procedure volume, but a minority of programs incorporated objective tools. A significant portion of trainees expected to complete ampersand:003C250 colonoscopies by the end of their training and not all PDs felt that all of their trainees reach endoscopic competence. The majority of trainees and PDs felt national recommendations for procedure tracking and objective tools would be helpful, suggesting the need for more formalized endoscopic curriculums in Canada.

Funding Agencies
None
A90 ASSESSING 30-DAY MORTALITY IN PATIENTS UNDERGOING EMERGENT ADD-ON ENDOSCOPIC GI PROCEDURES
Authors: Healey K , Borgaonkar M , McGrath J 
Published: February 2024

Abstract

Background
Gastrointestinal (GI) endoscopic procedures may need to be performed emergently on hospitalized patients. Current short-term mortality rates following emergent GI endoscopic procedures are attributed to their indication and vary by geographic area, ranging from 1.89% to as high as 10%. Recent studies describing clinical outcomes and mortality of non-scheduled GI endoscopic procedures are limited.

Aims
This study aimed to describe the 30-day mortality and clinical outcomes of patients who received endoscopic intervention as an add on, non-scheduled procedure over a 2-month period across 2 tertiary hospitals, in St. John’s, Newfoundland and Labrador.

Methods
We retrospectively reviewed the charts for all patients between July 1, 2021, and August 31, 2021, who received an esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, and percutaneous gastrostomy (PEG) across 2 tertiary hospitals in St. John’s, Newfoundland and Labrador. Endoscopic procedures on hospitalized patients that were added to the emergency endoscopy list were included. Procedures were done during working hours on weekdays or outside working hours at night-time, and during the weekend. Data on demographics, endoscopic findings, treatment outcomes, and 30-day mortality, were collected through electronic chart review. Descriptive statistics were conducted for data analysis.

Results
Of the 258 add on procedures performed on 213 patients, 17 patients (8.0%) died within 30 days of having had the procedure. The most frequently performed procedure was EGD, and the mortality associated with it was 9.4% (12/127), followed by sigmoidoscopy (1/29, 3.4%), colonoscopy (0/18, 0%), PEG (3/9; 33.3%). One patient who died had both EGD and colonoscopy (1/25, 4%). No patients died from both EGD and sigmoidoscopy (0/5, 0%). The median time between the procedure and death was 15 days. The median age was 72 years old. Most patients received endoscopic intervention for suspected bleeding. The major causes of death were cardiac, GI, malignancy, respiratory, and other.

Conclusions
Hospitalized patients are a distinct cohort with competing risks that need to be considered when planning endoscopic procedures. Further investigation is necessary with a larger patient cohort over multiple years.

Funding Agencies
Summer Undergraduate Research Award (Memorial University of Newfoundland)
A93 AN ANALYSIS OF POST-ENDOSCOPY EXPERIENCES WITHIN AN EARLY ADULT IBD PATIENT POPULATION AT A NATIONAL IBD CENTRE
Authors: Hu M , Mohmand Z , Wu W , Bollegala N 
Published: February 2024

Abstract

Background
Up to 25% of IBD patients are diagnosed before the age of 18, necessitating a process of transition from pediatric to early adult care. Poor endoscopy experiences have been described to jeopardize the overall patient experience with the healthcare system. There is a paucity of literature evaluating the endoscopy experiences of IBD patients during this pivotal point in their disease management.

Aims
The aim of this study is to describe the reported post-endoscopy experiences of early adult IBD patients (18 to 25 years old) compared to those in an adult model of care (26 years old, or above).

Methods
A retrospective analysis of patients with IBD treated at Mount Sinai Hospital from January 1st, 2017 to December 31st, 2021 who underwent an outpatient colonoscopy was performed. Qualitative and quantitative data were longitudinally collected from endoscopy records. The first phase of the study consisted of a comparison of outcomes between early adults (18 to 25 years) and adults (26 years, or above). The second phase consisted of a comparison of outcomes between sedation types (deep versus conscious). T-test was used to compare differences for continuous variables and Fisher exact test was used for categorical variables.

Results
In this initial pilot study of 171 patients, 12.9% of early adults underwent deep sedation compared to 11.4% of adults. Patients who underwent deep sedation were more likely to have Crohn’s disease compared to Ulcerative Colitis (95.2%, 57.7%, pampersand:003C0.01). There were no differences in mean procedure lengths in minutes (18.3, 18.6, p=0.80). Early adults who underwent conscious sedation required additional sedative medications during the procedure in 48.9% of cases compared to 32.3% in the adult cohort (p=0.04), however the mean total of conscious sedation medication used had no differences between the two groups (p=0.59). Nursing post-procedure subjective scoring measuring pain and nausea showed no significant difference (p=0.29). Physician narrative note descriptions of subjective procedural tolerance also showed no significant differences (p=0.78).

Conclusions
Patients with Crohn’s disease are more likely to require deep sedation for their adult colonoscopies compared to patients with Ulcerative Colitis. Gastroenterologists are not adequately prepared to gauge the amount of conscious sedation an early adult patient will require, necessitating top-up amounts peri-procedure more frequently. Current tools in the forms of subjective scoring and narrative documentation utilized by healthcare providers to measure procedural experience and tolerance are poor markers of actual patient experience. Future efforts should be focused on better understanding the endoscopic experience of the early adult IBD patient population and utilizing an innovative and collaborative approach.

Funding Agencies
Division of Gastroenterology, University of Toronto Faculty of Medicine Resident Research Grant
A97 INTERNAL MEDICINE RESIDENT AND STAFF PERCEPTIONS OF GASTROENTEROLOGY ROTATION
Authors: Klemm N K , Jayakumar S 
Published: February 2024

Abstract

Background
The choice of subspecialty by internal medicine residents is partially influenced by their experience with that service. Challenges exist between internal medicine and the high acuity, procedurally-heavy, gastroenterology (GI) service. Negative perceptions may limit the number of residents rotating through a gastroenterology elective, impacting knowledge and comfort managing common GI conditions.

Aims
To identify misperceptions of the GI service at a tertiary hospital, and evaluate resident and new staff comfort in managing common GI conditions.

Methods
Twenty-question survey sent to internal medicine residents during 2022-2023 and 13-question survey sent to staff that completed training from 2020-2022; both anonymous, and using Qualtrics software.

Results
The survey was completed by 18% (30/166) of residents and 20% (13/65) of staff. Most staff (62%) practiced in a community setting. Both cohorts cited overnight cross-coverage consults during (56%) and negative word-of mouth (38%), as reasons they avoided a GI elective. Most participants reported a little (33%) or moderate (47%) amount of GI teaching on medicine service and were unaware of formal lectures (79%) during a GI rotation. Residents and staff were most comfortable managing pancreatitis (98%) and ALF (74%). Staff wished for more experience managing pancreatic and liver masses and outpatient IBD flares; however both groups (86%) were unaware of the ambulatory week during the GI rotation.

Conclusions
Misperception and unawareness of a GI elective persist amongst internal medicine residents and has implications for new staff managing GI conditions. This study has led to action items that address these concerns.
Table 1: Resident & staff awareness, perceptions & knowledge of GI

Funding Agencies
None