Gastroenterology Physicians Research Articles

Prevalence, patterns, and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria

Abstract Introduction: Musculoskeletal issues are quite common among endoscopists especially considering the complexity of GI endoscopy with prolonged examination time. In particular, the combination of repetitive movements, long procedure time, high volume and setup of the endoscopy suite provide the basis for these health issues. Considering the increasing number of new endoscopic interventional and diagnostic procedures, ergonomics in gastrointestinal endoscopy has not been addressed to the same extent. There has been no study on musculoskeletal injuries among practicing endoscopists in Nigeria. This study was designed to study the prevalence, patterns and risk factors for endoscopy-related musculoskeletal injuries among endoscopists in Nigeria. Methods: This was a nationwide cross-sectional questionnaire-based study in which practicing endoscopists in Nigeria were administered an online Google form. The questions on the questionnaire were adapted from the Nordic Musculoskeletal Questionnaire (NMQ). The questionnaire also included social demographic variables. There were 66 respondents which included gastroenterology physicians and surgeons. Data was analyzed with IBM-SPSS version 25. Inferential statistics was done using chi-square with p-value set at 0.05. Results: The Prevalence of endoscopy-related musculoskeletal injuries among endoscopists in Nigeria is very high. The commonest sites affected were the wrist/hands, lower back, neck and shoulders. These injuries prevented about one-third of the endoscopists from carrying out their normal activities while the injuries were severe enough to necessitate therapy in more than two-thirds of the respondents. The only statistically significant risk factor for endoscopy-related musculoskeletal injury was female sex. Conclusion: Most of the endoscopists in Nigeria have not had any form of training on ergonomics. While most of the endoscopists adopted the correct posture while performing endoscopies, a significant number did not practice ergonomic timeout nor use the finger grip technique. Thus there was a knowledge gap as well as a practice gap. A proper ergonomic education is a key step in preventing endoscopy-related musculoskeletal injury.

Biosimilars for Pediatric Patients With Inflammatory Bowel Disease: Pediatric Gastroenterology Clinical Practice Survey.

Biosimilars are biological agents that have been demonstrated to have similar safety and efficacy profiles as the originator. The objective of this study was to evaluate the perspectives of pediatric gastroenterologists in the United States (U.S.) toward biosimilar use and to explore factors that impact their comfort level with prescribing infliximab biosimilars. A cross-sectional survey was developed and distributed to pediatric gastroenterology physicians from the U.S. via a listserv (Pediatric gastroenterology Bulletin Board). Respondent's demographics were recorded. Using a 6-point Likert scale, the survey assessed the respondent's perceptions toward biosimilars and initiating switches from the originator to biosimilar agent along with factors impacting provider's comfort level. Fischer exact tests were used to detect statistically significant differences in responses for hypotheses of interest. One hundred thirty-nine pediatric gastroenterologists completed the online survey (response rate 5.4%). Eighty-seven percent of respondents reported being comfortable prescribing infliximab biosimilars to anti-tumor necrosis factor naive patients, and 69% reported being comfortable doing a one-time switch if the patient was in clinical remission. Factors that negatively impacted a respondent's comfort level included respondents not practicing at an ImproveCareNow (ICN) center and managing less than 50 patients with inflammatory bowel diseases (IBD). Nearly 90% of pediatric gastroenterologists felt comfortable prescribing an infliximab biosimilar, and 70% felt comfortable with a one-time switch to the biosimilar if the patient was in clinical remission. Involvement in ICN a learning health system and caring for higher numbers of patients with IBD was associated with increased provider comfort with biosimilar use.

Intersectoral management of patients with abnormal liver enzymes and non-alcoholic fatty liver disease (NAFLD)

The prevalence of fatty liver disease has increased significantly in Germany in recent years. With an estimated 18 million German citizens being affected, it is now among the most prevalent diseases. Furthermore, it is also considered a relevant and independent risk factor for other common cardiovascular diseases such as heart attack or stroke. Finally, diabetes mellitus promotes the development of and an unfavorable course of fatty liver disease. Given the high prevalence and complications, the German healthcare system is reaching its limits.Therefore, close coordination of all healthcare providers and specialists involved in the treatment of these patients is essential. In an expert consensus involving private practice and hospital doctors from the fields of gastroenterology, endocrinology, cardiology, general practitioners and laboratory physicians, as well as in close coordination with patient representatives, we have designed a concept for the care of these patients in the German healthcare system. Necessary developments are also addressed. In addition to being useful as a practical guideline, this should also support health policy work, especially in the development of practical care solutions at the medical level.

