bluuebunny/crossref_metadata_2025_split huggingface dataset:
A65 PREDICTING TRANSITION SUCCESS IN YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: PRELIMINARY RESULTS
Authors: Bihari A , Goodman K , Wine E , Kroeker K 
Published: February 2022

Abstract

Background
Patients diagnosed with inflammatory bowel disease (IBD) in childhood present more often with extensive disease, are more likely to be admitted to hospital and are less adherent with clinic appointments. Due to these risks, a smooth, uninterrupted transition from pediatric to adult care should be a priority. We have conducted interviews with providers, patients, and parents about their opinions on indicators of successful transition. Themes of successful transition that emerged included independence in seeking care and disease management. Characterizing successful transition based on stakeholder input makes it possible to monitor its achievement and identify its determinants.

Aims
This study aims to: 1) describe the frequency of success indicators in transitioned patients and 2) identify predictors associated with success indicators. We hypothesize that patients with more experience in pediatric care (e.g., younger age at diagnosis or on biologics) are more likely to achieve success.

Methods
We conducted a retrospective medical chart review to obtain data on patients who transitioned to adult care between January, 2014 - September, 2019 at the University of Alberta. We abstracted potential predictors, including social and disease factors, at first adult appointment which had notes on pediatric history. We chose available success indicators related to two themes: independence in seeking care (e.g., attending appointments, communicating for oneself) and disease management (e.g., lab work frequency and medication adherence). We abstracted selected success indicators within a two-year period from first appointment in adult care. We used Poisson and logistic regression to estimate incidence rate ratios (IR) and odds ratios (OR) for the association of potential predictors with success indicators.

Results
We reviewed medical charts of 99 patients. At first adult appointment, the median age at diagnosis was 14.5 years old (IQR: 13.2 – 15.9) and 57.6% of patients were on biologic agents. Within two years, 42.4% of patients required a change to a different therapy, 22.2% had at least two instances where a parent called on their behalf, and 16.2% had notes of medication nonadherence in adult care. Regression analysis (Table 1) estimated that patients who lived &gt; 100km from clinic had a lab work incidence rate in the first year that was two-thirds that of patients who lived closer. Strong predictors of non-adherence in adult care included chart notes on pediatric medication non-adherence (OR~12) and, inversely, taking biologics (OR=0.34).

Conclusions
These results identified factors that could be used to identify patients likely to have poor outcomes following transition to adult care. These are preliminary results; we plan to analyze a total of 350 medical charts.

Funding Agencies
None
A73 CANADIAN INFLAMMATORY BOWEL DISEASE MOBILE APPS: CURRENT LANDSCAPE AND NEEDS
Authors: Chiew B A , Raman M , Tandon P , Panaccione R , Taylor L 
Published: February 2022

Abstract

Background
Evidence-based digital health applications (apps) offering comprehensive lifestyle therapies for inflammatory bowel disease (IBD) patients are limited in Canada.

Aims
The aims of this study were to explore the Canadian IBD digital app landscape and review preliminary data from a recently launched digital app for IBD, LyfeMD. (www.lyfemd.ca).

Methods
“IBD”, “Inflammatory bowel disease”, “UC”, “Ulcerative colitis”, “Crohns” and “Crohn’s disease (CD)” were searched by one team member (BC) on the App Store. Apps were included if they offered any type of lifestyle therapy, including education. The mobile application rating system (MARS) was used to evaluate each app and is a validated tool used to assess the quality of mobile health apps. For the LyfeMD app, 35 IBD users completed a baseline assessment survey to identify: 1) physical activity, sitting, and screen time, and; 2) stress, sleep, depression and anxiety. Eleven participants completed in-depth user experience evaluations after 4 weeks. Survey scores were calculated using published scoring protocols and descriptive data were prepared.

