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Hyde AM, Johnson E, Luig T, Schroeder D, Carbonneau M, Campbell-Scherer D, Tandon P. Implementing a cirrhosis order set in a tertiary healthcare system: a theory-informed formative evaluation. BMC Health Serv Res 2023; 23:636. [PMID: 37316822 DOI: 10.1186/s12913-023-09632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Standardized order sets are a means of increasing adherence to clinical practice guidelines and improving the quality of patient care. Implementation of novel quality improvement initiatives like order sets can be challenging. Before the COVID-19 pandemic, we conducted a formative evaluation to understand healthcare providers' perspectives on implementing clinical changes and the individual, collective and organizational contextual factors that might impact implementation at eight hospital sites in Alberta, Canada. METHODS We utilized concepts from the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) to understand the context, past implementation experiences, and perceptions of the cirrhosis order set. Eight focus groups were held with healthcare professionals caring for patients with cirrhosis. Data were coded deductively using relevant constructs of NPT and CFIR. A total of 54 healthcare professionals, including physicians, nurses, nurse practitioners, social workers and pharmacists and a physiotherapist, participated in the focus groups. RESULTS Key findings revealed that participants recognized the value of the cirrhosis order set and its potential to improve the quality of care. Participants highlighted potential implementation challenges, including multiple competing quality improvement initiatives, feelings of burnout, lack of communication between healthcare provider groups, and a lack of dedicated resources to support implementation. CONCLUSIONS Implementing a complex improvement initiative across clinician groups and acute care sites presents challenges. This work yielded insights into the significant influence of past implementation of similar interventions and highlighted the importance of communication between clinician groups and resources to support implementation. However, by using multiple theoretical lenses to illuminate what and how contextual and social processes will influence uptake, we can better anticipate challenges during the implementation process.
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Affiliation(s)
- A M Hyde
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada
| | - E Johnson
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada
| | - T Luig
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - D Schroeder
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - D Campbell-Scherer
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
- Office of Lifelong Learning and Physician Learning Program, Edmonton Clinic Health Academy (ECHA), 2-590, Edmonton, AB, T6G 1C9, Canada.
| | - P Tandon
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada.
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House SC, Tandon P, O'Connor K, Maxwell C, Kennedy E, Snelgrove J, DeBuck A, Brar M, Huang V. A91 INTERACTIONS BETWEEN PREGNANCY, DELIVERY, AND ILEAL POUCH-ANAL ANASTOMOSIS FOR INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CHART REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991144 DOI: 10.1093/jcag/gwac036.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects people in their reproductive years of life. Surgical treatment for medically refractory UC involves surgery over 2-3 stages, which includes a subtotal colectomy followed by creation of an ileal pouch-anal anastomosis (IPAA), known as a “J pouch”. The IPAA allows preservation of fecal continence and avoids the psychosocial impacts of a stoma. The IPAA procedure is a deep pelvic surgery, which may impact pregnancy outcomes. Caesarean section (C-section) delivery is often performed to avoid anal sphincter and J pouch damage from vaginal delivery. However, literature demonstrates conflicting results regarding the risks of C-section compared to vaginal delivery, including the impact on pouch function. Surveys of clinicians also report varying delivery recommendations. Purpose To describe the delivery methods, pregnancy outcomes and postpartum course of IBD patients with IPAA at Mount Sinai Hospital. Method A retrospective chart review is being performed for female patients at Mount Sinai Hospital (Toronto, Ontario) with a diagnosis of IBD and an IPAA. Eligible patients completed a pregnancy from January 1, 2002-February 1, 2021 post-IPAA surgery and had variables of interest accessible in their electronic medical record. Variables of interest include demographics, pregnancy history, IBD characteristics, IPAA surgery details, pregnancy outcomes, mode of delivery and characteristics, and postpartum complications. Clinical data will be presented as means, medians and frequencies. Differences between variables of interest will be evaluated with Student’s t-test or chi-squared test. Result(s) Three avenues of patient identification yielded 1113 patients to be screened. Inclusion criteria were met for 71 patients and chart review is complete for 36 patients who had a total of 53 pregnancies and delivered 56 babies. Most patients (49%) had a two-stage IPAA surgery, 21% required a three-stage surgery and 30% were undocumented. Most patients’ (55%) IPAA was created through laparotomy, while 13% was through laparoscopic procedure and 32% was undocumented. Seventy-four percent of deliveries were through C-section (75% of primiparous), 69% of which were indicated to protect the patient’s J pouch and 31% for an obstetrical indication. The remaining 26% of deliveries were vaginal, 29% of which were assisted with forceps or vacuum, 57% had tears (37.5% first-, 37.5% second-, and 25% third-degree) and 50% had an episiotomy. Conclusion(s) At Mount Sinai Hospital, most IBD patients with an IPAA who completed a pregnancy had a history of laparotomy to create their IPAA. Most patients (74%) with IBD and an IPAA are delivering through C-section, and mainly to protect their J pouch, which is in line with reports in the literature. Most patients had a tear or episiotomy during vaginal delivery. Rates of third-degree tears may be higher than in the general population. Trends will be further elucidated with advancement of the study. Disclosure of Interest None Declared
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Affiliation(s)
- S C House
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - P Tandon
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | | | - C Maxwell
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - E Kennedy
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - J Snelgrove
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - A DeBuck
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - M Brar
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
| | - V Huang
- University of Toronto,Mount Sinai Hospital, Toronto, Canada
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Tandon P, Huang V, Feig D, Sakin R, Maxwell C, Gao Y, Fell D, Seow C, Snelgrove J, Nguyen GC. A214 WOMEN WITH INFLAMMATORY BOWEL DISEASE HAVE INCREASED HEALTH-CARE UTILIZATION DURING PREGNANCY AND POSTPARTUM COMPARED TO THOSE WITHOUT INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991121 DOI: 10.1093/jcag/gwac036.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Compared to those without inflammatory bowel disease (IBD), women with IBD may have increased health-care utilization during pregnancy and postpartum. This may lead to significant morbidity and decrease in quality of life. Characterizing this health-care use is important for health-policy purposes to determine methods to shift care to the ambulatory setting. Purpose We aimed to compare health-care utilization of women with and without IBD during preconception, pregnancy and postpartum. Method We accessed administrative databases and validated algorithms at the Institute of Clinical Evaluative Services (ICES) in Ontario to identify women (age 18-55) with and without IBD who had a completed live, singleton pregnancy between 2003 and 2018. The primary outcome was to characterize differences in emergency department (ED) visits and hospitalizations between women with and without IBD during the 12 months preconception, pregnancy, and in the 12 months postpartum. The secondary outcome was to assess differences in prenatal care between women with and without IBD. Multivariable negative binomial regression with generalizing estimating equations, accounting for multiple pregnancies for each patient, was performed to report incidence rate ratios (IRR) with 95% confidence intervals (95% CI). Covariates included maternal age at conception, location of residence at conception (rural vs. urban), socioeconomic status (using surrogate marker of neighborhood income quintile), and maternal comorbidity. Result(s) 9158 pregnancies in 6163 women with IBD and 1,729,411 pregnancies in 1,091,013 women without IBD were included. Women with IBD were older at time of delivery and had greater pre-pregnancy comorbidities. During pregnancy, women with IBD were more likely to visit the ED (IRR 1.13, 95% CI,1.08-1.18) and be hospitalized (IRR 1.11, 95% CI,1.01-1.21) for non-IBD specific reasons. Similarly, during postpartum, women with IBD were more likely to visit the ED (IRR 1.21, 95% CI, 1.15-1.27) and be hospitalized (IRR 1.18, 95% CI, 1.05-1.32) for non-IBD specific reasons. Venous thromboembolic events accounted for 7.0% of all postpartum hospitalizations in women with IBD compared to 2.7% in those without IBD (p<0.0001). There was no difference in ED visits and hospitalizations between women with and without IBD in preconception. Finally, women with IBD had greater number of prenatal visits with obstetricians during pregnancy and were more likely to receive a first trimester prenatal visit compared to those without IBD. Conclusion(s) Compared to those without IBD, women with IBD are more likely to visit the ED and be hospitalized during pregnancy and postpartum, particularly for venous thromboembolic events. Efforts should be made from a health policy perspective to increase access to ambulatory care for patients with IBD during the peripartum period which in turn may reduce acute setting health-services utilization. Please acknowledge all funding agencies by checking the applicable boxes below CCC Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | | | | | | | | | - C Seow
- University of Calgary, Calgary, Canada
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Patel K, Eissa M, Nguyen VV, Abraldes JG, Shaheen AA, Theal J, Johnson E, Hyde A, Tandon P. A64 THE UPTAKE AND IMPACT OF AN ELECTRONIC CIRRHOSIS ADMISSION ORDER SET: AN EARLY EXPERIENCE AT A SINGLE CENTRE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991358 DOI: 10.1093/jcag/gwac036.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Cirrhosis is a chronic disease that confers high morbidity and mortality. It is a leading cause for hospital admissions and leads to significant healthcare resource utilization. Several guidelines outline recommendations to provide best practice to hospitalized patients with cirrhosis. Despite studies supporting a reduction in mortality when guideline based care is followed, this is achieved in less than 50% of hospitalized patients with cirrhosis1. Standardized electronic order sets can be a potential tool to improving clinical outcomes and bridging this gap in care. Purpose Since March 2021, an electronic cirrhosis admission order set has been available for at our hospital site. Using administrative data, we aimed to describe our early experience with: a) order set uptake by various services, b) characteristics of the population in which the order set was used versus not used, and explore c) the impact of order set use on in-hospital mortality. Method In this single centre cohort study, patients with cirrhosis were identified based an administrative data algorithm containing codes for cirrhosis and complications. This data was used to retrieve parameters such as patient age, sex, primary admitting service, resource intensity weight (RIW), Charlson comorbidity index (CCI) and in-hospital mortality. The chi-squared test and independent samples t-test were used to compare characteristics of patients in whom the order set was used versus not used. Multivariable logistic regression was used to determine the impact of order set use on in-hospital mortality. P value significance was established at <0.05. Result(s) A total of 825 patients were included in the analysis. The overall mean age (standard deviation) of patients was 58.5 (14.2) years with 57.5% being male. Average length of stay was 11.3 days with a mean CCI of 3.2 (2.3) and RIW of 3.3 (7.2). The primary admitting service was Gastroenterology in 36.1%, Internal Medicine in 35.6% and other services in 28.3% of cases. Of those admitted, the order set was used in 27.2% of cases. The overall in-hospital mortality of patients was 14.2%. Mean age, sex and CCI were not significantly different in patients admitted with the order set versus without. In patients admitted with the order set compared to without, RIW was significantly lower (2.06 (2.62) versus 3.80 (8.2), p<0.001), as was length of stay (9.5 (11.8) days compared to 12.0 (18.6) days, p =0.03) and in-hospital mortality (8.5% versus 16.3%, p =0.003). On multivariable regression analysis (Table 1), after adjustment for age, RIW and CCI, use of the order set was associated with lower in-hospital mortality (odds ratio 0.53 (95% CI 0.3 to 0.9), p=0.02). Image ![]()