P765 Tolerating infliximab therapeutic drug monitoring without anti-drug antibodies – an argument for drug intolerant assays?

Abstract Background Therapeutic drug monitoring (TDM) helps guide clinical decision making in IBD patients on infliximab (IFX). There are two types of IFX TDM assays, drug tolerant and intolerant, where drug tolerant assays allow the detection of anti-drug antibodies (ADA) in the presence of drug and the latter does not. Our immunology laboratory is in the process of changing from a drug tolerant to a drug intolerant IFX assay for cost reasons. We aimed to determine whether this switch would affect the management of IBD patients with therapeutic IFX levels and detectable antibodies. Methods This was a retrospective cross-sectional study in a central London tertiary hospital. Patients were included if they had a diagnosis of Crohn’s Disease (CD), Ulcerative Colitis (UC), or Indeterminate colitis, and had therapeutic IFX levels (>3mg/ml) with detectable anti-drug antibodies (ADA) (>10 AU/ml) between January 2017 to March 2022. Electronic health records were reviewed to determine clinical actions within 4 months of drug measurement. Actions were categorized into three groups by two gastroenterology physicians: no change to management, ADA dependent or independent actions. ADA dependent decisions were immunomodulator (IMM) addition or discontinuation. ADA independent decisions included switching biologic, stopping IFX, or escalation/de-escalation in IFX dosing. Results A total of 2675 IFX TDM tests were performed for IBD patients in the defined period. Of these, 237 patients had 477 TDM results with therapeutic IFX levels and detectable ADA. Baseline characteristics were 36.8% (n=87) female, mean age (y) of 30 (SD ±13), and 66.2% (n=157) had CD. At the time of measurement, 76.1% (n=363/477) of patients were on combination therapy with an IMM and 23.1% (n=110) had active disease on physicians’ global assessment. Changes to management were made in 23.5% (112/477) of clinics following TDM, but only 2.5% (12/477) of actions were ADA dependent. There was no difference in high titer ADA group (>40 AU/ml) compared to low. Variables that significantly affected clinical decisions were IFX dose (p<0.001), IFX interval (p=0.004), and clinical disease activity (p<0.001). Conclusion 1 in 40 clinical decisions made in patients with therapeutic drug levels and detectable ADAs rely on knowing the ADA level. A cost analysis, with an appropriate IFX drug level threshold under which ADAs would be performed, assessing the proposed switch to a drug intolerant TDM assay would help determine whether cost savings outweigh missed decision-making opportunities.

Hepatitis A and B vaccination in adults at risk: A survey of US healthcare providers’ attitudes and practices

ABSTRACT This study aimed to evaluate the attitudes and practices of US healthcare professionals (HCPs) regarding the Advisory Committee on Immunization Practices (ACIP) vaccination recommendations on HepA and HepB for adult patients at risk of contracting these infections or experiencing complications of hepatitis disease. This cross-sectional, web-based survey of 400 US HCPs, which included nurse practitioners and family medicine, internal medicine, infectious disease, emergency department, and gastroenterology physicians, assessed HCPs’ attitudes and practices regarding the ACIP recommendations for adult patients at risk for hepatitis disease. HCP participants were identified via a survey research panel. A recruitment quota of 400 HCPs was set, including 50 NPs, 100 FMs, 100 IMs, 50 GIs, 50 EDs, and 50 IDs. The most frequently reported reasons for not recommending either HepA or HepB vaccines were “I think the risk of HepA infection is low in this patient population” and “I am uncertain about what the guidelines say about vaccinating this population.” The most reported factors considered when determining eligibility for either vaccine were medical history and the patient’s willingness/motivation to be vaccinated. Most reported it was extremely or moderately important to prevent hepatitis disease by vaccinating adult patients at risk, and most also reported recommending a HepA vaccine or HepB vaccine to patients at risk. Although most HCPs reported recommending HepA and HepB vaccines to patients at risk, these findings contrast with the low reported vaccination rates among these populations, and improved awareness of the ACIP recommendations among HCPs is needed.

Two mental models of integrated care for advanced liver disease: qualitative study of multidisciplinary health professionals

ObjectivesThe purpose of this paper is to present two divergent mental models of integrated advanced liver disease (AdvLD) care among 26 providers who treat patients with AdvLD.Setting3 geographically dispersed United...

Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing

Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re-administered within 3months. Inter-rater and intra-rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. Thirty-four raters completed the initial survey of whom thirty-one (91%) completed the repeat survey. Overall inter-rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra-rater agreement was 76%. In contrast, overall inter-rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra-rater agreement was only 57%. Between-physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2-2.0, p=0.015). Higher intra-rater agreement was noted for diagnostic testing in faculty when compared to fellows (p=0.009). In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing.

Racial disparity in age and genotype defines urban hepatitis C patient profiles in the recent direct-acting antiviral era

Introduction: Hepatitis C virus (HCV) infections are a national health issue despite highly effective therapy and screening of the high prevalence age cohort. Since an increase in younger patients may be occurring, we evaluated HCV patients seen in our urban clinic for their demographics and treatment history. Methods:EMR charts of all 601 patients with a diagnosis of HCV seen in Wayne Health Clinics in 2019 were reviewed. Results:The HCV patients were predominantly African American (AA) (85%) with most yet to be treated (73%). AA patients were older than non-AA patients (63 vs 51years), had a greater likelihood of HCV genotype 1 (94% vs 60%) and had lower ALT values. Patients were seen and treated by both Gastroenterology (73%) and Infectious Disease (27%) physicians and SVR rates were greater than 95%. Fibrosis, as determined by serological biomarkers, was improved in AA patients who had achieved viral clearance (SVR) as compared to those who were untreated. Conclusions: AA patients were older and more likely to have genotype 1, and with less inflammation (ALT) as compared to Non-AA patients. The data confirms the continuing need to ensure linkage to all HCV patients to prevent additional HCV transmission and future liver disease manifestation. While fibrosis in our population correlates with age, there was a significant number of older AA patients with minimal fibrosis. Further evaluation of these patients may reveal a more recent acquisition versus a slower development of fibrosis over time.

HSR21-050: Access to Gastroenterology and Internal Medicine Physicians is Associated With Improved Outcomes in Colorectal Cancer: A Nation-Wide Analysis

"HSR21-050: Access to Gastroenterology and Internal Medicine Physicians is Associated With Improved Outcomes in Colorectal Cancer: A Nation-Wide Analysis" published on 17 Mar 2021 by National Comprehensive Cancer Network.

Impact of a Medical Scribe Program on Outpatient Pediatric Gastroenterology Clinic.

Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap. Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups. One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02). The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.

Addressing Gender Disparity: Increase in Female Leadership Increases Gender Equality in Program Director and Fellow Ranks.

Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI. Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test. In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04-12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34-6.6). Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

Physician and patient perceptions of fecal microbiota transplant for recurrent or refractory Clostridioides difficile in the first 6 years of a central stool bank.

Background and AimFecal microbiota transplantation (FMT) is a highly effective therapy for recurrent or refractory Clostridioides difficile infection (rCDI). Despite inclusion in society guidelines, the uptake of FMT therapy has been variable. Physician and patient attitudes may be a barrier to evidence‐based uptake of therapies; however, data assessing attitudes regarding FMT for rCDI are limited.MethodsThe South Australian FMT for CDI database prospectively recorded patient outcomes of FMT for CDI from August 2013 to January 2019. A total of 93 consecutive patients who underwent FMT for rCDI in South Australia were invited to participate in a 20‐question survey regarding the patient experience of FMT. All gastroenterologists and infectious disease physicians practicing in South Australia were invited to participate in an online survey comprised of 22 questions that addressed referral experience, indications for referral, perceived risks, and regulation and funding.ResultsFifty‐four patients (54/93, 58%) returned the survey, of whom 52 (96%) would recommend FMT to others, and 51 (94%) were satisfied with treatment outcome. Fifty physicians returned the online survey (50/100, 50%), of whom 23 (46%) were concerned about disease transmission risk, and 15 (30%) believed that the risk of FMT would outweigh the benefit. Infectious diseases physicians and advanced trainees had significantly greater concern regarding the potential alteration of the microbiome than gastroenterology physicians and advanced trainees (8/17 (47%) vs 6/33 (18%); P = 0.047).ConclusionDespite high levels of patient‐reported satisfaction following FMT, physician‐reported reservations exist and may present a barrier to uptake of this therapy.

