bluuebunny/crossref_metadata_2025_split huggingface dataset:
A66 THE IMPACT OF A MULTIDISCIPLINARY ADOLESCENT AND YOUNG ADULT (AYA) INFLAMMATORY BOWEL DISEASE (IBD) ON CLINIC NO SHOW RATES
Authors: Sharma R , Halder S L , Zachos M , Radoja C , Grant C , Chauhan U , Brackenridge E , Issenman R , Sherlock M , Dowhaniuk J K , Pai N , Brill H , Ratcliffe E , Narula N , Marshall J , Prowse K 
Published: February 2022

Abstract

Background
Transitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care.
IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population.
McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience.

Aims
To explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD.

Methods
The total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values &lt;0.05.

Results
The percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1).

Conclusions
Our results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic.

Funding Agencies
Grants-In-Aid
A68 THERAPEUTIC EFFECTS OF MEDICINAL CANNABINOIDS ON THE GASTROINTESTINAL SYSTEM IN PEDIATRIC PATIENTS: A SYSTEMATIC REVIEW
Authors: Sunil M , Karimi P , Leong R , Zuniga-Villanueva G , Ratcliffe E 
Published: February 2022

Abstract

Background
Changes in cannabis legalization in recent years have led to an increasing interest in medicinal cannabinoids for a variety of therapeutic uses, including those which target the gastrointestinal tract. These effects are mediated by interactions with the endocannabinoid system. As this system is present in early life, it is important to ensure pediatric representation in clinical studies regarding cannabinoid use.

Aims
We conducted a systematic review to assess the efficacy of medicinal cannabinoids in treating gastrointestinal symptoms in pediatric patients.

Methods
A literature search of Medline, Embase, CINAHL, Web of Science and the Cochrane Library was conducted from inception. Study design, patient characteristics, type, dose and duration of medicinal cannabinoid therapy, and gastrointestinal outcomes were extracted.

Results
From 7,303 records identified, five studies met all inclusion criteria. The focus of the included studies ranged from chemotherapy-induced nausea, inflammatory bowel disease and gastrointestinal symptoms associated with severe complex motor disorders. Results varied based on the symptom being treated, the type of cannabinoid, and the patient population, however, the most consistently improved symptom was chemotherapy-induced nausea.

Conclusions
Medicinal cannabinoids may have a potential role in treating specific gastrointestinal symptoms in specific patient populations. The limited number and heterogenicity of included studies highlight the requirement for future research to distinguish the effects amongst different cannabinoid types, patient populations and examine drug-interactions. In addition, the molecular interplay between disease processes, the endocannabinoid system and medicinal cannabinoids require investigation to further understand the mechanisms behind this intervention.

Funding Agencies
Natural Sciences and Engineering Research Council of Canada; Farncombe Family Digestive Health Research Institute
A70 SEVERE ENTERITIS AND IGA VASCULITIS IN A PEDIATRIC PATIENT WITH ULCERATIVE COLITIS ON VEDOLIZUMAB
Authors: Desai T , Jurencak R , Nair A , Carman N 
Published: February 2022

Abstract

Background
Pediatric Ulcerative Colitis (UC) is often unsatisfactorily controlled using ‘conventional’ therapies, thus there has been increasing use of biologic therapies and small molecules to try and improve rates of clinical remission and mucosal healing. Consequently, pediatric gastroenterologists and generalists should be aware of the complications and side effects of these newer molecules. Vedolizumab (VDZ) is a fully humanised anti-integrin therapy that is thought to limit systemic side effects given its gut-specific mechanism.

Aims
Here we report the unique case of a 14-year-old male with UC on vedolizumab presenting with severe abdominal pain, GI bleeding, markedly elevated inflammatory markers and subsequent purpura.

Methods
N/A

Results
A diagnosis of IgA vasculitis (IgAV) was made after extensive imaging, endoscopy and subspecialty consultation. Clinical course was complicated but ultimately responded to high dose steroid treatment without cessation of VDZ.

Conclusions
This case illustrates a potentially independent pathway behind IgAV in a patient on a gut-selective therapy with UC. This is the first pediatric case of vasculitis in a patient with UC on VDZ.

Funding Agencies
None
A71 POLYP TO ADENOMA CONVERSION FACTOR AS A SURROGATE FOR ADENOMA DETECTION RATE-– FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT
Authors: Alobaid S , Mcdonald C , Guizzetti L , Yan B , Jairath V , Sey M 
Published: February 2022

Abstract

Background
The adenoma detection rate (ADR) is one of the main quality indicators of a colonoscopy but requires combining endoscopic and histologic data. However, the polyp detection rate (PDR) requires only endoscopic assessment and has been proposed as a proxy measure for the ADR.