Conclusion(s) Uptake of the electronic cirrhosis admission order set was modest at only 27% of eligible admissions. Although it appears to be associated with lower in-hospital mortality, a chart review is in process to assess if this association still holds after accounting for the impact of additional confounders. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- K Patel
- Department of Medicine, Division of Gastroenterology
| | - M Eissa
- Department of Medicine, University of Alberta, Edmonton
| | - V V Nguyen
- Department of Medicine, University of Alberta, Edmonton
| | - J G Abraldes
- Department of Medicine, Division of Gastroenterology
| | - A -A Shaheen
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - J Theal
- Department of Medicine, Division of Gastroenterology
| | - E Johnson
- Department of Medicine, Division of Gastroenterology
| | - A Hyde
- Department of Medicine, Division of Gastroenterology
| | - P Tandon
- Department of Medicine, Division of Gastroenterology
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Wu RY, Tandon P, Ambrosio L, Dunsmore G, Wang G, Hotte N, Dieleman LA, Elahi S, Madsen K, Huang V. A175 DISEASE ACTIVITY IN FIRST TRIMESTER IS ASSOCIATED WITH REDUCED GROWTH IN INFANTS BORN TO WOMEN WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859139 DOI: 10.1093/jcag/gwab049.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Ulcerative colitis (UC) and Crohn’s disease (CD) are chronic inflammatory bowel diseases (IBD) that affect a significant portion of women in childbearing years. It is known that disease activity in early pregnancy negatively impacts obstetrical and perinatal outcomes, but the impact on infant growth is largely unknown. Aims The objective of this study was to compare the growth of infants born to women with active IBD during pregnancy versus those born to women with IBD in remission during pregnancy. Methods We conducted a prospective cohort study in a Canadian tertiary centre comprised of 98 pregnant women with IBD (63 with UC and 35 with CD) and 13 healthy pregnant women. We collected maternal demographic at trimester 1 and assessed disease activity at each trimester using clinical disease scores and fecal calprotectin. We then collected perinatal outcomes at delivery and followed the infants’ growth and feeding habits up to 12 months of age. Results A total of 103 mother-infant pairs were included in the study, of which 88 infants were born to women with IBD, and 15 born to women with active disease at trimester 1. Active disease at trimester 1 was associated with more adverse obstetrical outcomes, reduced 1-minute and 5-minute APGAR scores and more frequent NICU admissions. Infants born to women with active trimester 1 disease had reduced weight-for-age and length-for-age Z scores up to 6 months of age, in the absence of difference in feeding patterns. In addition, women with active disease at trimester 1 had increased expression of IL-8 and IFN-γ compared to those with trimester 1 remission. Conclusions Active IBD during first trimester is correlated with decreased infant weight and height up to 6 months of age, suggesting that strict disease control during first trimester, or even preconception, is essential for optimizing infant growth and perinatal outcomes. ![]()
Funding Agencies None
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Affiliation(s)
- R Y Wu
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - P Tandon
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - G Dunsmore
- University of Alberta, Edmonton, AB, Canada
| | - G Wang
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - N Hotte
- University of Alberta, Edmonton, AB, Canada
| | | | - S Elahi
- University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
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Hyde A, Johnson E, Bray C, Meier T, Carbonneau M, Spiers J, Tandon P. A88 UNDERSTANDING NURSE PERCEPTIONS OF CARING FOR PATIENTS WITH ALCOHOL USE DISORDER: A CROSS-SECTIONAL STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859295 DOI: 10.1093/jcag/gwab049.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Alcohol Use Disorder (AUD), the problematic consumption of alcohol, affects 107 million people worldwide. AUD increases morbidity and mortality and has a substantial impact on daily functioning including quality of life, relationships and employment. AUD is particularly detrimental in patients who already have liver damage like cirrhosis. The management of AUD includes screening, brief intervention and referral to treatment for psychological and pharmacotherapy based treatment. People with AUD have frequent interactions with the healthcare system. These interactions represent opportunities to engage patients with therapy. As front-line workers who have maximal contact with patients, nurses practicing in acute care are in an ideal position to initiate AUD related discussion with patients. Prior to the design of an educational intervention to increase nursing engagement with AUD screening and brief intervention, there is a need to understand baseline knowledge, attitudes and perceptions in this group. Aims The aim of the present study was to explore the knowledge, attitudes and perceptions of nurses caring for patients with cirrhosis and AUD. Methods We conducted a cross-sectional survey using the Survey of Attitudes and Perceptions (SAP). The SAP is derived from a validated tool to assess attitudes and perceptions towards patients with AUD. Anonymous surveys were distributed on inpatient medicine units across 5 geographic zones in Alberta between September 2019-March 2020. Data were analyzed using descriptive and inferential statistics. Results A total of 93 nurses from 7 inpatient medicine units across Alberta participated in the study. The majority of participants were Registered Nurses (74.9%), who practiced in an urban setting (69%), and had worked in their role for an average of 9.9 years. Few (22.6%) participants reported any prior structured education on caring for patients with AUD, with the majority reporting limited knowledge of alcohol and effects of alcohol consumption. Though most reported that caring for patients with AUD was part of their professional role, only 15.7% felt motivated to work with this group of patients. Responses to individual questions or sub-domains of the survey did not significantly differ by length or time in professional role, or practice setting. Conclusions Our results indicate that nurses have limited knowledge on caring for patients with AUD. Given the importance of AUD in the development and progression of cirrhosis as well as the frequency of hospitalizations for patients with cirrhosis, increasing nurse knowledge of AUD is crucial to improving the quality of care for these patients. The results of this study will be used to inform the development of an educational intervention to increase nursing knowledge of caring for patients with cirrhosis and AUD. Funding Agencies Alberta Innovates
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Affiliation(s)
- A Hyde
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - E Johnson
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - C Bray
- University of Alberta Faculty of Nursing, Edmonton, AB, Canada
| | - T Meier
- University of Alberta Faculty of Nursing, Edmonton, AB, Canada
| | - M Carbonneau
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - J Spiers
- University of Alberta Faculty of Nursing, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
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Chiew BA, Raman M, Tandon P, Panaccione R, Taylor L. A73 CANADIAN INFLAMMATORY BOWEL DISEASE MOBILE APPS: CURRENT LANDSCAPE AND NEEDS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859374 DOI: 10.1093/jcag/gwab049.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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
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Affiliation(s)
- B A Chiew
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - M Raman
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - P Tandon
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - R Panaccione
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - L Taylor
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Tao JJ, Govardhanam V, Tandon P, Huang V. A178 BIOLOGIC THERAPY DURING PREGNANCY AS PER GUIDELINE RECOMMENDATIONS REDUCES ADVERSE PREGNANCY RELATED OUTCOMES. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859375 DOI: 10.1093/jcag/gwab049.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) disease activity during pregnancy is associated with adverse neonatal and pregnancy-related outcomes. Biologics are used to suppress disease activity but crosses the placenta in the third trimester. Conflicting studies and guidelines on the timing of biologic dosing in pregnancy persist as we try to balance the risk of disease flare and possible adverse drug effects. The American Gastroenterology Association (AGA) recommends timing the final dose according to the half-life and dosing regimen of each biologic agent.
Aims
To compare neonatal and pregnancy-related outcomes in early versus late dosing of biologics.
Methods
This was a single-center retrospective cohort study conducted at Mount Sinai Hospital from 2016–2021. We included patients with an established diagnosis of IBD before pregnancy who were at least 18 years of age at the time of conception. All patients must have been treated with an IBD-specific biologic agent and had a documented final dose during the pregnancy. The early group received their last biologic dose earlier than the AGA recommendations and the late group received it within the recommended interval. A patient was considered to have a flare based on the overall clinical impression of their gastroenterologist informed by reported symptoms, investigations (fecal calprotectin, endoscopy), and response to treatment. Neonatal and pregnancy-related outcomes were compared amongst the two groups using the student’s t-test (for continuous variables) and Fischer’s exact test (for categorical variables) using SPSS Version 27.
Results
Of 322 patients who had a completed pregnancy at Mount Sinai Hospital, 107 were included in this study. 67 (62.6%) were in the early and 40 (37.4%) were in the late groups. Baseline characteristics including age, comorbidities, IBD phenotype and disease activity were similar between the two groups. The late group had significantly later gestational ages (37.4 vs 38.7 weeks, p=0.006), higher 5-minute Apgar scores (8.7 vs. 9.0, p=0.042), fewer NICU admissions (25.4% vs 5.0%, p=0.036), and fewer IBD flares (28.3% vs 11.1%, p=0.039) in the 6-month post-partum period. There were no significant differences in the rates of premature birth, caesarian sections, infections, and congenital abnormalities. Results are displayed in figure 1.
Conclusions
Our study suggests that late dosing of biologics according to the AGA guidelines was associated with favourable outcomes. However, this is an unadjusted analysis based on retrospective data and findings should be confirmed in a prospective manner to account for confounders.
Funding Agencies
None
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Affiliation(s)
- J J Tao
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - V Govardhanam
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Division of Gastroenterology, Toronto, ON, Canada
| | - V Huang
- University of Toronto, Division of Gastroenterology, Toronto, ON, Canada
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Nguyen DM, Tandon P, Govardhanam V, Hanna Y, Tao JJ, Cepo J, Maxwell C, Huang V. A177 INADEQUATE OR EXCESSIVE GESTATIONAL WEIGHT GAIN IN INFLAMMATORY BOWEL DISEASE AND IMPACT ON PREGNANCY AND NEONATAL OUTCOMES. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) are at a risk of adverse pregnancy outcomes. Prior studies have suggested that inadequate gestational weight gain is associated with preterm birth and intrauterine growth restriction.
Aims
We sought to characterize the proportion of people with IBD who gain inadequate or excessive weight during pregnancy and how this affects pregnancy and neonatal outcomes.
Methods
Pregnant patients with ulcerative colitis (UC), Crohn’s disease (CD), and inflammatory bowel disease unclassified (IBD-U) were identified retrospectively at Mount Sinai Hospital from 2016 to 2020. Total gestational weight gain (GWG) was calculated as the difference of the weight recorded at time of labor and pre-pregnancy weight. GWG was categorized as inadequate GWG, adequate GWG, and excessive GWG based on the pre-pregnancy body-mass index and standards set by the U.S. Institute of Medicine. Neonatal-related outcomes were also recorded for each patient and included preterm delivery, small for gestational age (SGA) and large for gestational age (LGA). Multiple logistic regression was used to assess the association between gestational weight gain and outcomes while controlling for maternal age, history of gestational diabetes, and preconception disease activity.