Results
The LyfeMD and My IBD Care app scored highest on the MARS with a total score of 4.8/5. Of the other eight apps identified, scores ranged from 2.4 to 4.6 (overall mean=4.0). LyfeMD differentiated itself from other apps by providing lifestyle programs to improve nutrition, physical activity and mental health. Of the LyfeMD users, 74% had CD (median Harvey Bradshaw index=3.1, IQR=1.1–4.8) and 26% had ulcerative colitis (median partial mayo score=1.0, 0.5–6.0), 60% had a BMI ≥25 kg/m2, 57% were meeting 150 minute/week activity guidelines, 49% had high sitting time, 100% had high screen time, 69% had a moderate to high level of stress, 100% experienced sleep problems, 69% reported depression, and 49% reported anxiety. Eleven people completed the detailed user experience evaluations. They reported the app helped them identify behaviour changes to improve overall wellness; most often what they eat (64%), overall well-being (64%) and physical activity (46%).

Conclusions
Two IBD apps available in Canada had a high MARS rating, however only the LyfeMD app offered comprehensive lifestyle therapies. The growing literature supports benefit for lifestyle therapies in IBD, and the LyfeMD app may be effective to identify areas amenable to lifestyle modification.

Funding Agencies
Ascend, Alberta Innovates
A74 SURVEILLANCE IMAGING FOLLOWING COMPLETELY RESECTED GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS: A SINGLE CENTER AUDIT OF LOCAL PRACTICE PATTERNS
Authors: Iannuzzi J , Yeo C , Sawhnry S , Pasieka J , Parkins V , Ruether D , Chan D , Albalawi Z , Lithgow K 
Published: February 2022

Abstract

Background
Neuroendocrine tumours (NET) are a heterogenous group of neoplasms that secrete peptides and neuroamines. For patients with potentially malignant gastroenteropancreatic (GEP) NET, surgical resection represents the only curative option. GEP NETs are characterized by long periods of disease-free survival and time-to-recurrence following surgical resection. Clinical guidelines recommend surveillance with cross sectional imaging, either CT or MRI, for at least 10 years.

Aims
The purpose of this study was to characterize local practice patterns of imaging surveillance (modality, frequency, and duration of follow-up) and how this compares to guideline recommendations.

Methods
We retrospectively reviewed clinical and imaging records from patients diagnosed with well-differentiated GEP NET at our center from January 2005 to July 2020 inclusive. Eligible cases were identified by a data analyst from the Alberta Cancer Board with each case being manually screened for eligibility. Exclusion criteria included patients with metastatic disease at presentation, G1 appendiceal NET &lt; 1 cm, R0 G1 T1 rectal NET, and insulinoma. Location of primary NET, modality of surveillance imaging, date of test and duration of follow-up collected. The mean number of surveillance scans per person and per person-year follow-up based on the location of the primary NET were calculated.

Results
A total of 387 cases were initially retrieved with 62 eligible cases identified. The mean length of follow-up was 71 months (range 8 to 147). The mean number of surveillance scans was 7 (range 2 to 14) and the mean number of surveillance scans per person year was 1.1. Frequency of surveillance scans per year of follow-up did not differ based on the location of the primary tumor (p=0.966). Imaging modalities included cross sectional imaging (MRI and contrast enhanced CT) and nuclear medicine imaging (octreotide, MIBG, F-18 FDG-PET, and Gallium-68 DOTATATE PET CT). Most commonly, cross-sectional imaging was performed with CT or MRI representing 38% (n=166) and 39% (n=170) of all surveillance respectively. Nuclear medicine imaging was used in 15% (n=61) of surveillance scans and 3% used combined cross-sectional and nuclear medicine. Amongst cases with resection date &gt;10 years (n=8) mean length of follow-up was 119 months (9.9 years).

Conclusions
Frequency and modality of imaging at our center is generally in accordance with current clinical guidelines, though the role of nuclear medicine imaging in this setting has not been established. CT and MRI were utilized equally during surveillance. The burden of these modalities in terms of radiation exposure and cost warrants further evaluation.