Aims
To calculate a conversion factor for PDR to ADR, for use as a future surrogate of ADR when only PDR is available.

Methods
The Southwest Ontario Colonoscopy cohort consists of all outpatient colonoscopies performed across 20 hospitals in Southwestern Ontario between April 2017 and February 2018. Data was collected prospectively through a mandatory quality assurance form that was completed after each procedure and pathology reports were manually reviewed. Endoscopies with associated histologic findings were included.
The PDR and true ADR were calculated for each physician. A weighted polyp to adenoma detection rate quotient (APDRQ) was calculated, weighting each physician’s APDRQ by the number of procedures performed. The APDRQ was determined for all outpatient procedures and specifically for screening/surveillance indications.

Results
During the study period, 57 endoscopists performed 31,721 colonoscopies. The overall PDR was 41.1% and the ADR was 26.5%. The weighted ADPDRQ was 0.638 (95% CI: 0.600, 0.675). When limited to screening/surveillance colonoscopies, the weighted ADPDR was 0.616 (95% CI: 0.564, 0.669). To better understand the influence of endoscopists with low ADR: PDR, we excluded those with ratio below (&lt;2 standard errors) the average, which resulted in greater ADR: PDR for all colonoscopies 0.695 (95% CI: 0.679, 0.711) and for screening/surveillance colonoscopies and 0.692 (95% CI: 0.677, 0.707).

Conclusions
In this large, population-based, cohort study, we calculated the ADR; PDR ratio. We propose this may be used in future studies to infer ADR when only PDR is available.

Scatter plot of correlation between ADR and PDR, by physician. The dashed line indicates the line for which ADR=PDR, the maximum value the ADR can take for a given PDR. The marker size is proportional to the number of colonoscopies performed.

Funding Agencies
None
A76 MEDICATION ADHERENCE AND BELIEFS ABOUT MEDICATION AND THE CORRELATION WITH KNOWLEDGE ABOUT INFLAMMATORY BOWEL DISEASE (IBD) IN PREGNANCY
Authors: Govardhanam V , Tandon P , Jogendran R , Huang V 
Published: February 2022

Abstract

Background
Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions including ulcerative colitis (UC), Crohn’s disease (CD) or IBD-unclassified that affect women of childbearing age. women with IBD have poor knowledge of disease management during pregnancy, as demonstrated by studies using the validated Crohn’s and Colitis Pregnancy Knowledge (CCPKnow) tool. These patients who lack knowledge about IBD and reproduction tend to have misguided fears and make uninformed decisions such as voluntary childlessness (VC) or poor medication adherence.

Aims
We aim to understand the correlation between improved knowledge about IBD and Medication Adherence Report Scale (MARS) and Beliefs about Medication Questionnaire (BMQ)

Methods
Adult women with IBD attending the pregnancy IBD clinic at the University of Alberta from 2014–2018 were enrolled. Each patient completed the Crohn’s and Colitis Pregnancy Knowledge (CCPKnow) questionnaire at baseline and after individualized education delivered at each clinic visit. BMQ and MARS Questionaries were completed using a 0–5 Likert scale at each visit. BMQ and MARS data were analysed using Wilcoxon signed ranks test by comparing pre-conception, intrapartum data (trimester) and post-partum scores. BMQ questions were classified under the BMQ Concerns category and BMQ necessity category for regression analysis.

Results
A total of 117 patients were enrolled in this study. 55 patients with CD (47.1%) and 62 patients with UC (52.9%). Statistically, a significant change was noted when comparing the median Trimester BMQ scores to pre-conception BMQ scores. (Z of -2.667, p=0.008) and Median post-partum BMQ scores to Median pre-conception BMQ scores. (Z of -2.547, p=.011). Trimester BMQ Concerns data had a strong negative correlation with CPPKnow scores (Correlation Co-efficient -.528, p&lt;0.05). Median Trimester MARS data had a strong positive correlation with CPPKnow scores (Correlation Co-efficient 0.644, p&lt;0.05).

Conclusions
Increased CPPKnow scores in patients were correlated with patients that were less concerned about IBD medication use and were noted to have higher medication adherence as reflected in the MARS scores post-intervention. A dedicated pregnancy clinic aimed at improving IBD and pregnancy knowledge in women would encourage greater adherence to IBD medication.

Funding Agencies
None
A77 IMPLEMENTATION OF GUT LINK-IBS; RESULTS OF A SEMI-STRUCTURED INTERVIEW OF PRIMARY CARE PROVIDERS
Authors: Sharma S , Heisler C , Jones J , Stewart M J 
Published: February 2022

Abstract

Background
The Division of Digestive Care and Endoscopy in Halifax, Nova Scotia has had longstanding challenges with GI referral volume outstripping divisional capacity resulting in limited access to specialist care. Many referrals for functional bowel disorders (FBD) are returned to referring providers. Although this helps rationalize limited system resources, it often impairs access to appropriate and necessary GI care. The co-development and implementation of clinical care pathways across gastroenterology and primary care may help to improve access to high-quality GI care.