Results
225 pregnancies were included (106 UC, 115 CD, 4 IBD-U). Forty-eight patients (21.3%) had inadequate, 91 (40.4%) adequate, and 86 (38.2%) excessive GWG. People of East Asian, African, and Hispanic ethnicity were more likely to have inadequate GWG. People with inadequate GWG were more likely than those with excessive GWG to have lower preconception BMI (21.7 vs 25.5 kg/m2, P=0.001). IBD type was not associated with inadequate GWG or excessive GWG, though people with inadequate GWG were 2-fold less likely to be on anti-TNF therapy. People with excessive GWG were more likely than those with adequate GWG to have babies with higher birth weight (3,364g vs 3,132g, P=0.003). People with inadequate GWG were not at increased risk of SGA compared to those with adequate GWG (adjusted odds ratio (aOR), 1.01; 95% CI: 0.37 – 2.71, P=0.99). Those with excessive GWG were substantially less likely to have an infant with SGA (aOR, 0.23; 95% CI: 0.07 – 0.72, P=0.01). On multivariable logistic regression analysis, excessive GWG was not associated with increased odds of delivering infants with LGA (aOR, 1.46; 95% CI: 0.54 – 3.95, P=0.46). There was no association between non-adequate gestational weight gain and preterm delivery or Caesarean delivery.
Conclusions
Less than half of persons with IBD have adequate GWG during pregnancy. Inadequate GWG was not associated with poor neonatal outcomes, and excessive GWG appeared to protect against delivering infants born SGA.
Funding Agencies
None
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Affiliation(s)
- D M Nguyen
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - V Govardhanam
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - Y Hanna
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - J J Tao
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - J Cepo
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - V Huang
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, ON, Canada
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10
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Johnson E, Ghosh SM, Daniels VJ, Wild TC, Tandon P, Hyde A. A78 “CHALLENGING PERSPECTIVES:” UNDERSTANDING CLINICIANS VIEWS ON MANAGING ALCOHOL USE DISORDER AND CIRRHOSIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859214 DOI: 10.1093/jcag/gwab049.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of anti-relapse pharmacotherapies. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. Aims The aim of this project is to summarize these findings to inform the development of an educational intervention. Methods We used a qualitative descriptive approach to explore the experiences of clinicians who provide care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified three themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, and (iii) Acknowledging the complexity of patients who have cirrhosis and AUD. Conclusions This research presents the perspectives of clinicians who manage people who have AUD and cirrhosis. Our results indicate that significant barriers exist that affect how clinicians manage AUD in the context of cirrhosis, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered in this investigation will be used to develop an accredited educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population. Funding Agencies Alberta Innovates Health Solutions
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Affiliation(s)
- E Johnson
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - S M Ghosh
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - V J Daniels
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - T C Wild
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | - A Hyde
- Medicine/Gastroenterology, University of Alberta, Edmonton, AB, Canada
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11
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Tandon P, O’Connor K, Steinhart H, Deshpande A, Maxwell C, Huang V. A174 PERCEPTIONS OF CANNABIS USE IN WOMEN WITH INFLAMMATORY BOWEL DISEASE OF REPRODUCTIVE AGE: A CROSS-SECTIONAL STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859278 DOI: 10.1093/jcag/gwab049.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cannabis use in inflammatory bowel disease (IBD) may lead to improvement in pain and general health perception. However, its use during pregnancy may result in adverse outcomes such as preterm birth and altered fetal brain development. It remains unknown how women with IBD perceive Cannabis use during pregnancy and whether they discuss its use with their health-care providers.
Aims
To determine practices in, and perceptions of, cannabis use during pregnancy in women with IBD of reproductive age.
Methods
Women with IBD (age 18–45) were recruited at Mount Sinai Hospital and via social media platforms. Participants anonymously completed surveys on baseline demographics and IBD characteristics. They also completed a Cannabis questionnaire which asked about current use, perceived risks during pregnancy, and discussions with health-care providers. Categorical variables were reported as frequencies and compared using the chi-square test. Continuous variables were reported as medians and compared using the Mann-Whitney U test.
Results
Sixty-four women were included, 26 (40.6%) with ulcerative colitis, 37 (57.8%) with Crohn’s disease, and 1 (1.6%) with indeterminate colitis. Nineteen (29.7%) were preconception, 40 (62.5%) were pregnant, and 5 (7.8%) were post-partum. Eleven (18.0%) patients reported current Cannabis use, 4 (6.3%) during pregnancy. Cannabis users were more likely to have discussed its use with a health-care provider compared to non-users (45.5% vs. 5.7%, p<0.001) and had longer IBD duration (12.00 vs. 9.00 years, p=0.05). Twenty-five (42.4%) were unsure of the risks of Cannabis use in pregnancy, of which only two had discussed this with a health-care provider. Reasons for fear of Cannabis use included risk of fetal oxygen restriction (n=13, 20.3%), impact on brain development (n=29, 46.0%), and risk of fetal respiratory issues (n=18, 28.6%). Only eight (12.5%) patients reported having a conversation about Cannabis use during pregnancy with their health-care provider; all of whom felt its consumption was unsafe during pregnancy.
Conclusions
Many women with IBD report being unsure of risks of Cannabis use during pregnancy. With the legalization of Cannabis in Canada, it is imperative patients and health-care providers discuss the risks and benefits of its use, particularly during vulnerable times such as pregnancy.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - K O’Connor
- University of Toronto, Woodbridge, ON, Canada
| | - H Steinhart
- University of Toronto, Woodbridge, ON, Canada
| | - A Deshpande
- University of Toronto, Woodbridge, ON, Canada
| | - C Maxwell
- University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- University of Toronto, Woodbridge, ON, Canada
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12
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Johnson E, Ghosh SM, Daniels VJ, Tandon P. A87 CHANGES IN CLINICIAN KNOWLEDGE, COMFORT, PREPAREDNESS, AND ATTITUDES ABOUT ALCOHOL USE DISORDER AND CIRRHOSIS AFTER A BRIEF EDUCATIONAL INTERVENTION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859286 DOI: 10.1093/jcag/gwab049.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Alcohol use disorder (AUD) is increasing in prevalence and has a substantial impact on morbidity and mortality in people with cirrhosis. The use of screening, brief intervention and referral to treatment (SBIRT) and relapse prevention medications (e.g. acamprosate) are recommended by recent guidelines. Unfortunately, many clinicians report insufficient training to feel confident using these interventions
Aims
We aimed to compare the effect of a brief educational intervention on AUD knowledge, comfort, attitudes, and preparedness in clinicians who provide care to patients with cirrhosis.
Methods
Clinicians were invited to participate in a 1.5-hour educational session conducted by a hepatologist and addiction medicine specialist. The session included information about SBIRT and pharmacotherapy. Pre-training knowledge, comfort, and practice behaviors were assessed using previously published questions. Baseline attitudes were measured using the Short Alcohol and Alcohol Problems Perception Questionnaire. Participants were invited to repeat the questionnaires immediately post-training and statistical analysis conducted.
Results
Eighty-two clinicians attended the session. Among the 38 attendees who completed both the pre- and post-questionnaires, 34% were GIs/internists, 45% were family medicine physicians, and the remainder (21%) did not specify or were not prescribers. Scores for self-reported intention and preparedness to treat AUD, comfort, and knowledge improved significantly from the pre-training phase. Attitudes also improved from the pre-training phase, with significant improvements in the SAAPPQ subscales of role adequacy (p=0.03) and motivation (p=0.04).
Conclusions
Recognizing the small sample size, a brief educational session demonstrated promising results in the promotion of knowledge, attitudes, preparedness, and comfort for clinicians managing AUD in patients with cirrhosis. Feedback from these sessions will be used to design an accredited educational series for roll-out in 2022.
Funding Agencies
Alberta Innovates Health Solutions
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Affiliation(s)
- E Johnson
- 1. Medicine, University of Alberta, Edmonton, AB, Canada
| | - S M Ghosh
- 1. Medicine, University of Alberta, Edmonton, AB, Canada
| | - V J Daniels
- 1. Medicine, University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- 2. University of Alberta, Edmonton, AB, Canada
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13
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Govardhanam V, Tandon P, Jogendran R, Huang V. A76 MEDICATION ADHERENCE AND BELIEFS ABOUT MEDICATION AND THE CORRELATION WITH KNOWLEDGE ABOUT INFLAMMATORY BOWEL DISEASE (IBD) IN PREGNANCY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859191 DOI: 10.1093/jcag/gwab049.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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<0.05). Median Trimester MARS data had a strong positive correlation with CPPKnow scores (Correlation Co-efficient 0.644, p<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
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Affiliation(s)
- V Govardhanam
- University of Toronto Faculty of Medicine, Brampton, ON, Canada
| | - P Tandon
- University of Toronto Faculty of Medicine, Brampton, ON, Canada
| | - R Jogendran
- University of Toronto Faculty of Medicine, Brampton, ON, Canada
| | - V Huang
- University of Toronto Faculty of Medicine, Brampton, ON, Canada
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14
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Nguyen VV, Wang S, Whitlock R, Xu C, Taneja S, Singh S, Abraldes J, Burak K, Bailey R, Lai J, Tandon P. A223 THE CHAIR STAND TEST IS A RELIABLE FRAILTY METRIC FOR PREDICTING WAITLIST MORBIDITY AND MORTALITY IN PATIENTS WITH CIRRHOSIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859355 DOI: 10.1093/jcag/gwab049.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Frailty is defined as a clinical state of increased vulnerability to health and age associated stressors. The liver frailty index (LFI), composed of grip strength, chair stand and balance testing, is an accepted predictor of morbidity and mortality in cirrhosis. With the need for COVID-19 related social distancing, many appointments are being carried out virtually. The chair stand subcomponent of the LFI has the potential to be evaluated virtually, with a high reliability as compared to in-person testing noted in other disease populations. Aims To determine if the chair stand test is an independent predictor of morbidity and mortality in patients with cirrhosis. Methods 822 adult patients with cirrhosis were prospectively enrolled from five centers (3 in Canada, 1 in the United States, and 1 in India). Inclusion criteria included adult patients with cirrhosis. 787 of these patients completed a chair stand test at baseline, measured as the time (seconds) a patient takes to rise from sitting with their arms folded across their chest five times (measured in-person). The times were divided into 3 categories: >15 seconds, between 10 and 15 seconds, and <10 seconds. Patients who could not complete 5 chair stands were classified in the >15 seconds category. Primary outcome was all-cause mortality. Secondary outcome was unplanned all-cause hospital admission. Fine-Gray proportional hazard regression models were used to evaluate the association between the chair stand time and the outcomes. We adjusted for baseline age, sex, and MELD score and accounted for liver transplantation as a competing risk. Cumulative incidence functions were used to create a graphical representation of the survival analysis. Results Patients were divided into three groups: group 1, <10 seconds (n = 276); group 2, 10–15 seconds (n = 290); and group 3, >15 seconds (n = 221). Mortality was increased in group 3 in comparison to group 1 (HR 3.21, 95% CI: 2.16–4.78, p<0.001). Similarly, the hazard of non-elective hospitalizations was higher in group 3 in comparison to group 1 (HR 2.24, 95% CI: 1.73–2.91, p<0.001). Overall, patients with chair stand times greater than 15 seconds had increased all-cause mortality (HR 2.78, 95% CI 2.01–3.83, p<0.001) and non-elective hospitalizations (HR 1.84, 95% CI 1.48–2.29, p<0.001) when compared to patients with times less than 15 seconds. Conclusions A time to complete 5 chair stands of >15 seconds predicts morbidity and mortality in patients with cirrhosis. This test shows promise as a frailty measure that could be evaluated over a virtual platform. ![]()
Funding Agencies None
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Affiliation(s)
- V V Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - S Wang
- Gastroenterology, University of Alberta, Edmonton, SK, Canada
| | - R Whitlock
- Chronic Disease Intervention Centre, Winnipeg, MB, Canada
| | - C Xu
- Department of Medicine, San Francisco, CA
| | - S Taneja
- Department of Hepatology, Chandigarh, India
| | - S Singh
- Department of Hepatology, Chandigarh, India
| | - J Abraldes
- University of Alberta, Edmonton, AB, Canada
| | - K Burak
- Liver Unit, Division of Gastroenterology and Hepatology, Calgary, AB, Canada
| | - R Bailey
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - J Lai
- Division of Gastroenterology and Hepatology, San Francisco, CA
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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15
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Tao JJ, Tandon P, Huang VW. A151 COMPARABLE NEONATAL AND PREGNANCY-RELATED OUTCOMES BETWEEN EARLY AND LATE DISCONTINUATION OF BIOLOGICS IN PREGNANT WOMEN WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) disease activity during pregnancy is related to adverse neonatal and pregnancy-related outcomes. Biologics are used to suppress disease activity, however, since there is known transplacental passage, the American Gastroenterology Association (AGA) recommends timing the final dose with drug-specific half-lives although there is little evidence demonstrating adverse outcomes.
