bluuebunny/crossref_metadata_2025_split huggingface dataset:
A92 THE CURRENT STATE OF PEDIATRIC TO ADULT TRANSITION OF CARE: A ROUND TABLE DISCUSSION WITH KEY STAKEHOLDER GROUPS
Authors: Hu M , Gakhal N , Kabakulak C , LoMonaco J , Bollegala N 
Published: February 2024

Abstract

Background
There is a severe paucity in available resources to facilitate a safe and effective pediatric to adult health care transition for patients with chronic disease.

Aims
This study aims to better understand the experiences of key stakeholder groups involved in pediatric to adult transition of care across various chronic disease specialties within a tertiary care urban environment.

Methods
A focus group was conducted on July 12th, 2018 at Women’s College Hospital with key stakeholder groups. Questions focused on the top issues related to pediatric to adult transition of care and an ideal transition model for their respective patient populations. The second part of this study included individual interviews with patients and carepartners. Focus group meetings and individual interviews were both audio-recorded and transcribed for qualitative thematic analysis.

Results
Seventeen pediatric and adult care physicians representing ten chronic disease specialties were represented. Seven patients and care partners were interviewed. Major focus group themes included: disproportionate access to resources between and within specialties (n=10), lack of mental health support in the adult setting (n=8), fragmentation of care due to multiple providers as a result of patients leaving for employment or education (n=6), patients feeling alienated due to decrease in allied health support or due to shorter appointment times (n=8), and difficulty retaining consistent care due to missed appointments as a result of inconsistent communications or change in location for education or employment (n=7). Ideal care models were suggested to include: centralized intake procedure to identify patients who may require extra support (n=9), education for scheduling administrators about second chances after a no-show (n=5), implementation of joint clinics with pediatric and adult care teams or back-and-forth clinic sessions to ensure bidirectional provider comfort before discharge to adult care system (n=4), and implementation of a dedicated transitions navigator or point of contact for patients (n=10).
The individual patient and carepartner interviews emphasized the need for: centralized and comprehensive online resource (n=7), simple and clear educational content introducing the adult healthcare system (n=7), opportunities to meet and share information with other individuals in a similar position (n=3), and availability of a transitions navigator (n=4).

Conclusions
Current pediatric to adult transition of care resources are fragmented, allocated inefficiently, difficult to ascertain and often constrained to a specific condition or location. Future efforts should focus on improving the care transition process for high-risk patient populations by taking a comprehensive approach utilizing innovative, and multidisciplinary solutions.

Funding Agencies
None
A94 PRE-RESECTION OPTICAL EVALUATION RELIABLY DIFFERENTIATES BETWEEN SERRATED AND ADENOMATOUS LARGE NON-PEDUNCULATED COLORECTAL POLYPS
Authors: Jiang S X , Zarrin A , Walia A , Galorport C , Xiong W , Enns R , Lam E , Shahidi N 
Published: February 2024

Abstract

Background
Modality selection between cold snare resection (CSR) and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is largely predicated on the ability to differentiate between serrated and adenomatous histopathology. While optical evaluation has modest accuracy for diminutive polyps, performance has not been evaluated for large non-pedunculated colorectal polyps (LNPCPs).

Aims
To evaluate the performance of pre-resection optical evaluation to differentiate between serrated and adenomatous LNPCPs.

Methods
Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection for a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). Pre-resection optical evaluation was performed using high-definition white-light and narrow-band imaging (NBI) with or without near-focus. The Japanese NBI Expert Team (JNET) classification was used to differentiate between serrated (JNET I) vs. adenomatous (JNET IIA, IIB) LNPCPs. Traditional serrated adenomas (TSAs) and cancers were excluded from analysis. Sensitivity, specificity, and accuracy were used to evaluate optical evaluation performance.