Telehealth Utilization in Gastroenterology Clinics Amid the COVID-19 Pandemic: Impact on Clinical Practice and Gastroenterology Training

Telehealth Utilization in Gastroenterology Clinics Amid the COVID-19 Pandemic: Impact on Clinical Practice and Gastroenterology Training

1168 Time Spent on Ambulatory Electronic Health Records Outside of Scheduled Work Hours by Gastroenterology Physicians

INTRODUCTION: The introduction of electronic health records (EHR) has been linked to physician burnout. This study aims to quantify the time gastroenterology physicians spend on ambulatory EHR outside of scheduled work hours. METHODS: Data was collected for time spent in ambulatory EHR for the eight-week period 02/03/2019 - 03/30/2019. Cumulative scheduled time was calculated for each physician. Hospital-based clinical encounters and time spent in hospital-based EHR were excluded from analysis. Ratios of ambulatory EHR time to scheduled time were calculated. We also analyzed data on physician FTE status, post-fellowship experience, new patient visit time interval, and correlated these data with the aforementioned ratio. P-values &lt; 0.05 were considered significant. This study was reviewed by our Institutional Review Board, and a waiver was obtained. RESULTS: Data was available for 41 providers; 18 providers were excluded (5 non-physicians, 3 with FTE status &lt; 0.2, 2 pediatric gastroenterologists, 8 without available scheduled time data). Data were analyzed for 23 gastroenterology physicians with 7,373 ambulatory encounters (3465 office visits, 310 office-based procedures, and 3598 ASC) across 4 sites. The average weekly time spent in EHR was 41.30 ± 11.73 hours, and the average weekly scheduled time was 24.48 ± 7.64 hours. Correspondingly, the average ratio of EHR time to scheduled time was determined to be 1.78 ± 0.70. Part-time and full-time physicians were also compared. There was a greater proportion of males in the full-time group rather than the part-time group (90.91% vs. 58.33%, P = 0.076). In addition, there was a trend towards a higher ratio of EHR time to scheduled time for part-time physicians (1.99 ± 0.88 vs. 1.56 ± 0.36), although this was not statistically significant (P = 0.15). The only statistically significant predictor of ratio was FTE status, treated as a continuous variable; the slope of the linear regression model was -3.06 ± 0.83 (P = 0.001) and the corresponding R2 was 0.39. Neither experience, in years after fellowship, nor new patient visit interval, were correlated with ratio. CONCLUSION: Our data show that gastroenterology physicians spend significant time outside of their scheduled time on EHR-related tasks. More studies are needed to better understand the distribution of time across different tasks; targeted countermeasures, such automation and utilization of non-physician staff, may help reduce the burden of EHR time and, correspondingly, the risk for physician burnout.

542 Gastroenterologist Sentiment Toward Artificial Intelligence (AI) in Endoscopic Practice: A Nationwide Survey

INTRODUCTION: Application of artificial intelligence (AI) in gastroenterology has been shown to improve the performance of endoscopists in several tasks including colonic polyp detection. However, little is known about how gastroenterologists perceive AI, especially with respect to its costs, ease of use, and efficacy. This nationwide survey is amongst the first to describe how practicing gastroenterologists view this emerging technology METHODS: In this cross-sectional observational study, an online survey was sent to practicing gastroenterology physicians and fellows across the US. This included questions about physician background as well as questions about physician understanding and perception of AI. Descriptive statistics were utilized to summarize physician sentiment toward AI. Chi-square test or Fisher's exact test were utilized to assess whether background information about physicians was correlated to their sentiment towards AI. Finally, a multivariate regression model was created to determine which physician factors were most correlated to physician sentiment RESULTS: Online surveys were sent by email to 330 gastroenterologists nationwide representing a variety of practice settings and experience levels out of which 124 physicians completed the survey and were included in the analysis. 86% of physicians reported interest in AI-assisted colonoscopy and 84.7% agreed that computer assisted polyp detection (CAPD) would improve their endoscopic performance. Univariate analysis showed that physicians practicing in academic centers versus private practices (P = 0.025) and physicians with less than 15 years post-fellowship experience versus physicians with more than 15 years of post-fellowship experience (P = .006) had a greater expectation of AI improving endoscopic performance. Multivariate analysis showed that post-fellowship experience of less than 15 years was the most important factor in determining whether a physician was likely to believe that CAPD would improve endoscopic performance (OR = 4.03; P = .04). The most common concerns about implementation of AI in endoscopic procedures were cost (75.2%) and development of operator dependence (62.8%) CONCLUSION: Gastroenterologists nationwide have an interest in the application of artificial intelligence to endoscopic procedures in gastroenterology, and many believe that this technology would improve their clinical performance. Further studies are needed to determine if AI applications in gastroenterology are cost-saving and time neutral.