Aims
We aim to assess the safety of early versus late discontinuation of biologics according to drug-specific half-lives by comparing various neonatal and pregnancy-related outcomes.
Methods
This is a REB approved single-center retrospective cohort study on all patients with IBD ≥18 years of age on a biologic agent prior to conception, have a documented final dose during pregnancy, and were seen at Mount Sinai Hospital from 2016–2019. Neonate and pregnancy-related outcomes were compared amongst the two groups (Table 1) using the student’s t-test (birthweight, gestational age, Apgar scores) and Fischer’s exact test (NICU admission, congenital anomalies, GBS, chorioamnionitis) analyzed in SPSS Version 27. The level of significance was set at p<0.05.
Results
We identified 53 patients on biologics pre-conception. 26 patients had a documented final dose (19 early cohort, 7 late cohort) and were included in the analysis. Aside from mean birthweight (3014 vs 3561 g, p=0.036), there were no statistically significant differences between the early and late cohorts for gestational age (37.4 vs 39.0 weeks, p=0.20), 1- and 5-min Apgar scores (7.8 vs 8.8, p=0.37 and 8.5 vs 9.0, p=0.49), NICU admissions (p=0.54), congenital anomalies (p=1.00), GBS (p=0.55), and chorioamnionitis (p=1.00).
Conclusions
Overall, our study suggests that early and late discontinuation of biologics have comparable safety profiles based on various neonatal and pregnancy-related outcomes. In fact, we see significantly higher birthweights in the late cohort along with a consistent (non-statistically significant) trend of later gestational ages, and higher Apgar scores. Further, no cases involving NICU admissions, congenital abnormalities, GBS, or chorioamnionitis were seen in the late cohort. Next, we hope to verify our findings by conducting a prospective cohort study with a larger study population and more comprehensive data collection. This will provide higher statistical power and allow for additional subgroup analyses based on objective disease activity (FCP levels) and therapeutic drug monitoring (serum drug levels).
Funding Agencies
None
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Affiliation(s)
- J J Tao
- University of Toronto Department of Medicine, Toronto, ON, Canada
| | - P Tandon
- University of Toronto Division of Gastroenterology, Toronto, ON, Canada
| | - V W Huang
- University of Toronto Division of Gastroenterology, Toronto, ON, Canada
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16
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Tandon P, O’Connor K, Maxwell C, Nguyen GC, Huang VW. A176 THE IMPACT OF COVID-19 ON ANXIETY, DEPRESSION, AND STRESS IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: A CROSS-SECTIONAL SURVEY. J Can Assoc Gastroenterol 2021. [PMCID: PMC7958723 DOI: 10.1093/jcag/gwab002.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Women with inflammatory bowel disease (IBD) are at an increased risk of mental-health illness and reduced fertility.
Aims
To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental-health and pregnancy plans of women with IBD.
Methods
Women with IBD (age 18–45) were asked to anonymously complete surveys on baseline demographics, IBD characteristics, and mental health comorbidities. They were also asked to comment on prior symptoms consistent with COVID-19 and whether they were tested for the virus. Finally, patients were asked to complete three mental health surveys to reflect on anxiety (Generalized Anxiety Disorder-7 (GAD7)), depression (Patient Health Questionnaire-9 (PHQ9)), and stress (Perceived Stress Scale (PSS)) symptoms prior to and during the pandemic. Total scores were reported as continuous variables and means with standard deviations (SD) were compared using paired T-tests.
Results
Twenty-nine patients (12 UC, 17 CD) were included. 14 patients were preconception, 12 were pregnant, and 3 were post-partum. The mean age was 31.4 (SD 3.7). Fifteen of 29 (51.7%) of patients were on anti-tumor necrosis factor therapy. Twelve (41.4%) and 6 (20.7%) patients had pre-morbid anxiety and depression prior to the pandemic. COVID-19 symptoms were reported in 8 patients (27.5%). Six patients had undergone COVID-19 testing, all of whom had a negative test. Four patients indicated that COVID-19 had negatively affected their plans for pregnancy, with reasons reported including fear of the hospital (n=1), fear of COVID-19 impact on the fetus (n=2), and uncertainty on the duration of COVID-19 (n=1). During the pandemic, fourteen of 28 (50%) patients experienced symptoms of anxiety (GAD score > 5), with a majority (70%) experiencing mild symptoms (score 5–9). During the pandemic, 60.7% (17/28) and 71.4% (20/28) reported symptoms of depression (PHQ9 > 4) and at least moderate stress (PSS > 14) respectively. Furthermore, compared to pre-pandemic, 57.1% (16/28) and 67.9% (19/28) had an increase in depression and stress symptoms during the pandemic respectively. This appeared to only apply to those with CD, but not UC (Table 1). Compared to pre-pandemic, those with stricturing CD appeared to have higher stress scores whereas those with fistulizing and perianal disease appeared to have higher depression scores during the COVID-19 pandemic (Table 1). A lower house-hold income and a reduction in exercise during the COVID-19 pandemic appeared to increase the risk of stress, depression, and anxiety symptoms.
Conclusions
Over half of women with IBD indicate worsening of anxiety, depression, and stress symptoms during the COVID-19 pandemic. It remains critical that health-care professionals address these mental health concerns during these otherwise difficult times.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - K O’Connor
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - G C Nguyen
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - V W Huang
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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17
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Watt M, Hyde A, Madsen K, Peerani F, Tandon P. A169 EXPLORING PATIENT PERSPECTIVES ON AN ONLINE STRESS REDUCTION BASED WELLNESS INTERVENTION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD). J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite strong connections between stress and inflammatory bowel disease (IBD) associated symptoms, there has been limited research on stress reduction interventions for patients with IBD. Moreover, the research that has been conducted on this topic has shown mixed results with very few studies having used qualitative methodology to explore the patient experience.
Aims
Our objectives for this study were to explore: (i) the experience of having IBD, (ii) the influence of an online 12-week stress reduction program on participant’s physical and emotional symptoms of IBD and (iii) the acceptability of the online program.
Methods
We used a qualitative descriptive approach embedded within a larger randomised control trial (RCT) to explore the experiences of participants. Upon completion of the program, participants were invited to participate in semi-structured interviews. Interviews were analysed through an inductive process whereby transcripts were coded, with codes grouped into larger categories and then themes. Data collection and analysis occurred in a concurrent and iterative manner to enable refinement of interview questions and reflections on the research process.
Results
We analysed a total of 55 interviews. Three main themes emerged from the data: (i) IBD as a source of stress and uncertainty, (ii) understanding the positive impacts of the stress reduction program, and (iii) enhancing program desirability. Participants reported a reduction in IBD symptom burden with improvements in their ability to manage everyday and disease-associated stressors, while building a positive mindset. Weekly check-ins with program facilitators enabled participants to build routine, enhancing accountability. Variation in program content and fostering connections with others in the IBD community were identified as potential program improvements.
Conclusions
Our findings highlight the debilitating nature of IBD, with participants reporting significant disruptions to daily activities, uncertainty, and stress which served to worsen symptoms. Stress reduction programs like the one explored in our study offer an accessible avenue for reducing perceived stress, enhancing resilience and improving the physical condition of individuals diagnosed with IBD. Future research should explore the application of online stress reduction programs in patients experiencing other gastrointestinal disease.
Funding Agencies
CIHRUniversity Hospital Foundation, American College of Gastroenterology, CIHR IMAGINE grant
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Affiliation(s)
- M Watt
- University of Alberta, Edmonton, AB, Canada
| | - A Hyde
- University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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18
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Wang S, Xu C, Whitlock R, Taneja S, Singh S, Abraldes J, Lai J, Tandon P. A223 FRAILTY INCREASES THE RISK OF CIRRHOSIS DISEASE PROGRESSION, DEATH, AND HOSPITALIZATION IN CIRRHOSIS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In cirrhosis, frailty is associated with increased risk of morbidity and mortality, including an increased risk of hospitalization. While frailty is established as a prognostic marker in cirrhosis, its impact on the progression of cirrhosis, especially in earlier stages of disease, remains unclear.
Aims
To determine the relationship between frailty and risk of cirrhosis progression, mortality, and unplanned hospitalizations in patients with cirrhosis across the spectrum of disease.
Methods
Adult patients with cirrhosis from two centers in North America and one in India were included in this retrospective review of prospectively collected data. Frailty was measured at baseline using the Liver Frailty Index (LFI), comprising grip strength, chair stands, and balance testing. Progression of cirrhosis was defined by an increase from one ordinal stage to the next using the D’Amico classification. Factors associated with progression, mortality, and hospitalizations were evaluated using multivariate competing risk regression models, with transplant as a competing risk.