Results
From 06/2022-09/2023, 266 patients underwent 282 procedures for a total of 335 LNPCPs. Median size was 30mm (IQR 20-40mm). Histopathology identified 215 (64.2%) adenomatous, 91 (27.2%) serrated, 16 (4.8%) cancerous, and 13 (3.9%) other LNPCPs; including 5 TSAs. Of the 91 serrated lesions, 90 (98.9%) were predicted as serrated; sensitivity, specificity, and accuracy were 98.90% (95% CI 94.03-99.97), 99.53% (95% CI 97.44-99.99), 99.35% (95% CI 97.66-99.92), respectively. Of the 215 adenomatous lesions, 213 (99.1%) were predicted as adenomatous; sensitivity, specificity, and accuracy were 99.07% (95% CI 96.68-99.89), 98.90% (95% CI 94.03-99.97), 99.02% (95% CI 97.16-99.80), respectively.

Conclusions
Optical evaluation demonstrates excellent performance characteristics to differentiate between serrated and adenomatous LNPCPs; therefore, empowering endoscopists to reliably apply a selective resection algorithm between CSR, EMR and ESD.

Funding Agencies
None
A96 A QUALITY ASSESSMENT STUDY TO DETERMINE IF TISSUE ACQUISTION AND SPECIMEN HANDLING IMPACT THE DIAGNOSTIC YIELD OF ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION OF SOLID MASS
Authors: Khan S , Mathura P , Puttangunta L , Girgis S , Zhang J , Nilsson J , Wesilenko S 
Published: February 2024

Abstract

Background
Endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy (FNAB) of solid mass lesions has a sensitivity and specificity between 50-100%. Tissue acquisition and specimen handling are factors that may contribute to this variability. At our institution, 3 endoscopists perform EUS. The aspirated material obtained is expressed onto slides for cytology (prepared by a nurse) and solid tissue fragments transferred into formalin. At the discretion of the endoscopist, aspirated material is collected in saline for cell block preparation.

Aims
To assess the impact of tissue collection and specimen handling on diagnostic yield of EUS-FNAB of solid mass lesions.

Methods
A chart audit was completed for all patients undergoing EUS-FNAB of solid mass lesions between January 1, 2022 and December 31, 2022. Descriptive statistics were completed. A definite diagnosis was considered when calculating the diagnostic yield.

Results
A total of 184 patients (100 M, 84 F), mean age 64±13 years (range 14-89 years), underwent 200 EUS-FNABs by 3 endoscopists. Pancreatic masses were the most common indication in 118/200 (59%) cases. A 22-gauge FNAB needle was used in 189/200 (95%) cases. A total of 285 needle passes were performed in 149 cases (mean 1.9/case). In the remaining 51 cases (26%), the number of needle passes was not specified. Tissue samples were transported in formalin in 190 cases, on cytology slides in 170 cases, and in saline for cell block preparation in 41 cases. Overall, a definite diagnosis was achieved in 149/200 cases (75%). Stratifying for needle passes, a definite diagnosis was achieved in 22/39 (56%), 71/85 (84%), 20/24 (83%), and 1/1 (100%) cases that had 1, 2, 3, and 4 needle passes. Of the 51 cases with unspecified needle passes, a definite diagnosis was achieved in 35 cases (69%). The diagnostic yield obtained with saline for cell block was similar to that obtained with formalin and cytology slides (30/41 [73%] vs. 144/190 [76%] and 132/170 [78%]).

Conclusions
Increasing the minimum number of needles passes for tissue acquisition to 3 per case may increase the diagnostic yield of EUS-FNAB. Documenting the number of needles passes in the endoscopy report is an important quality indicator. Cytology slides and tissue in formalin should be considered standard of care but aspirated material should continue to be used for cell block preparation. However, there is some concern that saline as a transport medium may de-vitalize the aspirated material, so it should be replaced with formalin to preserve tissue integrity.

Funding Agencies
None
A99 HIGHER HOSPITAL INPATIENT RACIAL DIVERSITY IS ASSOCIATED WITH BETTER OUTCOMES AMONG HISPANIC AND INDIGENOUS AMERICAN PATIENTS FOR FIVE COMMON GASTROINTESTINAL DIAGNOSES
Authors: Lawendy B , Sedarous M , Babajide O , Adekunle A , Rubens M , Okafor P 
Published: February 2024

Abstract

Background
There is evidence that gastrointestinal disease (GI) outcomes are poorer among patients from underrepresented backgrounds. However, the impact of hospital patient racial diversity on GI outcomes is understudied.