Funding Agencies
None
A89 PERCEPTIONS OF NON-TECHNICAL SKILLS IN GASTROINTESTINAL ENDOSCOPY: A THEMATIC ANALYSIS OF FOUR FOCUS GROUPS
Authors: Scaffidi M , Gimpaya N , Pattni C , Genis S , Khan R , Li J , Bansal R , Grover S 
Published: February 2022

Abstract

Background
Nontechnical skills (NTS), which involve an individual’s cognitive, attitudinal, and social skills that supplement task expertise, are an essential component in the practice of gastrointestinal endoscopy. There is a growing body of literature that highlights the association between these skills and patient outcomes. To date, however, these skills have not been adequately defined within the context of gastrointestinal endoscopy.

Aims
To define the domain and corresponding characteristics of NTS in GI endoscopy.

Methods
We conducted a qualitative study at a tertiary-care academic center in Toronto, Ontario. Specifically, we held four focus groups with physician endoscopists, nurses who work in an endoscopy unit, and patients who have had previous endoscopies, in order to ascertain their input on the role of NTS in gastrointestinal endoscopy. The three groups were interviewed independently and there was one focus group of both physicians and nurses that was used for validation of our initial thematic framework. Data from the focus groups was collected using a combination of field notes and discussion transcriptions. Three authors independently generated codes from these data. Using these codes, a thematic network analysis was used to identify emerging themes. The primary outcome of this study was the development of a cohesive thematic network of NTS in endoscopy, including their characteristics and examples.

Results
The four focus groups included a total of 34 participants, including 15 physician endoscopists, 15 nurses, and 4 patients. Using thematic network analysis, we identified six dimensions of NTS using the first three focus groups: communication; professionalism; teamwork; leadership; decision-making; and situational awareness. Additional topics related to the practice and evaluation of NTS were identified. In particular, there is a degree of subjectivity in the appraisal of NTS due to the nuances among individual practice, aside from egregious errors of NTS (e.g. unprofessional behaviours). The use of video recordings was suggested as a way to capture signs of good NTS, such as appropriate levels of calmness during procedures and attention to patient comfort. Finally, patient involvement can be useful for evaluating communication and professionalism based on patient comprehension and the nature of the therapeutic relationship.

Conclusions
Our findings provide the first cohesive framework of NTS in gastrointestinal endoscopy that is anchored in real world experiences with relevant stakeholders – physicians, nurses, and patients. Future research should consolidate these findings into an assessment tool for NTS in order to evaluate and provide feedback to endoscopists who are both in training and in practice.

Funding Agencies
CAG
A99 PHARMACEUTICAL INDUSTRY FUNDING TO GASTROINTESTINAL PATIENT ADVOCACY ORGANIZATIONS
Authors: Verma Y , Bansal R , Gimpaya N , Scaffidi M , Khan R , Grover S 
Published: February 2022

Abstract

Background
Patient advocacy organizations (PAOs) are not-for-profit organizations that aim to support families and individuals afflicted by illnesses. PAOs play a significant role in guiding health policy, providing education to patients, lobbying, and supporting research. Previous studies have demonstrated that PAOs may receive financial payments from pharmaceutical and medical device manufacturers. This may create a risk of conflict of interest.

Aims
To assess the prevalence and transparency of financial donations from industry to gastrointestinal patient advocacy groups based in the United States (US).

Methods
We conducted a cross-sectional study to determine the prevalence of industry donations to PAOs. Data was extracted from the Kaiser Health News (KHN) Database, a database that tracked payments from pharmaceutical companies to PAOs in 2015. After an initial list of 1215 PAOs was obtained from the database, authors extracted the annual revenues, websites and mission statements for each PAO. Authors individually screened each organization’s mission statement and website to determine whether their primary scope of focus included gastroenterology. A final list of 11 PAOs with annual revenues surpassing $500,000 USD was included for descriptive analysis. From this list, the annual reports and websites of each group were reviewed to determine the extent of transparency of PAOs disclosing financial relationships with industry sponsors. The primary outcome of our study was the total amount of funding that each PAO received from pharmaceutical companies. The secondary outcome was the self-reported amount of funding stated on each PAO’s website and annual report.

