A213 UNDERSTANDING PATIENT AND PHYSICIAN ATTITUDES AND EXPECTATIONS REGARDING IDENTIFYING AND MANAGING ANXIETY AND DEPRESSION IN IBD

Background

Patients living with Inflammatory Bowel Disease (IBD) commonly experience a number of mental health-related challenges, specifically anxiety and mood disorders (AMDs). Although there has been an awareness of the relationship between IBD and AMD within the GI research and clinical space; detection, treatment, and management amongst care providers is limited. Therefore, we are seeking to explore the overall experiences of patients living with Inflammatory Bowel Disease to identify and evaluate their experiences in interactions with GI clinicians around mental health in diverse care settings in order to determine how to best support mental health care amongst IBD patients.

Purpose

We aimed to explore perspectives, experiences and barriers to engaging with mental health-related challenges amongst IBD patients when interacting with gastroenterologists over the course of their health journey.

Method

We conducted 5 semi-structured online focus groups co-facilitated by patient researchers in early 2020 through Zoom which spanned for a total of 2.5 hours each. Participants were recruited through social media channels, GI clinics, the IMAGINE-SPOR unit, and Crohn’s and Colitis Canada. A semi-structured interview guide was developed for patient researchers to follow during the focus groups which provided guided questions that would allow patient participants to explore and reflect on: their experiences living with IBD, their expectations around mental health support, their perception of the engagement of GIs in mental health discussions, and their expectations for mental health support and services moving forward. Audio recordings from the semi-structured focus groups were then transcribed and thematic analysis was used to identify emerging themes and patient expectations.

Result(s)

We identified the following key themes: 1) experiences with IBD: difficulties related to reintegrating into social settings, feelings of loneliness; 2) expectations around mental health support: the need to develop their own resiliency strategies due to the lack of structural resources regarding mental health and IBD in the clinical space; 3) GI engagement: HCPs were dismissive of mental health symptoms, often gaslighting patients when mentioning mental health concerns during clinical encounters; and 4) expectations: a need to standardize mental health care across IBD care practice with a focus on potentially integrating healthcare providers of diverse care settings to help address the need for mental health support in such a vast patient population.

Conclusion(s)

Our study suggests that effective detection, management and awareness, along with the integration of feedback from patient lived experiences can help inform the development of mental health support and services which cater to the needs of people living with IBD. Results from this study will be interpreted in line with insight gathered from upcoming interviews of gastroenterologists and HCPs.

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CIHR, Other

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IMAGINE SPOR INCUBATOR Grant

Disclosure of Interest

None Declared

Higher psycho-physiological refinement in world-class Norwegian athletes: brain measures of performance capacity

This study tested the hypothesis that the degree of psycho-physiological development is related to performance level in world-class athletes. We compared physiological and psychological patterns of 33 Norwegian world-class athletes to patterns in 33 average performing athletes. The subjects were matched for gender, age, and type of sport. Electroencephalography activity was recorded to measure brain integration; skin conductance was recorded to measure habituation to a loud stimulus; and paper-and-pencil tests were given to assess self-development, moral development, and frequency of peak experiences. A factor analysis (varimax rotation) reduced the eight variables to three factors that together accounted for 65.3% of the total variance: (1) physiological integration--brain integration and habituation rates, (2) self- and moral development, and (3) peak experiences. A MANOVA conducted on the factor scores showed a significant main effect for the experimental group collapsing across the three factors (P<0.0001). Individual ANOVAs showed significantly higher values for development (P=0.021) and physiological integration (P<0.0001) factor scores for the world-class athletes. The above measures can be seen as different expressions of an underlying dimension--human development. These data support the concept that higher psycho-physiological growth underlies higher performance.

Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure

BACKGROUND AND PURPOSE

The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores.

SUBJECTS AND METHODS

A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability.

RESULTS

The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall.

CONCLUSION AND DISCUSSION

These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress.

Glycolipids of human primary testicular germ cell tumours

The glycolipid content of human non-seminomatous germ cell tumour cell lines correlates with their differentiation lineage. To analyse whether this reflects the situation in primary tumours, we studied five embryonal carcinomas, five yolk sac tumours and nine (mixed) non-seminomas, using thin-layer chromatography and carbohydrate immunostaining. We also analysed the glycolipid content of 19 seminomas to reveal their relationship with non-seminomas. Lactosylceramide (CDH) was detected in all embryonal carcinomas, but in fewer than half of the seminomas. Seminomas and embryonal carcinomas contained globoseries glycolipids, including globotriosylceramide (Gb3), globoside (Gb4), galactosy globoside (Gb5) and sialy1 galactosyl globoside (GL7). The lacto-series glycolipid Le(x) was found in all embryonal carcinomas, but only in one seminoma. Gangliosides GD3 and GT3 were detected in many seminomas, but rarely in embryonal carcinomas. Yolk sac tumours displayed a heterogeneous glycolipid profile. Compared with seminomas and pure embryonal carcinomas, differentiated non-seminomas had reduced levels of globo-series glycolipids, especially Gb3 and Gb5, whereas CDH, Le(x), GD3 and GT3 were found in the majority of cases. Thus, the glycolipid content of non-seminoma cell lines reflects the situation in primary tumours. Globo-series glycolipids are similarly expressed in seminomas and embryonal carcinomas. The expression of Gb3 and Gb5 is reduced in non-seminomas upon differentiation. Le(x) expression in non-seminomas, including embryonal carcinomas, allows discrimination from seminomas. Expression of gangliosides in seminomas might indicate their maturation from ganglioside-negative precursor cells. Reprogramming of these precursors would result in the formation of Le(x)-expressing embryonal carcinomas.