Aims
We aimed to investigate the impact of hospital patient racial diversity on GI outcomes

Methods
Using the 2019 National Inpatient Sample (NIS), racial diversity was defined by the percentage of Hispanic or Indigenous American patients discharged from each hospital. GI discharge diagnoses were defined by diagnostic related group. We included GI bleeding, inflammatory bowel diseases, GI obstruction, cirrhosis, and alcoholic hepatitis. Logistic regression was used to predict major complication rates or comorbidity (MCC), long length of stay (LOS), and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of Hispanic and Indigenous Americans with patient race. Results were validated with the 2018 NIS dataset.

Results
Our analysis cohort of 537,830 hospitalizations included 252,225 GI bleeding discharges, 59,310 gastrointestinal obstruction discharges, 106,820 cirrhosis and alcoholic hepatitis discharges, and 119,475 inflammatory bowel diseases discharges. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Indigenous American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to white patients, Hispanic patients had higher MCC rates [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28]. The same trend was seen among Indigenous American patients [OR 1.25, (95% CI) 1.09-1.43]. However, as hospital Hispanic diversity increased, inpatient MCC outcomes for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14], and were even better among Indigenous American patients as hospital inpatient Indigenous American diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar improvement in MCC with increasing Hispanic and Indigenous American diversity was observed in the 2018 validation cohort. Table 1 highlights impact of increasing diversity on LOS and total charges.

Conclusions
Increasing hospital inpatient Hispanic and Indigenous American diversity is associated with better outcomes for these underrepresented minority groups. More research is needed on the impact of cultural competence and linguistic concordance on patient outcomes.

Funding Agencies
None
A100 HEREDITARY HEMORRHAGIC TELANGIECTASIA: MORE THAN JUST ANOTHER RECTAL BLEED
Authors: Leung D , Guo J Y , Zepeda-Gomez S , Wesilenko S , Halloran B , Vethanayagam D 
Published: February 2024

Abstract

Background
Hereditary hemorrhagic telangiectasia (HHT), previously known as Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterized by widespread telangiectasia and visceral arteriovenous (AV) malformations. Diagnosis of HHT is commonly guided by The Curaçao Diagnostic Criteria. Molecular genetics can help confirm the clinical diagnosis. Genes involved include ENG, ACVRL1, SMAD4, and GDF2, which affect the bone morphogenic protein signaling pathway important in maintaining vascular endothelial integrity.

Aims
This report aims to review the case of a young male from a rural community in Northern Alberta with a possible new diagnosis of HHT, presenting with rectal bleeding in the setting of family history of telangiectasias.

Methods
Retrospective review of one patient.

Results
We report the case of a 33-year-old male who presented with a 1-day history of rectal bleeding (bright red turning to black) with hemoglobin at 116g/L. Past medical history was significant for occasional epistaxis since age 8, previous gastrointestinal bleed and laparotomy with pathology showing small intestinal vascular malformation at the age of 15, and small bowel obstruction secondary to adhesions requiring resection at the age of 26. There was no history of iron deficiency anemia. Family history was positive for a mother who had Von Willebrand disease and partial colectomy at the age of 28 due to bowel telangiectasias. His mother had no formal HHT diagnosis, but it was unclear if molecular genetics had been performed. Inpatient colonoscopy showed no culprit lesions but free-floating blood clots throughout the colon (Image). EGD and push enteroscopy were normal. CT enterography was then performed showing AV fistula in the distal ileum and venous malformations in the jejunum. Video capsule endoscopy followed revealed a few non-bleeding telangiectasia and petechiae. The patient was assessed to have possible HHT by The Curaçao Diagnostic Criteria. He was supplemented with IV iron and started on short-acting octreotide. On discharge, he received funding approval for long-acting octreotide and was referred to the Edmonton HHT clinic for follow up and further screening.