Results
From our analysis of 11 PAOs, 9 (81%) organizations received payments from pharmaceutical companies. The median dollar value of donations received was $31,052 USD (IQR=$25 to $302,550). The total dollar value of donations received was $4,059,433 USD. Across the 9 PAOs that received donations, 5 (56%) organizations disclosed a financial relationship with a pharmaceutical company on their website and 2 (22%) disclosed the value of industry donations within a range. No group specified an exact amount of funding received.

Conclusions
Our results demonstrate that a majority of US based gastrointestinal PAOs receive funding from pharmaceutical companies. Furthermore, our results show that many PAOs that receive industry funding do not disclose this amount on their website or annual reports. Given their role in providing patient centered support, it is important for PAOs to disclose financial relationships with industry so as to not produce a conflict of interest.

Funding Agencies
None
A102 INDICATION FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND ASSOCIATION WITH HEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Parvizian M K , Zhang M , Edwards M , Bhoey P , Hookey L , Rodrigues D 
Published: February 2022

Abstract

Background
Hemorrhage is a complication associated with up to 2% of cases of Endoscopic Retrograde Cholangiopancreatography (ERCP), most commonly following sphincterotomy. Studies investigating risk factors associated with hemorrhage, such as ERCP indication, have been conflicting.

Aims
We performed a systematic review and meta-analysis to determine the association between the indication for ERCP and ERCP-associated hemorrhage.

Methods
A systematic search of MEDLINE, EMBASE, and CENTRAL was done from inception until September 2021 for studies reporting on factors associated with ERCP-associated hemorrhage (both immediate and delayed) in adults. Exclusion criteria included: pediatric patients, no outcome of interest, did not investigate hemorrhage risk factors, inappropriate study design (basic science, reviews, and case reports/series), or if no English text was available. A DerSimonian and Laird random-effects meta-analysis was performed to generate pooled Odds Ratios (OR) with 95% Confidence Intervals (CIs) for each procedural indication in relation to hemorrhage.

Results
952 records were identified of which 17 were included in our quantitative analysis. Common indications included acute cholangitis, choledocholithiasis, Sphincter of Oddi dysfunction (SOD), acute pancreatitis, chronic pancreatitis, and malignancy-associated duct obstruction. Rates of hemorrhage varied in the included studies (median 2.2%; IQR 1.7–6.9). Sphincterotomy rates also differed in the included studies (median 100%; IQR 71.1–100). Five studies did not report on antiplatelet or anticoagulant use with the remaining reporting varying rates of antiplatelet (median 8.3%; IQR 0–26.5) and anticoagulant (median 0.8%; IQR 0–2.25) use. Hemorrhage was significantly associated with acute cholangitis (OR 2.48; 95% CI 1.62–3.78) and choledocholithiasis (OR 1.76; 95% CI 1.06–2.94) but not SOD (OR 1.38; 95% CI 0.74–2.58), malignancy (OR 0.68; 95% CI 0.29–1.59), acute pancreatitis (OR 1.08; 95% CI 0.30–3.82), or chronic pancreatitis (OR 0.56; 95% CI 0.16–1.99).

Conclusions
Acute cholangitis and choledocholithiasis were associated with increased hemorrhage, whereas SOD, malignancy, acute pancreatitis, and chronic pancreatitis were not. Providers should consider procedural indication when counselling patients on hemorrhage risk in ERCP.