P006 DISCORDANCE OF COMMUNICATION PRIORITIES BETWEEN HEALTHCARE PROFESSIONALS AND PATIENTS WITH ULCERATIVE COLITIS: RESULTS OF A GLOBAL ULCERATIVE COLITIS NARRATIVE SURVEY

The Ulcerative Colitis (UC) Narrative is a global survey of patients (pts) and gastroenterology physicians (GIs) aimed at identifying the impact of the disease and comparing and contrasting perceptions of UC burden and management approaches. We describe the prioritization of topics for discussion at routine appointments from pt and GI perspectives, and examine the potential impact of any discordance. Data are presented from 2100 pts and 1254 GIs in Australia, Canada, Finland, France, Germany, Italy, Japan, Spain, the UK, and the USA. Surveys were conducted online and by phone by The Harris Poll between August 2017 and February 2018. Eligible adult pts with UC (confirmed by endoscopy) were those who had visited a GI in the previous 12 months and had ever received prescription medication for UC. Self-reported medication history was used as a proxy for disease severity, with pts with moderate to severe UC defined as pts who had ever taken immunosuppressants, tumor necrosis factor inhibitors, other biologics, or corticosteroids for >4 of the past 12 months. Pts who had only ever taken 5-aminosalicylates or had a colectomy were excluded. Eligible GIs were those who saw ≥10 UC pts each month (≥5 in Japan), of whom ≥10% were taking a biologic and did not practice in a long-term care facility or hospice. Data are presented from all respondents who consented and completed the survey. Pts were a mean age of 40.8 years (standard deviation [SD] 12.4), 53% were male, and 82% had moderate to severe UC, with 67% considering their UC to be controlled with few to no symptoms. Survey responses showed some overlap between pts and GIs in their priorities for discussion at routine appointments. The top priorities selected for pts were discussions on ‘ability to manage symptoms’ (32%), ‘symptoms/problems experienced since last visit’ (29%), ‘how to control inflammation’ (29%), and ‘cancer risk’ (24%), while GIs’ highest priorities for discussion included ‘symptoms since last visit’ (53%), ‘ability to manage symptoms’ (40%), and ‘side effects of current treatment’ (40%). The greatest discordance between pt and GI prioritization was observed for cancer risk (24% vs 11%), fatigue management (16% vs 5%), emotional impact (13% vs 7%), and new medications (21% vs 15%). Both pts (63%) and GIs (79%) wish they had more time at appointments. Symptom control is a high priority for discussion among pts with UC and GIs, but other topics such as cancer risk, fatigue management, emotional impact, and new medications were viewed as less of a priority for GIs than for pts. GIs need to be mindful of those topics of greatest concern to the pt, and identify ways to discuss topics important to both parties, since shortage of appointment time is a barrier to communication.

P023 PATIENT AND HEALTHCARE PROFESSIONAL VIEWS ON EMOTIONAL HEALTH AND INTIMACY IN ULCERATIVE COLITIS: RESULTS OF A GLOBAL ULCERATIVE COLITIS NARRATIVE SURVEY

The Ulcerative Colitis (UC) Narrative is a global survey of patients (pts) and gastroenterology physicians (GIs) aimed at identifying the impact of the disease and comparing and contrasting perceptions of UC burden and management approaches. Here, we present data from 2100 pts and 1254 GIs in Australia, Canada, Finland, France, Germany, Italy, Japan, Spain, the UK, and the USA, with a focus on emotional health and intimacy in the care of pts with UC. Surveys were conducted online and by phone by The Harris Poll between August 2017 and February 2018. Eligible adult pts with UC (endoscopy confirmed) were those who had visited a GI in the previous 12 months and had ever received prescription medication for UC. Self-reported medication history was used as a proxy for disease severity, with pts with moderate to severe UC defined as pts who had ever taken immunosuppressants, tumor necrosis factor inhibitors, other biologics, or corticosteroids for >4 of the past 12 months. Pts who had only ever taken 5-aminosalicylates or had a colectomy were excluded. Eligible GIs were those who saw ≥10 UC pts each month (≥5 in Japan), of whom ≥10% were taking a biologic and did not practice in a long-term care facility or hospice. Data are presented from all respondents who consented and completed the survey. Mean pt age was 40.8 (standard deviation [SD] 12.4) years and 82% of pts had moderate to severe UC. Although only 21% and 15% of pts had ever been diagnosed with anxiety or depression, respectively, 7% were seeing a psychiatrist, psychologist, or therapist as part of their UC management. The majority of pts (84%) found UC mentally exhausting, even pts whose UC was not moderate to severe (75%) or pts whose UC was controlled with few to no symptoms (82%). Discussing the emotional impact of UC during routine appointments was less of a priority for GIs compared with pts (7% of GIs considered it one of their top three priorities vs 13% of pts). Only 45% of pts felt comfortable discussing sex life and personal relationship concerns with their GI. Three in ten pts (30%) wished their GIs better understood the effect of UC on their mental health, whereas only 40% of pts (and 44% of GIs) considered managing the psychological impact of UC to be important in managing UC. Only half of pts (52%) felt comfortable discussing emotional concerns with their GI; however, only 23% of GIs regularly discussed the impact of UC on mental and emotional health with pts. Emotional and mental health issues are infrequently discussed at routine appointments. This suggests that mental health concerns are often not covered during appointments, despite most pts reporting UC as a mentally exhausting condition. The mental burden and exhaustion of UC should not be underestimated and GIs need to initiate these discussions during consultations.