Conclusions
HHT remains underdiagnosed in both children and adults. Maintaining a strong suspicion and prompt diagnosis via the Curaçao Criteria is crucial for appropriate screening of the multisystem complications which stem from the AV malformations. This multidisciplinary approach can aid in reducing morbidity and mortality.

Funding Agencies
None
A106 COLONOSCOPY TEACHING: A SURVEY OF CANADIAN GASTROENTEROLOGY RESIDENTS
Authors: Park G , Komeylian H , Kohansal A , Stewart M 
Published: February 2024

Abstract

Background
With the advancement in equipment and techniques, colonoscopy training continues to evolve. Programs such as the Skills Enhancement for Endoscopy (SEE) curriculum developed by the Canadian Association of Gastroenterology teach techniques such as loop reduction, patient turning, and water immersion aimed at improving adenoma detection, cecal intubation, and patient comfort. While there is vast literature focused on assessing learners’ endoscopic competencies, there is limited data pertaining to the training of specific colonoscopy techniques.

Aims
To assess various colonoscopy techniques used to train gastroenterology residents in Canada.

Methods
A survey of gastroenterology trainees was developed to assess specific aspects of their experience with colonoscopy education. This included questions on the frequency of position changes, use of pediatrics colonoscopes, water immersion, loops reduction, and SEE program initiatives. The survey was advertised at the 2023 Gastroenterology Residents-In-Training Course with a link to the survey e-mailed to all attendees. This survey has been re-distributed to the current gastroenterology resident cohort and therefore this abstract’s results are interim data pending further survey responses.

Results
At the time of survey administration, there were 69 gastroenterology residents registered in Canada. Responses were received from 21(30%) residents; 5 in post graduate year (PGY) 4 and 16 in PGY5. One quarter (24%) of residents reported that colonoscopy teaching methods were uniform amongst faculty members and one third (33%) reported that more than half of their preceptors mentioned SEE program initiatives. Thirty-eight percent of residents reported that more than half of their preceptors suggested position change on insertion when the scope is advancing well on insertion. Majority of residents (90%) reported that water immersion during colonoscope insertion was recommended by most preceptors. Most residents (76%) reported that position change to help with loop reduction was suggested by more than half of their preceptors. Fifty-seven percent of residents reported that more than half of their preceptors commented on type of loop formation and reduction techniques. Once the cecum is reached, a minority of residents (29%) reported that more than half of preceptors recommended position change specifically to improve cecal visualization.

Conclusions
Certain colonoscopy techniques such as turning patients, water immersion, and loop reduction can assist with adenoma detection rates and patient comfort. However, there exists considerable variability in colonoscopy techniques taught to Canadian gastroenterology residents. Increased standardization among colonoscopy technique education may benefit gastroenterology trainees.

Funding Agencies
None
A107 ANALYSIS OF THE EFFICACY IN TRANSITIONING FROM FOBT TO FIT FOR COLORECTAL CANCER SCREENING AT A SINGLE CENTRE IN ONTARIO
Authors: Nguyen A , Porwal G 
Published: February 2024

Abstract

Background
Colonoscopy is the gold standard for detecting colorectal cancer (CRC) and advanced lesions, but is an invasive and carries some risks, with limited availability and accessibility. Alternatively, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are both non-invasive, cost-effective screening tests that can also be used to detect CRC, advanced lesions, and polyps, identifying individuals to be prioritized to undergo colonoscopy. FOBT screens for small amounts of blood in stool by detecting heme through a chemical reaction. FIT confirms the presence of blood in stool by using antibodies to detect hemoglobin. Prior to 2019, Ontario employed FOBT as the preferred method for CRC screening in eligible individuals. In early 2019, Ontario transitioned to FIT as the preferred screening test, due its established superior test performance for identifying patients with high risk lesions for colon cancer.