Results
In total, 822 patients with cirrhosis were included. The median MELD score was 15.5 ± 6.0. Of these patients, 201 (24.5%), 488 (59.4%), and 133 (16.2%) were classified as frail, pre-frail, and robust, respectively. Over a median follow up time of 1.2 years, 60 (7.3%) patients developed progression of cirrhosis, 187 (22.7%) died, 233 (28.3%) underwent liver transplantation, and 342 (41.6%) were alive without cirrhosis progression or transplant. Adjusting for age, sex, and MELD at baseline, being frail was associated with an increased risk of progression to the next cirrhosis stage or to death as compared to being robust (HR 2.47, 95% CI 1.63–3.76, p<0.001). As a continuous variable, every increase in the LFI by 0.1 unit increased the risk of decompensation or death by 1.05-fold (95% CI 1.04–1.07, p<0.001). Similarly, patients who were frail were more likely to be hospitalized as compared to patients who were robust (HR 2.88, 95% CI 2.08–3.98, p<0.001).
Conclusions
Frailty was associated with an increased risk of cirrhosis progression or death, and hospitalization, independent of MELD at baseline. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing frailty.
Funding Agencies
None
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Affiliation(s)
- S Wang
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - C Xu
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - R Whitlock
- Chronic Disease Innovation Centre, Winnipeg, MB, Canada
| | - S Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - S Singh
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - J Abraldes
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - J Lai
- Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA
| | - P Tandon
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada
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19
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Hanna Y, Tandon P, Huang VW. A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established.
Aims
To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention.
Methods
All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin > 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant.
Results
127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception.
Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005).
13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830).
Conclusions
Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding.
Funding Agencies
None
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Affiliation(s)
- Y Hanna
- University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Toronto, ON, Canada
| | - V W Huang
- University of Toronto, Toronto, ON, Canada
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20
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Tandon P, Hanna Y, Cepo J, Maxwell C, Huang VW. A180 RISK FACTORS FOR INADEQUATE GESTATIONAL WEIGHT GAIN IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with inflammatory bowel disease (IBD) are at a risk of inadequate gestational weight-gain (GWG) which in turn may increase the risk of adverse pregnancy outcomes.
Aims
To determine the risk factors for inadequate GWG in these patients and to determine the impact on adverse pregnancy outcomes.
Methods
Pregnant patients with IBD, both ulcerative colitis (UC) and Crohn’s disease (CD), were identified retrospectively at the Mount Sinai Hospital from 2016 to 2020. Total gestational weight-gain (GWG) was calculated as the difference of the weight recorded at time of labor and pre-pregnancy weight. GWG was further stratified into less than adequate, adequate, and more than adequate based on the pre-pregnancy body-mass index and standards set by the U.S. Institute of Medicine. Pregnancy-related outcomes were also recorded for each patient. Disease activity was recorded at each trimester visit and defined by a fecal calprotectin (FCP) > 250 ug/g. Differences in the mean GWG were compared using independent T-test with standard deviations (SD) whereas categorical variables were compared using the Chi-square (x2) test.
Results
71 pregnancies in 71 patients were included (33 UC and 38 CD). Thirteen patients (18.3%) had less than adequate, 23 (32.4%) adequate, and 35 (49.3%) more than adequate GWG. Of the 33 patients with UC, 4 (12.2%) had less than adequate, 15 (45.5%) had adequate, and 14 (42.4%) had more than adequate GWG. Of the 38 patients with CD, 9 (23.7%) had less than adequate, 8 (21.1%) had adequate, and 21 (55.3%) had more than adequate GWG (p=0.07) for CD vs. UC). In those with CD, both fistulizing and stricturing CD phenotypes appeared to be numerically associated with inadequate GWG. Specifically, none of the 13 patients with fistulizing CD had adequate GWG compared to 32.0% (8/25) in those without fistulizing disease (p=0.07). Similarly, only 2/22 (9.1%) of those with stricturing CD had adequate GWG compared to 6/16 (37.5%) in those without stricturing disease (p=0.07). Furthermore, of seven patients with active disease in the first trimester, only one had adequate GWG (14.3%) compared to 37.5% (3/8) of those in clinical remission (p=0.044). Active disease in trimesters two and three was not associated with inadequate GWG. Finally, the mean GWG was higher in those undergoing Cesarean (37.8 kg (SD 14.1) vs. 30.4 kg (SD 10.5), p=0.014)) and emergency Cesarean delivery (43.5 kg (SD 17.6) vs. 31.9 kg (SD 10.7) (p=0.004) compared to vaginal delivery respectively.
Conclusions
Patients with CD, but not UC, and those with active disease in the first trimester, are at risk of inadequate GWG during pregnancy. In those with larger GWG, a higher rate of emergency Cesarean birth was noted. Optimal intervention to achieve recommended gestational weight-gains in patients with IBD remains to be determined.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Y Hanna
- University of Toronto, Mississauga, ON, Canada
| | - J Cepo
- Registered Dietitian, Mount Sinai Hospital, Toronto, ON, Canada
| | - C Maxwell
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada, Toronto, ON, Canada
| | - V W Huang
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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21
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Govardhanam V, Tandon P, huang V. A181 CAUSES FOR C-SECTION IN IBD PATIENTS: A RETROSPECTIVE REVIEW. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions including ulcerative colitis (UC), Crohn’s disease (CD) or IBD-unclassified. Current expert guidelines recommend only two IBD-related reasons to consider C-section: perianal CD and ileal pouch-anal anastomosis (IPAA) history. However, the incidence of C section among IBD patients is higher than the non-IBD patients. There is a sparsity of literature on what other factors influence the decision to perform caesarean delivery among IBD patients.
Aims
To investigate IBD-related and non-IBD related reasons leading to C-section in IBD patients.
Methods
A retrospective chart review was performed on women with IBD, >18 years of age and/or older, who delivered at Mount Sinai Hospital, Toronto 2016–2019. OB records and OR records were reviewed to obtain information specific to C-section.
Results
A total of 119 deliveries were reviewed. 47 out of the 119 had C-section delivery. 42.9% (N=21) of C-section was in UC patients and 57.1% (N=28) was in CD patients. Maternal request comprised 2.1% (N=1) and arrest of cervical dilation 6.4% (N=3). 20.4% (N=10) patients failed vaginal delivery. Only 8.7% of C-section deliveries were Primiparous. 42.9% (N=12) of patients from the CD category that underwent C-section had fistulizing CD. 46.4% (N=13) of patients with CD had stricturing CD and underwent C-Section. 63.8% (N=30) of the patients that had C-section had planned C-Section. 26.6% (N=8) of the planned C-section was due to a history of the perianal disease and only 13.3% (N=4) had an active perianal disease. Other causes for planned C-section included J-pouch (10%, N=3) and active UC (2.1%, N=1). As per expert recommendation, we would anticipate 14% of patients to have C-section due to IBD related reasons however we found that 30% of the patients had C-section due to IBD related reasons.
Conclusions
Based on the preliminary data from our retrospective study we find that 30% of the C-sections were due to IBD related reasons and 70% C-sections were from non-IBD related reasons.
Funding Agencies
None
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Affiliation(s)
- V Govardhanam
- University of Toronto, St. Michael\’s Hospital, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - V huang
- University of Toronto, Woodbridge, ON, Canada
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22
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Chis R, Tandon P, Huang VW. A185 THE IMPACT OF PRIOR SURGERY ON ADVERSE PREGNANCY OUTCOMES IN PREGNANT PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
During the course of inflammatory bowel disease (IBD), approximately 20% of patients with ulcerative colitis (UC) and 80% of Crohn’s disease (CD) patients will require surgery. The most common operation is total proctocolectomy and ileoanal pouch anastomosis (IPAA) for UC patients and ileocecal (IC) resection for CD. In pregnant IBD patients, guidelines name the presence of IPAA as a relative indication for Cesarean section (C-section). The effect of prior IBD-related surgery on mode of delivery and pregnancy-related outcomes remains unknown.
Aims
To describe pregnancy-related outcomes in pregnant women with IBD who have undergone prior IBD-related surgery.
Methods
We performed a retrospective cohort study of pregnant women with IBD including those with prior IBD-related surgeries including IPAA, IC resection, total or partial colectomy and ileostomy formation who delivered an infant at our medical center from 2016 to 2020. We assessed the mode of delivery, delivery characteristics (emergency vs. planned C-section) and maternal and neonatal outcomes
Results
Fifty-six UC patients and 64 CD patients were included in the analysis, of which 10 and 24 had undergone prior IBD-related surgery, respectively. The mean age at conception was 34.10 years in the surgical UC group and 30.30 years in the surgical CD group.
Mode of delivery: C-section rates were higher in post-surgical compared to non-surgical UC patients (70% vs. 30.4%, p = 0.02). Similar numbers of C-sections were performed emergently in the surgical compared to non-surgical UC group (10% vs. 18%, p = 0.53). Comparatively, there was no significant difference in C-section rates in post -surgical compared to non-surgical CD mothers (50% vs. 40%, p = 0.44), with 13% performed emergently in both groups.
Maternal outcomes: Gestational diabetes developed in 10% of surgical UC and 4.5% of surgical CD patients. Premature rupture of membranes developed in 10% of surgical UC and 9.1% of surgical CD patients. There was no difference in pre-eclampsia rates in the surgical and non-surgical CD groups (9.1% vs 13.2%, p = 0.64).
Neonatal outcomes: There was no significant difference in pre-term birth rates in post-surgical compared to non-surgical UC mothers (10% vs. 15.2%, p = 0.67) or in surgical compared to non-surgical CD mothers (13.6% vs. 5.1%, p = 0.29). Neonatal Intensive Care Unit (NICU) requirements were higher in infants born to post-surgical CD compared to non-surgical CD mothers (18.2% vs. 2.7%, p = 0.04). More low birth weight (LBW) infants were born to post-surgical CD vs non-surgical CD mothers (13.6% vs. 0%, p = 0.02).
Conclusions
Women with IBD who have had prior IBD-related surgery may be at increased risk of developing adverse gestational and neonatal outcomes. Women with surgical UC have an increased incidence of Cesarean delivery.
Funding Agencies
None
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Affiliation(s)
- R Chis
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - V W Huang
- Gastroenterology, University of Toronto, Toronto, ON, Canada
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23
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Wang G, Rodriguez N, Ambrosio L, Tandon P, Huang VW. A168 HEALTH-RELATED QUALITY OF LIFE IN WOMEN WITH INFLAMMATORY BOWEL DISEASE: FROM PRECONCEPTION TO POSTPARTUM. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), impacts health-related quality of life (HRQoL). In pregnancy and postpartum, distinguishing IBD-specific symptoms is challenging. The extent to which pregnancy and disease activity affects HRQoL in IBD patients remains unknown.
Aims
To assess women with and without IBD at pre-, intra-, and postpartum timepoints, and examine the impact of pregnancy, IBD type, and disease activity on IBD-related HRQoL.