Aims
The project aimed to engage primary healthcare providers (PHCPs) to identify environmental and behavioral barriers and facilitators for managing undifferentiated lower GI disorders in primary care. Data generated from stakeholder engagement will be used to develop, implement, and evaluate strategies for referral and management of FBD. A real-world, functional clinical care pathway that supports the implementation of evidence-based practices in the diagnosis and management of functional GI conditions within primary care will enhance care and timely access to specialist.

Methods
This is a qualitative study using semi-structured interviews of PHCPs working in Nova Scotia. Interview questions were developed and guided by the evidence-based implementation science frameworks. Physicians were recruited through existing primary care networks. Participants were offered a Zoom™virtual semi-structured interview. A brief intake questionnaire was administered to collect baseline demographics. Interviews were recorded and transcribed for data analysis. Data were categorized into coding schemes and themes were created using an inductive coding approach.

Results
As of October 2021, 9 interviews have been conducted. Average participant age was 44 years, with the majority identifying practice in a group or collaborative care setting (n=7, 78%). Five worked in urban practice settings and the remainder in rural areas. Preliminary major themes included:
1. A lack of satisfaction with access to gastrointestinal care, with most physicians noting it to be worse than access to other specialist services.
2. Management of FBDs were felt to be within the scope of primary care practice
3. Access to diagnostic tests like fecal calprotectin with appropriate education on its use as a diagnostic tool would be useful.
4. PHCP’s suggested care pathways be easy to use, require minimal time, and ideally be implemented within their pre-existing EMR or in paper form.

Conclusions
PHCPs acknowledge a significant burden of undifferentiated lower GI complaints in their practice and poor access to gastroenterology services. All participants were open to helping develop and use a clinical care pathway for the investigation and management of undifferentiated lower GI symptoms. Data collection and analysis are ongoing.

Funding Agencies
None
A79 AIMING TO PROVIDE EARLIER CARE WHILE REDUCING SPECIALTY CLINIC WAIT TIMES: DEVELOPING A RELIABLE PROCESS OF ASSESSING THE ELIGIBILITY OF GASTROENTEROLOGY REFERRALS FOR PRIMARY CARE PATHWAYS
Authors: Budhram D , Neary E , Kelley M , Hookey L 
Published: February 2022

Abstract

Background
Gastrointestinal (GI) diseases are common and are a source of substantial morbidity, mortality, and cost, accounting for the largest share of medical referrals from primary care physicians (PCPs) in Canada. Long wait times and increasing numbers of referrals for GI consultation have thus become a significant issue, and while awaiting consultation many patients experience impaired quality of life. Primary care clinical pathways are structured care plans outlining detailed steps for treating patients with specific GI conditions, supporting the translation of clinical guidelines into local protocols and clinical practice.

Aims
To identify the proportion of referrals sent from PCPs to the Queen’s Gastroenterology division that meet the eligibility criteria for a clinical care pathway.

Methods
A review was conducted to identify the proportion of non-urgent referrals in triage sent from PCPs to the Queen’s Gastroenterology division that met the criteria for a clinical care pathway from July 2019 to May 2020. The reason for referral from PCP to gastroenterology was recorded. Individual patient characteristics included in each referral letter were assessed, including age, sex, GI symptoms or signs, relevant clinical features (i.e. time course of symptoms, frequency of bowel movements), relevant laboratory parameters (i.e. CBC, LFTs, electrolytes) or any investigations ordered to evaluate the cause of the patient’s symptoms or signs by the PCP. Four reviewers assessed an initial sample of 200 referral letters and classified each patient’s eligibility for a primary care pathway (GERD, diarrhea, IBS, dyspepsia, or ineligible). After every 100 referrals, discrepancies were reviewed, and a consensus was reached for each case. Data from 100 subsequent referral letters were collected by two independent reviewers, and the inter-rater reliability was calculated. Following a high level of agreement, the final 70 referrals were assessed by two reviewers.

Results
Out of 370 referrals sent from PCPs to the Queen’s Gastroenterology division from July 2019 to December 2019, a total of 170 (46%) met the eligibility criteria for a clinical care pathway. From the eligible referrals, the proportion of patients in each pathway were as follows: 35% GERD, 12% diarrhea, 34% IBS and 19% dyspepsia. The inter-rater reliability for the first 100 referrals assessed by two independent reviewers was 94% (κ = 0.873).