Invincible Athletics program: aerobic exercise and performance without strain

This study compared physiologic pattern during conventional aerobic exercise to those during Invincible Athletics--a program emphasizing balance and comfort during exercise to increase strength, endurance, and mind-body coordination gradually without the negative effects of the stress/recovery cycle. While heart rats were similar during both workouts, during Invincible Athletics: (1) perceived comfort tended to be higher and perceived exertion tended to be lower; (2) breath rates were significantly lower; (3) respiratory sinus arrhythmia and central-parietal alpha relative power were significantly higher; and (4) endurance was significantly longer. Respiratory sinus arrhythmia decreases with physiologic and mental stress. Heightened respiratory sinus arrhythmia and EEG alpha relative power along with subjective reports of greater comfort, less exertion, and observed increased endurance suggest that during Invincible Athletics athletes may be more easily adapting to the demands made upon them.

Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Clinical impact in the emergency room

We prospectively studied the performance of emergency room strategies using a single sampling of total creatine kinase (CK) only and total CK with, if total CK levels were elevated, CK-MB levels in 639 patients with acute chest pain, including 386 patients who were admitted and 253 patients who were discharged. Acute myocardial infarction was diagnosed in 104 patients and excluded in 535. An elevated total CK level had a sensitivity of only 38% and specificity of only 80%, whereas a CK-MB level over 5% of an elevated total CK level had a sensitivity of only 34% and specificity of 88%. The sensitivities of both CK and CK-MB were higher in patients who arrived more than four hours after the onset of symptoms, and, in this population, the strategy using CK-MB performed significantly better than the strategy using total CK alone. Since a very positive CK-MB in a low-risk patient can greatly raise the probability of myocardial infarction, future strategies using CK-MB may have a role in selected subsets in determining which patients should not be sent home. However, the sensitivity of a single sampling of CK and CK-MB is too low for these assays to be used to exclude myocardial infarction in the emergency room or to be used as the rationale for deciding not to admit a patient.

Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy

Our study addresses the question of efficacy of drainage after cholecystectomy by evaluation of the leakage of radiolabeled bile. Based on our data, drains placed at the time of surgery do not appear to reliably remove bile or to decrease morbidity. Our study reveals that bile leakage after cholecystectomy is frequent, cannot be accurately predicted at operation, is not related to the experience of the operating surgeons, and does not necessarily correlate with morbidity. The shorter postoperative hospital stay in the group of patients with subhepatic bile leakage compared with the group without evidence of leakage after cholecystectomy is not statistically significant. However, this trend does suggest that there is no increase in morbidity associated with bile leakage per se. A large, clinically significant bile leak can easily be treated by modern interventional radiologic techniques if drainage is indicated. A larger, double-blind study is necessary to further evaluate the issues surrounding bile leakage and drainage after cholecystectomy.

Gallium-67 citrate scanning--a new adjunct in the detection and follow-up of extrapulmonary tuberculosis: concise communication

Gallium-67 citrate scans were obtained in 11 patients considered at risk for extrapulmonary tuberculosis. Radiographic and bacteriologic studies were performed routinely and tissue biopsy selectively. Of five patients with proven extrapulmonary tuberculosis, there were three with renal tuberculosis, one with Pott's disease, and one with peritoneal tuberculosis. The Ga-67 scan correctly predicted presence or absence of active extrapulmonary foci in all 11 patients. Follow-up scans correlated well with clinical response to therapy. The diagnosis of extrapulmonary tuberculosis is often overlooked because of nonspecific symptoms and frequent lack of concurrent lung involvement. Scanning with Ga-67 citrate offers a reliable and simple means of screening patients at risk and of monitoring response to treatment.

Azotobacter vinelandii RNA polymerase. VII. Enzyme transitions during unprimed r[I-C] synthesis

Transitions in the state of RNA polymerase were demonstrated during the unprimed synthesis of the r[I-C] copolymer. No detectable change in the usual dimer-monomer pattern was noted during the lag phase (0-25 min at 37 degrees ) after analysis of the reaction mixture by acrylamide gel electrophoresis. At the end of the lag phase, a major alteration in the electrophoretic pattern occurred, marked by the disappearance of the dimer-monomer bands and the concomitant appearance of a series of monomer-r[I-C] copolymer complexes. As these complexes of r[I-C] copolymer with one or more polymerase monomer were formed, an enzymatically inactive component (gamma protein) of the polymerase was displaced. During the phase of rapid r[I-C] copolymer synthesis, the active form of the A. vinelandii RNA polymerase was the r[I-C] monomer lacking the gamma protein.