Methods
Preconception (PC) and pregnant women aged ≥18 years with and without IBD completed surveys at various timepoints from PC to 12 months postpartum (PP). The Short IBD Questionnaire (SIBDQ) is a validated survey that assesses HRQoL in IBD patients and covers bowel, emotional, systemic, and social domains; a higher score indicates a better HRQoL. Participants completed SIBDQ and modified Harvey Bradshaw Index (mHBI) for CD or partial Mayo score (pMayo) for UC. Clinically active disease was defined as mHBI ≥5 or pMayo ≥2; objectively active disease was defined as C-reactive protein (CRP) ≥8.0mg/L or fecal calprotectin (FC) ≥250mg/kg. Continuous variables were analyzed by the t-test whereas categorical variables were assessed by the chi-squared test, with p<0.05 suggestive of statistical significance.
Results
61 patients with IBD (36 UC, 25 CD) and 12 healthy controls were included. In IBD patients, SIBDQ was positively associated with income during PC, but not once patients became pregnant. No association was found with education level. There were no significant differences in mean SIBDQ between study timepoints. SIBDQ was significantly lower in IBD patients with clinically active disease at all trimesters of pregnancy and all PP timepoints, but not at PC. SIBDQ was significantly lower in patients with high CRP during trimester 1 (T1), but not later in pregnancy. Generally, SIBDQ was lower in patients with higher FC; SIBDQ bowel scores were significantly lower in patients with high FC at T2, T3, and PP6.
During PC, SIBDQ was significantly higher in UC patients than CD patients; this difference was lost in pregnancy. During PP, SIBDQ bowel and social scores were significantly lower in UC patients than CD patients at 6 months. Compared to healthy controls, IBD patients had significantly lower SIBDQ at PC, T1, and T2; they also had significantly lower SIBDQ bowel scores in early PP, which resolved by 12 months. In IBD patients, no association was found between PP SIBDQ scores and breastfeeding or delivery method.
Conclusions
Women with IBD experience worse HRQoL in early pregnancy, and worse bowel-related HRQoL postpartum. UC patients have better PC HRQoL but suffer worse postpartum bowel-related HRQoL than CD patients. Overall, SIBDQ correlates well with clinical and biochemical disease activity during pregnancy and postpartum.
Funding Agencies
Women and Children’s Health Research Institute (WCHRI), Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta Faculty of Medicine
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Affiliation(s)
- G Wang
- University of Toronto, Toronto, ON, Canada
| | | | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- Mount Sinai Hospital, Toronto, ON, Canada
| | - V W Huang
- Mount Sinai Hospital, Toronto, ON, Canada
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24
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Johnson E, Carbonneau M, Campbell-Scherer D, Tandon P, Hyde A. A75 IMPLEMENTING A CIRRHOSIS ORDER SET: A QUALITATIVE ANALYSIS OF PROVIDER-IDENTIFIED BARRIERS AND FACILITATORS. J Can Assoc Gastroenterol 2021. [PMCID: PMC7958751 DOI: 10.1093/jcag/gwab002.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Cirrhosis is the leading cause of mortality and morbidity in individuals with gastrointestinal disease. Multiple care gaps exist for hospitalized patients with cirrhosis, resulting in high rates of re-hospitalization (e.g. 44% at 90 days in Alberta). The Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial with an aim to reduce acute-care utilization by implementing an electronic order set and supporting education across eight hospital sites in Alberta. Aims As part of the pre-implementation evaluation, this qualitative study analyzed data from provider focus groups to identify barriers and facilitators to implementation. Methods We conducted focus groups at eight hospital sites with a total of 54 healthcare providers (3–12 per site). A semi-structured interview guide based upon constructs of the Consolidated Framework for Implementation Research (CFIR) and Normalization Process Theory (NPT) frameworks was used to guide the focus groups. Focus groups were recorded and transcribed verbatim. Data was analyzed thematically and inductively. Results Five major themes emerged across all eight sites: (i) understanding past implementation experiences, (ii) resource challenges, (iii) competing priorities among healthcare providers, (iv) system challenges, and (v) urban versus rural differences. Site-specific barriers included perceived lack of patient flow, time restraints, and concerns about the quality and quantity of past implementation interventions. Facilitators included passionate project champions, and an ample feedback process. Conclusions Focus groups were useful for identifying pre-implementation barriers and facilitators of an electronic orders set. Findings from this study are being refined to address the influence of COVID-19, and the data will be used to inform the intervention roll-out at each of the sites. Funding Agencies Alberta Innovates
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Affiliation(s)
- E Johnson
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Carbonneau
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - P Tandon
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Hyde
- Medicine, University of Alberta, Edmonton, AB, Canada
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25
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Power R, Bartha G, Harris J, Boyle S, Levy E, Milani P, Tandon P, McNitt P, Morra M, Desai S, Saldivar S, Clark M, Haudenschild C, West J, Chen R. 87P An augmented exome/transcriptome-based platform for precision cancer therapy selection, clinical trial matching, and oncology research applications, enabling next-generation composite biomarkers by combining tumour and immune features. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Bishay K, Tandon P, Bourassa-Blanchette S, Laurie SA, McCurdy JD. The risk of diarrhea and colitis in patients with lung cancer treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Curr Oncol 2020; 27:e486-e494. [PMID: 33173388 PMCID: PMC7606037 DOI: 10.3747/co.27.6251] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Immune checkpoint inhibitors (icis), including inhibitors of PD-1, PD-L1, and ctla-4, are relatively novel therapies for lung cancer, although their use might be limited by gastrointestinal toxicity. The aim of the present study was to determine the risk of diarrhea and colitis associated with icis in lung cancer and the rates of discontinuation because of those toxicities. Methods Electronic databases were searched for prospective trials reporting the risk of diarrhea and colitis in patients with lung cancer treated with PD-1, PD-L1, and ctla-4 inhibitors. The incidences of diarrhea and colitis and their grades were assessed clinically using standardized reporting criteria. Pooled incidence and weighted relative risk estimates for diarrhea and colitis with 95% confidence intervals (cis) were estimated using a random effects model. The incidence of discontinuations for gi toxicity was also calculated. Results Twenty-seven studies were included: sixteen studies with PD-1 inhibitors, nine studies with PD-L1 inhibitors, and four studies combining PD-based strategies with ctla-4 inhibitors. The incidence of all-grade diarrhea was 9.1% (95% ci: 7.8% to 10.5%) for anti-PD-1 therapy and 11.0% (95% ci: 7.5% to 14.5%) for anti-PD-L1 therapy. The incidence of all-grade colitis was 0.9% (95% ci: 0.4% to 1.3%) for anti-PD-1 therapy and 0.4% (95% ci: 0.0% to 0.8%) for anti-PD-L1 therapy. The relative risk for all-grade diarrhea was higher with combination anti-PD-1 and anti-ctla-4 than with anti-PD-1 monotherapy (relative risk: 1.61; 95% ci: 1.14 to 2.29). Anti-PD-1 therapy was discontinued in 4.1% of patients with diarrhea (95% ci: 0.7% to 7.4%) and in 35.7% of those with colitis (95% ci: 0.0% to 81.1%); combination therapy was discontinued in 10.1% of patients with diarrhea (95% ci: 4.8% to 15.4%) and in 39.9% of those with colitis (95% ci: 3.9% to 75.9%). Conclusions Diarrhea is a relatively frequently encountered gi toxicity when ici therapy is used in lung cancer treatment. Colitis is less frequently encountered, although when it does occur, it often results in therapy discontinuation.
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Affiliation(s)
- K Bishay
- Division of Gastroenterology, University of Toronto, Toronto, ON
| | - P Tandon
- Division of Gastroenterology, University of Toronto, Toronto, ON
| | | | - S A Laurie
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, ON
| | - J D McCurdy
- Division of Gastroenterology, The Ottawa Hospital, Ottawa, ON
- The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
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27
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Tandon P, Sasson AN, Gallinger Z. A245 IMPROVING KNOWLEDGE TRANSFER OF PREVENTATIVE CARE IN INFLAMMATORY BOWEL DISEASE USING ELECTRONIC LEARNING. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a complex chronic disease and it is imperative that gastroenterologists are familiar with the unique needs of the IBD patient. An important part of management involves education surrounding the general health maintenance needs of this patient population, especially those on immunomodulator and biologic therapy or those being considered for such treatment. A recent study showed that Canadian GI trainees are uncomfortable managing preventative care in IBD including vaccinations and bone protection. Using educational videos for trainees to improve core knowledge of these concepts remains unclear.
Aims
Assess educational efficacy of a core training module on trainee confidence and knowledge on preventative care in IBD.
Methods
This study assessed a preventative care in IBD video used as an educational tool in the University of Toronto GI trainee program as part of the annual GI in-training objective structured clinical examination (OSCE). Prior to the OSCE, a randomly selected cohort of trainees were provided the preventative care video. The remaining trainees prepared for the OSCE as standard. At the OSCE, one station asked all trainees to address preventative care in IBD with a standardized patient. Following the OSCE, a standardized evaluation of trainee confidence and degree of knowledge on vaccination, cancer screening, bone health, and mental health in IBD patients was performed. These evaluations and OSCE score were then compared between both cohorts. Data was analyzed using a t-test and p<0.05 was considered significant.
Results
A total of 10 subjects took part in the study. 5 subjects were exposed to the video prior to the OSCE and 5 were not exposed. Overall total score for trainees who had seen the video prior to the OSCE had a mean score of 85.3% (38.4/45) compared to those who had not seen the video prior had a mean score of 65.3% (29.4/45) with a p = 0.03. Global score in those exposed to the video was 70% (3.5/5) compared to 48% (2.4/5) in the unexposed group with a p= 0.006. Upon assessment of individuals topics, there was a trend in improved knowledge of vaccination and mental health screening in those exposed vs. unexposed to the educational video (52.6% vs. 32.6%, and 80% vs. 20%, respectively). No significant difference was identified between groups with respect to cancer screening and bone health.
Conclusions
Our study shows evidence that use of educational videos was efficacious with respect to GI trainee confidence and knowledge surrounding key concepts in preventative care of IBD patients. This exposure allows for improved patient education and management and lead to better-quality patient care. Overall, this study identifies a knowledge gap in trainee education and highlights the need for development of training tools to improve overall management of this complex and dynamic disease.
Funding Agencies
CAGVideo was a CAG accredited educational material, and supported by an educational grant from the Canadian Association of Gastroenterology and Abbvie Canada
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Affiliation(s)
- P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - A N Sasson
- Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Z Gallinger
- University of Toronto, Woodbridge, ON, Canada
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Leung K, Tandon P, Govardhanam V, Maxwell C, Huang V. A220 A COMPREHENSIVE SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RISK OF ADVERSE NEONATAL OUTCOME IN INFLAMMATORY BOWEL DISEASE AND PREGNANCY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) often affects women in their child-bearing years. These women may be at an increased risk of adverse neonatal outcomes.