Funding Agencies
None
A104 PATIENT AND PUBLIC INVOLVEMENT (PPIN) IN IBD RESEARCH - A SCOPING REVIEW
Authors: Elsolh K , Neary E , Seleq S , Gimpaya N , Scaffidi M , Khan R , Grover S 
Published: February 2022

Abstract

Background
Over the past 10 years, interest in patient and public involvement (PPIn) in research has grown. Several arguments support the engagement of patients as partners in the research process. Patients with lived experience of a condition can offer their knowledge to study design as experience-based experts, helping researchers incorporate patient-pertinent outcomes. PPIn has also been shown to boost patient enrolment and retention in clinical trials. Benefits, challenges, and best practices of PPIn have been examined in other fields. However, to date, no study has examined PPIn in inflammatory bowel disease (IBD) research. Many factors amenable to research involvement may impact IBD patients’ quality of life, including disease morbidity, complications, and efficacy/side effects of therapy.

Aims
This review aims to characterize methods of PPIn in IBD research and highlight themes relating to best practices, benefits, and challenges.

Methods
We ran a systematic search on MEDLINE, EMBASE, and Cochrane for all IBD research studies in which IBD patients were involved in the research process. PPIn included but was not limited to patient input in one of the following 3 stages: Study Design (prioritization of research topics, outcome selection, study tool development), Study Execution (recruitment, data collection & analysis), and Dissemination of Research. After abstract and full-text screening, 14 studies were selected.

Results
Patients were recruited for PPIn through IBD and patient organizations (7/14), outpatient clinics (4/14), tertiary care sites (2/14), and pre-existing patient advisory groups (1/14). The majority of studies (11/14) engaged patients in the development of study materials, which included a physical activity intervention for stoma patients, an IBD pregnancy decision aid, and a quality of life questionnaire. Two studies interviewed patients to determine comprehensibility of survey items and guide revisions. One study involved patients in data analysis and manuscript development. Most consultations were open-ended, including focus groups (8/14) and semi-structured interviews (3/14). According to study authors, PPIn helps guide IBD research priorities by focusing on patient-relevant issues. Authors also cited the role of PPIn in designing patient-friendly study tools. One challenge reported by 2 studies was that PPIn requires patients to have access to high-quality information and requires a significant time commitment, which may contribute to demographic biases.

Conclusions
The majority of IBD studies engaged patients in an open-ended format and were engaged in study design, particularly in developing study materials. Authors recommend continuous involvement of patients throughout the research process to address their research priorities.

Funding Agencies
None
A105 ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ILEOCECAL VALVE NEOPLASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Donaldson K , Arif A A , Qian H , Lam E , Shahidi N C 
Published: February 2022

Abstract

Background
Neoplastic lesions at the ileocecal valve (ICV) represent a complex lesion subgroup given the unique anatomical characteristics of this location. Both endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for colorectal neoplasia but comparative analyses for ICV lesions are lacking.

Aims
Evaluate the performance of EMR and ESD for ICV neoplasia.

Methods
Between Jan 2000 to Aug 2021, two authors independently searched MEDLINE, EMBASE and Cochrane Libraries for relevant citations evaluating the performance of either EMR and/or ESD for ICV neoplasia; defined as lesions involving at least one component of the ICV complex. The rate of technical success (complete removal of all neoplastic tissue during index procedure of those lesions deemed amenable to endoscopic resection), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation, and recurrence were assessed. Meta-analysis was performed using a random-effects model.

Results
Nine studies (367 patients, 252 EMR, 115 ESD) were included in the analysis. Successful removal of all visible neoplastic tissue of those deemed amenable to endoscopic resection was 98.1% (EMR 99.6%, ESD 97.4%). Of note, only 2 studies, both assessing EMR, provided data on lesions which were not considered for endoscopic resection ranging from 5.6–23.7%. Average procedure time ranged from 45–49 minutes for EMR and 52–191 minutes for ESD. Clinically significant post-endoscopic resection bleeding occurred in 6.2% (EMR 9.4%, ESD 4.4%). Delayed perforation occurred in 0.6% (EMR 0.4%, ESD 2.0%). Recurrence occurred in 3.1% (EMR 13.2%, ESD 1.9%).

Conclusions
Endoscopic resection, both with EMR and ESD, demonstrates high technical success and good adverse event profiles amongst ICV neoplasia deemed amenable for endoscopic resection.

Funding Agencies
None