Aims
This single-centre retrospective study analyzed the change in efficacy of detecting advanced lesions, when transitioning from FOBT to FIT, as identified on subsequent colonoscopy

Methods
A retrospective chart review was conducted of approximately 1000 patients undergoing colonoscopy for FOBT or FIT at Cambridge Memorial Hospital, covering the period of transition from FOBT to FIT. Colonoscopies were performed by 10 endoscopists. Patients were stratified into 2 groups based on fecal test type, FOBT (N = 344) and FIT (N = 572). Overall and individual proportions of cancer, polyps, adenomas, advanced adenomas (AA), and sessile serrated adenomas (SSA) detection in the subsequent colonoscopies were calculated for both groups. The efficacy of both tests was then assessed using statistical analysis.

Results
In total, 344 patients were included for FOBT analysis and results included: cancer (5.52%), any polyp (56.69%), adenoma (43.6%), AA (20.64), and SSA (6.1%). In contrast, 572 patients were included for analysis of FIT group and results included: cancer (3.85%), any polyp (83.22%), adenoma (76.92%), AA (43.01), and SSA (12.94%). Cancer detection was similar in the 2 groups. There was significant improvement in polyp, adenoma, advanced adenoma, and sessile serrated adenoma detection with FIT compared to FOBT. This improvement was consistent in all endoscopists, but more pronounced in endoscopists with lower detection rates in FOBT cases.

Conclusions
The use of FIT as a screening stool test, as compared to FOBT, was associated with a significantly improved detection for polyps, adenomas, AA, and SSA, confirming greater accuracy and sensitivity of FIT as a screening tool. This result confirms the premise, at least at a single institution, that by switching to FIT, Ontario has improved colon cancer screening and prevention with more efficient and higher yield utilization of a limited and costly health care resource

Funding Agencies
None
A108 AN EVALUATION OF IMPLEMENTATION OF A CENTRALIZED REFERRAL AND BOOKING PROCESS ON WAIT TIMES FOR COLONOSCOPIES
Authors: Nguyen A , Porwal G 
Published: February 2024

Abstract

Background
Colonoscopies in the majority of centres in Ontario are booked by individual endoscopists via their individual offices (practices). As such, wait times for procedures will vary significant from centre to centre, or even from endoscopist to endoscopist at the same centre, depending on individual expertise, experience, procedure types, and local availability of endoscopic resources. This system could lead to significant variability in access to care for patients.

Aims
This study analyzed the effect of implementing a centralized referral and booking process for colonoscopy, for a specific indication, at a single centre in Ontario.

Methods
This was a single centre retrospective study analyzing wait times for patients that underwent a colonoscopy at Cambridge Memorial Hospital (CMH) between April 2017 to July 2022 for either positive fecal occult blood test (FOBT) or fecal immunochemistry test (FIT). The province of Ontario transitioned from FOBT to FIT as the primary tool for colon cancer screening in 2019. Prior to this transition, colonoscopy for positive FOBT performed at CMH were booked by individual endoscopists, with wait times from referral to procedure having great variability. In conjunction with Ontario’s transition to FIT for colon cancer screening, all endoscopists at CMH agreed to participate in a centralized referral and booking process specifically for colonoscopy for positive FIT indication. A chart review of all patients undergoing colonoscopy for either FOBT (non central booking) or FIT (central booking). Patients that self-delayed were excluded. Wait times (WT) was calculated as time between date of referral and date of procedure. The effect of the centralized booking system on wait times was then assessed using statistical analysis.

Results
In total, 344 patients were included for analysis from before March 2019 (non centralized booking process). The average WT in this group was determined to be 99.2 days (range 50-171 days), of which 147 patients had a WT of less than 56 days (42.7%). In contrast, a total 572 patients were included for analysis after March 2019 (centralized booking process), the average WT was determined to be 44.2 days (range 32-59 days), of which, 526 patients had a WT of less than 56 days (92.0%). The centralized booking process reduced average wait times by 55 days (55.4%), and improved procedure WTs meeting mandated time frame of 56 days by 49.3%. This improvement in wait times was most pronounced for endoscopists with the longest wait times in a non centralized system.

Conclusions
The implementation of a centralized referral and booking process (for a single indication for colonoscopy) was associated with significantly reduced WTs. These findings suggest a centralized referral and booking process (for well defined clinical needs) can potentially significantly improve patient wait times.

Funding Agencies
None