Aims
The aim of this study was to evaluate the risk of these outcomes in this population of patients, with an emphasis of determining risk factors for development of these conditions.
Methods
Medline, Embase, and Cochrane library were searched through to May 2019 for studies reporting adverse neonatal outcomes in IBD patients. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the risk of these outcomes in patients with IBD compared to healthy controls, with risk factors such as disease activity and medication exposure also being assessed.
Results
Sixty studies were included (8194 pregnancies with inflammatory bowel disease and 3253 healthy pregnancies). Compared to healthy controls, patients with inflammatory bowel disease were more likely to deliver infants with low birth weight (LBW) (OR 2.78, 95% CI 1.16–6.66) and infants who were admitted to the neonatal intensive care unit (NICU) (OR 3.33, 95% CI 1.83–6.05). Patients with Crohn’s disease had an increased risk of infants born with congenital anomalies (OR 3.03, 95% CI, 1.43–6.42), whereas patients with ulcerative colitis had an increased risk of preterm delivery (OR 2.68, 95% CI, 1.12–6.43). Active disease increased the risk of preterm birth (OR 2.06, 95% CI 1.21–3.51), LBW (OR 2.96, 95% CI 1.54–5.70), and small for gestation age (OR 2.62, 95% CI 1.18–5.83) compared to disease in remission. Tumor necrosis factor antagonists was associated with increased risk of NICU admission (OR 2.42, 95% CI 1.31–4.45) and LBW (OR 1.54, 95% CI, 1.01–2.35).
Conclusions
Patients with inflammatory bowel disease are at an increased risk of developing adverse neonatal outcomes such as preterm birth, LBW, congenital anomalies, and NICU admissions. Patients with clinically active disease and those exposed to anti-TNF therapy may be at higher risk of developing these adverse outcomes. The findings of this study are important to communicate to patients and healthcare providers alike. Furthermore, this information may help to mitigate these risks through collaborative specialized care during pregnancy in order to reduce the overall morbidity and mortality for both mother and baby.
Funding Agencies
None
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Affiliation(s)
- K Leung
- University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Toronto, ON, Canada
| | | | - C Maxwell
- University of Toronto, Toronto, ON, Canada
| | - V Huang
- University of Toronto, Toronto, ON, Canada
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29
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Tandon P, Lee E, Hitz L, Huang V. A244 MATERNAL THIOPURINE AND ANTI-TUMOR NECROSIS FACTOR THERAPY DURING PREGNANCY IS ASSOCIATED WITH AN INCREASED RISK OF PLACENTAL-RELATED DISEASES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Though previous studies have suggested that most therapies for inflammatory bowel disease (IBD) are safe during pregnancy, the effect of these medications on placental-related diseases remain unknown.
Aims
To determine the effect of gestational medication exposure on pregnancy-related outcomes in patients with IBD.
Methods
We retrospectively reviewed the University of Alberta and University of Toronto pregnancy databases to identify patients (age > 18) who underwent routine assessment by a gastroenterologist at least once during pregnancy (first trimester (T1), second trimester (T2), and third trimester (T3). Pregnancy-related outcomes (maternal, obstetrical, and neonatal) were recorded from obstetrical records. Low-birth weight (LBW) was defined as an infant weight < 2500g at birth. Pre-term delivery was defined as birth < 37 weeks gestation. Medication exposure, such as 5-aminosalicylates (5-ASA), thiopurines, steroids, and anti-tumor necrosis factor (TNF) therapy was recorded for each trimester. Categorical variables were statistically compared using the Chi-square (x2) test through the SPSS software.
Results
A total of 84 patients were included. Compared to those not exposed to thiopurines, patients exposed to thiopurine therapy during T2 had an increased risk of pre-term birth (26.7% vs. 7.7%, p=0.046) and pre-eclampsia (13.3% vs. 0%, p=0.008) and a trend towards an increased risk of placental abruption (6.7% vs, 0%, p=0.061). Furthermore, compared to those not treated with corticosteroids, those prescribed corticosteroid therapy during any trimester had an increased risk of pre-term birth (T1 exposure: 50% vs. 10.2%, p=0.024; T2 exposure: 37.5% vs. 8.5%. p=0.018; T3 exposure: 42.9% vs. 8.8%, p=0.008) and infants born with LBW (T1 exposure: 50.0% vs. 7.8%, p=0.009; T2 exposure: 37.5% vs. 8.2%, p=0.015; T3 exposure: 57.1% vs. 8.6%, p=0.0005). Those exposed to corticosteroids in T3 only had an increased risk of PPROM (60.0% vs. 7.5%, p=0.0003) and chorioamnionitis (14.3% vs. 0%, p=0.002). Finally, anti-TNF therapy in T2 was associated with an increased risk of pre-eclampsia (9.1% vs. 0%, p=0.040. 5-ASA therapy was not associated with an increased risk of any adverse pregnancy-related outcome. No medication increased the risk of other maternal (i.e. gestational diabetes, emergency Cesarean-section delivery) and neonatal (intensive care unit admission, congenital anomalies) outcomes.
Conclusions
Placental related diseases, such as pre-eclampsia, appear to be increased with maternal exposure to thiopurine and anti-TNF therapy during pregnancy. Larger studies are required to confirm these associations.
Funding Agencies
None
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Affiliation(s)
- P Tandon
- Division of Gastroenterology, University of Toronto, Woodbridge, ON, Canada
| | - E Lee
- Division of Gastroenterology, University of Toronto, Woodbridge, ON, Canada
| | - L Hitz
- Division of Gastroenterology, University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- Division of Gastroenterology, University of Toronto, Woodbridge, ON, Canada
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Govardhanam V, Tandon P, Leung K, Maxwell C, Huang V. A250 SYSTEMATIC REVIEW WITH META-ANALYSIS: ADVERSE PREGNANCY-RELATED OUTCOMES WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a chronic inflammatory condition. While it is reported that IBD may result in adverse pregnancy-related outcomes, its effects on placental related diseases are relatively not known.
Aims
The aim of our work was to determine the risk of adverse pregnancy outcomes in patients with IBD.
Methods
Medline, Embase, and Cochrane library were searched for studies that reported adverse maternal and obstetrical outcomes in patients with IBD. Weighted odds ratios (OR) with 95% confidence intervals (CI) were calculated for the risk of these outcomes in patients with IBD compared to healthy controls.
Results
Fifty-three studies were included (7917 patients with IBD and 3253 healthy controls). Cesarean delivery was more common in patients with IBD compared to healthy controls (OR 1.79, 95% CI, 1.16–2.77). This remained significant for UC (OR 1.80, 95% CI, 1.21–2.90) but not CD (OR 1.48, 95% CI, 0.94–2.34). Similarly, gestational diabetes occurred more commonly in IBD (OR 2.96, 95% CI, 1.47–5.98). Furthermore, the incidences of placental diseases were low, 2.0% (95% CI, 0.9–3.1%) for pre-eclampsia, 3.3% (95% CI, 0–7.2%) for placental abruption, 0.5% (95% CI, 0.2–0.9%) for placenta previa, and 0.3% (95% CI, 0–0.5%) for chorioamnionitis. Finally, patients with IBD were more likely to experience preterm premature rupture of membranes (PPROM, OR 12.10, 95% CI, 2.15–67.98), but not an early pregnancy loss (OR 1.63, 95% CI 0.49–5.43). Anti-tumour necrosis factor therapy was not associated with chorioamnionitis (OR 1.12, 95% CI, 0.16–7.67), early pregnancy loss (OR 1.49, 95% CI, 0.83- 2.64), and placenta previa (OR 1.58, 95% CI, 0.30–8.47).
Conclusions
Patients with IBD are more likely to develop adverse pregnancy-related outcomes such as Gestational Diabetes and PPROM. Pregnancy in patients with IBD should be considered a high-risk period and as such, a multi-disciplinary team, including gastroenterologists, obstetricians and maternal-fetal medicine specialists, is necessary to recognize and effectively manage adverse obstetrical outcomes in order to reduce overall morbidity and mortality.
Funding Agencies
None
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Affiliation(s)
| | - P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - K Leung
- Internal Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - C Maxwell
- University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- University of Toronto, Woodbridge, ON, Canada
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Yusuf A, Tandon P, Huang V. A162 THE UTILITY OF FECAL CALPROTECTIN IN PREDICTING SEVERITY OF CLOSTRIDIUM DIFFICILE INFECTION: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clostridium difficile is an anaerobic, spore-forming, gram-positive bacillus, and a leading cause of infectious diarrhea in hospitalized patients. It is associated with high mortality and morbidity, and places an enormous burden on the healthcare system. Symptoms and severity of CDI vary widely, from illness that resolves with antibiotics, to toxic megacolon, colectomy, and death. The ability to risk-stratify patients to predict severe versus non-severe outcomes at baseline would be clinically useful. The role of fecal calprotectin in predicting severity of CDI has not been well established.
Aims
To perform a systematic review of the literature on the ability of fecal calprotectin to predict disease severity in patients with CDI.
Methods
PubMed, OVID (EMBASE/MedLine) and Cochrane Library databases were searched up until October 2, 2019. Publications of pediatric populations, Inflammatory Bowel diseases, and those only published as abstracts were excluded.
Results
130 non-duplicate citations were screened; after title/abstract screening, and full-text review, 7 articles were included for analysis. Articles were from 2014 onwards, and varied from 29 to 232 patients/samples analyzed; 832 patients in total were analyzed. Three studies were conducted in the USA, two in Europe, one in Israel and in South Korea. Four studies were prospective, and the remaining three were retrospective cohort studies. There was significant heterogeneity between studies with respect to population size, age (when reported), fecal calprotectin assay and cutoff used, method of diagnosis of CDI, and criteria for defining disease severity. There was wide variation in median fecal calprotectin levels between studies. Four studies demonstrated a statistically significant difference of fecal calprotectin according to disease severity, and three did not, of which two of these demonstrated an overall predictive trend with fecal calprotectin.
Conclusions
It is unclear whether fecal calprotectin is predictive of severity of CDI in adult patients without IBD. In the existing literature, there seems to be a statistically significant association or trend towards association in most studies, but due to heterogeneity of methods, assays, cutoffs and populations, the data within these studies cannot be pooled in meta-analysis. Further high-powered, well-designed studies are required to clarify this important clinical question.