Conclusions
These findings demonstrate that a significant proportion of the patient population referred from PCPs to Queen’s Gastroenterology would be eligible for a primary care pathway. Future steps include implementing these pathways to determine their effectiveness in reducing wait times and empowering PCPs to care for patients who do not require specialist referral.

Funding Agencies
None
A85 LIKELIHOOD OF ENDOSCOPY CANCELLATION BASED ON VANCOMYCIN-RESISTANT ENTEROCOCCI (VRE) COLONIZATION STATUS AND INFECTION CONTROL PRACTICES
Authors: Lee J G , Ou G 
Published: February 2022

Abstract

Background
“Terminal cleaning” is a practice of rigorous cleaning of endoscopy suite following endoscopies for patients colonized with vancomycin-resistant enterocci (VRE) with the intention of reducing VRE transmission. Such practice entails double-wiping all surfaces including the floor with disinfectants before a non-VRE patient can use the endoscopy room. While intuitive, such time-consuming practice is not supported by evidence and may have unintended negative impact on patient access to timely endoscopic evaluation.

Aims
To determine whether terminal cleaning of endoscopy suite for VRE-colonized patients has any negative impact on inpatient access to timely endoscopic evaluation.

Methods
As part of a quality improvement study, inpatient endoscopy data was gathered over a 3-month period between February 2021 and April 2021 at a tertiary centre. EUS, ERCP, and travel cases outside of the endoscopy suite were excluded. The cancellation rates were compared between VRE-colonized patients and non-VRE patients using the Fisher’s exact test. P value of &lt;0.05 was considered statistically significant.

Results
A total of 262 inpatient endoscopic procedures were scheduled and included in the study. Sixty-six (25.2%) of inpatient procedures were cancelled during this period (Table 1). A total of 24 procedures were scheduled for VRE patients, 9 of which were cancelled because of insufficient operating time and two due to concurrent carbapenamase-producing organism carriage and poor bowel preparation. In the non-VRE group, 55 (23.3%) procedures were cancelled for various reasons (Table 1). In subgroup analysis where cancellations related to COVID-19 (n=14) were omitted, VRE patients had a significantly higher rate of procedure cancellations compared to non-VRE patients (42.3% vs. 18.5%; p&lt;0.01).

Conclusions
The overall endoscopy cancellation rate for VRE-colonized patients was higher than those who were non-VRE-colonized. We propose that this is likely secondary to the delays from unnecessary terminal cleans imposed for VRE-colonized patients and await for post-intervention data.

Funding Agencies
None
A90 WHEN DO TRAINEES ACHIEVE COMPETENCY IN PERFORMING ENDOSCOPIC SUBMUCOSAL DISSECTION: A SYSTEMATIC REVIEW
Authors: Kaviani R , Tomaszewski M , Shahidi N C 
Published: February 2022

Abstract

Background
Endoscopic submucosal dissection (ESD) is an established organ sparing curative endoscopic resection technique for the management of pre-malignant and superficially invasive malignant lesions of the gastrointestinal tract. However, little is understood of its learning curve with suggested competency measures including en bloc resection, R0 resection, adverse events and resection speed.

Aims
We aimed to perform a systematic review on when competency is achieved in ESD.

Methods
Two authors independently searched MEDLINE and EMBASE (1946 to Aug 2021) for full-text original citations including grey literature assessing the ESD learning curve. A learning curve was defined as an assessment of competency as a function of increasing trainee experience. Thresholds for competency were defined as en bloc resection ≥ 80%, R0 resection ≥ 80%, perforation rate ≤ 5% and resection speed ≤ 6.67min/cm2.

Results
Forty-three studies (1 esophageal, 11 gastric, 27 colorectum, 4 multiple sites) with 157 trainees and 8780 ESD procedures were included. Baseline experience in esophagogastroduodenoscopy, colonoscopy, endoscopic mucosal resection and ESD were 800–10,000, 100–10,000, 4–700 and 0–300 procedures, respectively. 16 studies used animal model training prior to assessing the ESD learning curve.
En bloc resection, R0 resection, perforation rate and resection speed were used as markers of competency in 33, 29, 28 and 21 studies, respectively. When pooling evaluations where competency was achieved, it was reached in the esophagus, stomach, colorectum and for multiple sites between &lt;10, &lt;10–150, &lt;10–301, and &lt;20–300 procedures, respectively (Table 1). However, competency in R0 resection, perforation rate, and resection speed was not uniformly achieved within 12 studies.

Conclusions
Competency in ESD can be achieved in &lt;10 - 399 procedures, with variability dependent on organ site and baseline level of training. With the widespread adoption of ESD, standardization of training and the assessment of competency are needed.

Funding Agencies
None