A Novel Care Model for Neonatal Intestinal Failure Patients Is Associated With Cost Savings and Improved Outcomes.

BackgroundNeonates with intestinal failure (IF) have prolonged admissions in the neonatal intensive care unit (NICU) and require lifelong follow-up with gastroenterology (GE) as outpatients. Inpatient management of these patients typically relies on many rotating practitioners and currently discharge criteria do not exist. We sought to create standardized discharge criteria with a continuity care model for neonatal IF patients.MethodsInpatient care was streamlined to two GE physicians with weekly consultations. We implemented standardized discharge goals for both enteral and total parental nutrition (TPN) by: 1) Enteral feedings of at least 5 mL/h were tolerated; 2) Stable central venous access was intact; 3) TPN was cycled to 20 h/day or less; and 4) No other medical issues required NICU admission. Patient records were reviewed after 18 months of implementing standardized discharge criteria and we compared their outcomes to a historical cohort of IF patients.ResultsOptimal discharge criteria were met in 12 patients and a cohort of 26 historical patients was used for comparison. Patients in optimal versus historical groups had similar baseline characteristics (medians, all P values = non-significant (NS)): gestational age (36 vs. 35 weeks), birth weight (1,990 vs. 2,076 g), birth length (45 vs. 44 cm), and small bowel length after definitive surgery (63 vs. 55 cm). Compared to the historical group, the optimal cohort was discharged earlier (median length of stay 69 vs. 126 days, P < 0.01), with a reduced total stay of 684 NICU days, fewer central line-associated bloodstream infections (CLABSIs) (4 vs. 10 per 1,000 patient days, P = 0.04), and had fewer readmissions (7 vs. 17 per 1,000 patient days, P < 0.01), respectively.ConclusionsConcentrating the care of IF patients to a GE team invested in long-term care, while implementing safe discharge criteria, resulted in a dramatic length of stay reduction with fewer CLABSIs and readmissions compared to historical management. At approximately 4,000 dollars per day in NICU hospital charges, this program saved over 2.7 million dollars in care costs while allowing families and their infants more time at home. The safety and applicability of the optimal discharge criteria presented here should be studied further. Similar programs may be effective at other large NICUs.

Where Is the Gap? Comparing the Spread of Liver and Intrahepatic Bile Duct Cancer With Gastroenterology Work Force in America

Introduction: Liver and intrahepatic bile duct cancer is the seventh leading cause of cancer death in men and women. According to data from Center for Disease Control and Prevention (CDC), during the last decade, rates of newly diagnosed liver cancer cases went up to 38 %. During the same time Death rate from liver cancer has increased more than 50 %. Methods: The incidence and death rate of newly diagnosed of liver and intra hepatic bile duct cancer were obtained from CDC database. This was compared to the board certified gastroenterology physicians based on Zip code that was obtained from Doximity Physician Database, and mapped with Google fusion tables. Results: The incidence of newly diagnosed liver and intrahepatic cancer was concentrated in the Western, North Eastern and Southwest areas. The death rate was highest in the Southern and Western regions of the United States. We identified that gastroenterology physicians and fellowship programs tend to more concentrate in the Northeast and other major cities in the West cost of the United States. The death rates due to liver cancer in the North Eastern areas were well below the National average. Conclusion: This study compares the Gastroenterology workforce and liver cancer incidence and death rate further demonstrates that the death rate due to liver cancer is lower in the areas were Physician workforce is higher. By addressing physician shortage in the areas that have highest death rates may further decrease the incidence and death rates due to liver cancer.946_A Figure 1. Gastroenterology Work force