Funding Agencies
None
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Affiliation(s)
- A Yusuf
- Department of Medicine, Department of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - P Tandon
- University of Toronto, Woodbridge, ON, Canada
| | - V Huang
- Mount Sinai Hospital, Toronto, ON, Canada
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Power R, Bartha G, Harris J, Boyle S, Levy E, Milani P, Tandon P, Li R, Chinnappa M, Haddad A, McNitt P, McClory R, Morra M, Saldivar S, Clark M, Haudenschild C, Newburn E, Johnson C, Chen R, West J. A comprehensive tumour immunogenomics platform for precision immunotherapy: Enabling simultaneous characterization of tumours and the TME from a single FFPE sample. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz447.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Paris M, Heyland D, Tandon P, Furberg H, Premji T, Mourtzakis M. OR35: Automated Body Composition Analysis of Computed Tomography Scans Using Neural Networks. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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34
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Wishart E, Taylor L, Lam L, Marr KJ, Stapleton M, Fitzgerald Q, Chiu E, Tandon P, Raman M. A179 EXPLORING RELATIONSHIPS BETWEEN HANDGRIP STRENGTH, MID-UPPER ARM CIRCUMFERENCE, SUBJECTIVE GLOBAL ASSESSMENT AND ADVERSE CLINICAL OUTCOMES IN CIRRHOSIS: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Wishart
- University of Calgary, Calgary, AB, Canada
| | - L Taylor
- University of Calgary, Calgary, AB, Canada
| | - L Lam
- Alberta Health Services, Calgary, AB, Canada
| | - K J Marr
- University of Calgary, Calgary, AB, Canada
| | | | | | - E Chiu
- University of Calgary, Calgary, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
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Affiliation(s)
- P Tandon
- Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - L Rotin
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - F Habal
- Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
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36
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Chiu E, Taylor L, Lam L, Marr K, Stapleton M, Fitzgerald Q, Tandon P, Raman M. A176 IMPROVEMENT IN NUTRITION STATUS IS ASSOCIATED WITH LOWER RATES OF INFECTION AND HEPATIC ENCEPHALOPATHY: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Chiu
- University of Calgary, Calgary, AB, Canada
| | - L Taylor
- University of Calgary, Calgary, AB, Canada
| | - L Lam
- Alberta Health Services, Calgary, AB, Canada
| | - K Marr
- University of Calgary, Calgary, AB, Canada
| | | | | | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
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37
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Eslamparast T, Taylor L, Shommu N, Kumar A, Farhat K, Fitzgerald Q, Tandon P, Raman M. A56 LEVELS OF AGREEMENT BETWEEN PATIENT AND PRACTITIONER LED MALUTRITION SCREENING TOOLS IN CIRRHOSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Eslamparast
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - L Taylor
- University of Calgary, Calgary, AB, Canada
| | - N Shommu
- University of Calgary, Calgary, AB, Canada
| | - A Kumar
- University of Calgary, Calgary, AB, Canada
| | - K Farhat
- University of Alberta, Edmonton, AB, Canada
| | | | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
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38
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Tandon P, Bishay K, Bishay S, Yelle D, Carrigan I, Wooller K, Kelly EM. A57 ACUTE VARICEAL GASTROINTESTINAL BLEEDING DOES NOT INFER POOR SURVIVAL COMPARED TO NON-VARICEAL BLEEDING IN PATIENTS WITH CIRRHOSIS: A RETROSPECTIVE, OBSERVATIONAL STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Tandon
- Division of Gastroenterology and Hepatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - K Bishay
- Division of Gastroenterology and Hepatology, The Ottawa Hospital, Ottawa, ON, Canada
| | - S Bishay
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - D Yelle
- Division of General Internal Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - I Carrigan
- University of Ottawa, Ottawa, ON, Canada
| | - K Wooller
- Division of General Internal Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - E M Kelly
- Division of Gastroenterology and Hepatology, The Ottawa Hospital, Ottawa, ON, Canada
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39
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Dang T, Ebadi M, Montano-Loza AJ, Tandon P. A182 SIX-MINUTE WALK TEST AND SARCOPENIA IN PREDICTING MORTALITY IN PATIENTS WITH CIRRHOSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Dang
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Ebadi
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - A J Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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40
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Bishay K, Chaudhuri D, Tandon P, Trivedi V, James PD, Kelly EM, Thavorn K, Kyeremanteng K. A48 PROPHYLACTIC ENDOTRACHEAL INTUBATION IN CRITICALLY ILL PATIENTS WITH UPPER GASTROINTESTINAL BLEED: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Bishay
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - D Chaudhuri
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - P Tandon
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - V Trivedi
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - P D James
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - E M Kelly
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - K Thavorn
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
| | - K Kyeremanteng
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
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41
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Ney M, Bhardwaj P, Dobbs B, Safari F, Kalainy S, Ma M, Bailey R, Abraldes J, Rolfson D, Tandon P. A193 COGNITIVE DYSFUNCTION IS PRESENT IN HALF OF STABLE OUTPATIENTS WITH CIRRHOSIS AND IS STRONGLY ASSOCIATED WITH THE POTENTIALLY MODIFICABLE FACTORS, DEPRESSION AND LOW MUSCLE STRENGTH. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Ney
- University of Calgary, Calgary, AB, Canada
| | - P Bhardwaj
- University of Alberta, Edmonton, AB, Canada
| | - B Dobbs
- University of Alberta, Edmonton, AB, Canada
| | - F Safari
- University of Alberta, Edmonton, AB, Canada
| | - S Kalainy
- University of Alberta, Edmonton, AB, Canada
| | - M Ma
- University of Alberta, Edmonton, AB, Canada
| | - R Bailey
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - J Abraldes
- Liver Unit, University of Alberta, Edmonton, AB, Canada
| | - D Rolfson
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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42
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Eslamparast T, Farhat K, Taylor L, Shommu N, Kumar A, Fitzgerald Q, Kroeker K, Raman M, Tandon P. A112 THE VALIDITY OF PATIENT-LED SELF-SCREENS FOR IDENTIFYING MALNUTRITION IN INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Eslamparast
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Farhat
- University of Alberta, Edmonton, AB, Canada
| | - L Taylor
- University of Calgary, Calgary, AB, Canada
| | - N Shommu
- University of Calgary, Calgary, AB, Canada
| | - A Kumar
- University of Calgary, Calgary, AB, Canada
| | | | - K Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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43
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Carbonneau M, Davyduke T, Tandon P, Ma M, Newnham K, DenHeyer V, Abraldes J. A24 SPECIALIZED MULTIDISCIPLINARY CARE IN CIRRHOSIS IMPROVES MORTALITY AND REDUCES ACUTE CARE UTILIZATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Carbonneau
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - T Davyduke
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
| | - M Ma
- University of Alberta, Edmonton, AB, Canada
| | - K Newnham
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - V DenHeyer
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - J Abraldes
- Liver Unit, University of Alberta, Edmonton, AB, Canada
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44
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Niazi M, Chavda S, Hjartarson E, Bailey RJ, Tandon P, brisebois AJ. A190 A PROSPECTIVE EVALUATION OF SYMPTOM BURDEN, OPIOID RISK, AND PERCEIVED BENEFITS OF NON-PHARMACOLOGICAL THERAPY IN CIRRHOSIS PATIENTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Niazi
- University of Alberta, Edmonton, AB, Canada
| | - S Chavda
- University of Alberta, Edmonton, AB, Canada
| | | | - R J Bailey
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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45
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Bishay K, Tandon P, Bishay S, Yelle D, Carrigan I, Wooller K, Kelly EM. A60 PREDICTIVE FACTORS OF INTENSIVE CARE UNIT ADMISSION AND MORTALITY IN CIRRHOTIC PATIENTS WITH UPPER GASTROINTESTINAL BLEEDS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Bishay
- The Ottawa Hospital, Ottawa, ON, Canada
| | - P Tandon
- The Ottawa Hospital, Woodbridge, ON, Canada
| | - S Bishay
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Yelle
- The Ottawa Hospital, Ottawa, ON, Canada
| | - I Carrigan
- University of Ottawa, Ottawa, ON, Canada
| | - K Wooller
- The Ottawa Hospital, Woodbridge, ON, Canada
| | - E M Kelly
- Gastroenterology and Hepatology, University of Ottawa, Ottawa, ON, Canada
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46
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Kruger C, McNeely M, Bailey R, Yavari M, Abraldes J, Carbonneau M, Newnham K, Mathiesen V, Ma M, Thompson R, Paterson I, Haykowsky M, Tandon P. A25 HOME EXERCISE THERAPY IS WELL TOLERATED AND IMPROVES EXERCISE CAPACITY IN PATIENTS WITH CHILD PUGH A AND B CIRRHOSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Kruger
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - M McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Bailey
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - M Yavari
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Abraldes
- Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Carbonneau
- Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Newnham
- Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Mathiesen
- Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Ma
- Cirrhosis Care Clinic, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - I Paterson
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Haykowsky
- Division of Gastroenterology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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47
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Dang T, Mitchell N, Farhat K, Abraldes J, Ma M, Bailey R, Tandon P. A183 ANXIETY IMPACTS HEALTH-RELATED QUALITY OF LIFE AND HOSPITALIZATIONS IN PATIENTS WITH CIRRHOSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Dang
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - N Mitchell
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Farhat
- University of Alberta, Edmonton, AB, Canada
| | - J Abraldes
- University of Alberta, Edmonton, AB, Canada
| | - M Ma
- University of Alberta, Edmonton, AB, Canada
| | - R Bailey
- Royal Alexandra Hospital, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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48
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Eslamparast T, Vandermeer B, Raman M, Mathiesen V, Belland D, Ma M, Tandon P. A235 SYSTEMATIC REVIEW AND META-ANALYSIS: COMPARING OF ESTIMATED ENERGY REQUIREMENTS IN CIRRHOTIC PATIENTS USING INDIRECT CALORIMETRY VERSUS PREDICTION EQUATIONS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Eslamparast
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - V Mathiesen
- Alberta Health Services, Edmonton, AB, Canada
| | - D Belland
- Alberta Health Services, Edmonton, AB, Canada
| | - M Ma
- University of Alberta, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, Edmonton, AB, Canada
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49
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Amin A, Shah D, Cabrera-García L, Carbonneau M, Newnham K, Tandon P, Abraldes J. A236 METRONIDAZOLE IN THE TREATMENT OF RECURRENT HEPATIC ENCEPHALOPATHY: A CASE SERIES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Amin
- (Core) Internal Medicine Program, University of Alberta, Edmonton, AB, Canada
| | - D Shah
- University of Alberta, EDMONTON, AB, Canada
| | - L Cabrera-García
- (Core) Internal Medicine Program, University of Alberta, Edmonton, AB, Canada
| | - M Carbonneau
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - K Newnham
- Cirrhosis Care Clinic, University of Alberta Hospital, Edmonton, AB, Canada
| | - P Tandon
- University of Alberta, EDMONTON, AB, Canada
| | - J Abraldes
- Liver Unit, University of Alberta, Edmonton, AB, Canada
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50
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Li S, Ney M, Eslamparast T, Raman M, Tandon P. A317 A SYSTEMATIC REVIEW OF NUTRITION SCREENING, NUTRITION ASSESSMENT AND CLINICAL OUTCOMES IN INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Li
- Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Ney
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - T Eslamparast
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - M Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - P Tandon
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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