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Murthy SK, Weizman AV, Kuenzig ME, Windsor JW, Kaplan GG, Benchimol EI, Bernstein CN, Bitton A, Coward S, Jones JL, Lee K, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Sabrie N, Gupta S, Brar G, Khan R, Im JHB, Davis T, Weinstein J, St-Pierre J, Chis R, Meka S, Cheah E, Goddard Q, Gorospe J, Kerr J, Beaudion KD, Patel A, Russo S, Blyth J, Blyth S, Charron-Bishop D, Targownik LE. The 2023 Impact of Inflammatory Bowel Disease in Canada: Treatment Landscape. J Can Assoc Gastroenterol 2023; 6:S97-S110. [PMID: 37674501 PMCID: PMC10478812 DOI: 10.1093/jcag/gwad015] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
The therapeutic landscape for inflammatory bowel disease (IBD) has changed considerably over the past two decades, owing to the development and widespread penetration of targeted therapies, including biologics and small molecules. While some conventional treatments continue to have an important role in the management of IBD, treatment of IBD is increasingly moving towards targeted therapies given their greater efficacy and safety in comparison to conventional agents. Early introduction of these therapies-particularly in persons with Crohn's disease-combining targeted therapies with traditional anti-metabolite immunomodulators and targeting objective markers of disease activity (in addition to symptoms), have been shown to improve health outcomes and will be increasingly adopted over time. The substantially increased costs associated with targeted therapies has led to a ballooning of healthcare expenditure to treat IBD over the past 15 years. The introduction of less expensive biosimilar anti-tumour necrosis factor therapies may bend this cost curve downwards, potentially allowing for more widespread access to these medications. Newer therapies targeting different inflammatory pathways and complementary and alternative therapies (including novel diets) will continue to shape the IBD treatment landscape. More precise use of a growing number of targeted therapies in the right individuals at the right time will help minimize the development of expensive and disabling complications, which has the potential to further reduce costs and improve outcomes.
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Affiliation(s)
- Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Adam V Weizman
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Nasruddin Sabrie
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarang Gupta
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gurmun Brar
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joëlle St-Pierre
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roxana Chis
- Department of Gastroenterology and Hepatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Saketh Meka
- Department of Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Eric Cheah
- Department of Gastroenterology and Clinical Nutrition, The Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jack Kerr
- Department of Medicine, Memorial University of Newfoundland, St John’s Newfoundland, Canada
| | - Kayla D Beaudion
- Department of Interdisciplinary Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sophia Russo
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Colombia, Canada
| | | | | | | | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Khan R, Homsi H, Gimpaya N, Lisondra J, Sabrie N, Gholami R, Bansal R, Scaffidi MA, Lightfoot D, James PD, Siau K, Forbes N, Wani S, Keswani RN, Walsh CM, Grover SC. Validity evidence for observational ERCP competency assessment tools: a systematic review. Endoscopy 2023; 55:847-856. [PMID: 36822219 DOI: 10.1055/a-2041-7546] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND : Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical for supporting learning and documenting attainment of skill. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. METHODS : We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. RESULTS : From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one for simulated ERCP, and one for simulated and clinical ERCP. Validity evidence scores ranged from 2 to 12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence, with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality (maximum score 13.5) was strong, with scores ranging from 10 to 12.5. CONCLUSIONS : The BESAT, ERCP DOPS, and TEESAT had strong validity evidence compared with other assessments. Integrating tools into training may help drive learners' development and support competency decision making.
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Affiliation(s)
- Rishad Khan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Hoomam Homsi
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - James Lisondra
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | | | - Reza Gholami
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
| | - Rishi Bansal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - David Lightfoot
- Health Science Library, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| | - Paul D James
- Division of Gastroenterology, University Health Network, Toronto, Canada
| | - Keith Siau
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, United Kingdom
- Immunology and Immunotherapy, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rajesh N Keswani
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Catharine M Walsh
- The Wilson Centre, University of Toronto, Toronto, Canada
- SickKids Research and Learning Institute, The Hospital for Sick Children, Toronto, Canada
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Toronto, Canada
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Sabrie N, Jogendran M, Jogendran R, Targownik L. A209 ASSESSMENT OF OUTCOMES OF PATIENTS ADMITTED WITH ACUTE, SEVERE ULCERATIVE COLITIS ON ESTABLISHED BIOLOGIC THERAPY: A SINGLE CENTRE RETROSPECTIVE ANALYSIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991267 DOI: 10.1093/jcag/gwac036.209] [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 Acute, severe, ulcerative colitis (ASUC) is associated with a high morbidity and mortality. Current guidelines recommend the initiation of high dose intravenous steroids, followed by anti-TNF therapy if a satisfactory therapeutic response is not rapidly achieved. However, guidelines are agnostic on how to manage patients who are admitted for ASUC despite being on established biologic therapy. Furthermore, short-term clinical outcomes in this population are not well characterized. Purpose The aim of this study is to assess the differences in short-term clinical outcomes in patients admitted with ASUC who are on established biologic therapy compared to those not on established biologic therapy. Method We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until December 2021. Patients were included if they were deemed to have a severe flare, defined as having 6 or more loose bowel movements per day with at least one of the following features: temperature of 38.0 Celsius, tachycardia, anemia, or elevated inflammatory markers. Included subjects were considered to be on established biologic therapy if they had a biologic within 56 days prior to admission, all other admitted subjects were included as controls. Our primary outcome was the difference in hospital length of stay (HLOS). We also contrasted duration of intravenous steroids, rates of surgical consultation, rates of in-hospital colectomy, and readmission rates within 90 days of discharge. Result(s) 130 charts were included in our study, 53 of which were patients on established biologic therapy, and 77 of which were patients not on established biologic therapy. The HLOS between the two groups was not significantly different, (7.23 days [established biologic therapy] vs.7.47 days [not on biologic therapy], p value = 0.77). Patients on established biologic therapy were more likely to receive an inpatient surgical consultation (33.96% vs 7.79%, p-value <0.001). However, rates of colectomy prior to discharge were not statistically different (1.89% vs 0%, p-value = 0.23). Patients on established biologic therapy were significantly more likely to be readmitted within 90 days of discharge (30.19% vs 12.99%, p-value = 0.016). Image ![]()
Conclusion(s) Although there were no differences in HLOS and colectomy rates between the 2 groups, patients with ASUC on established biologic therapy were more likely to be readmitted within 3 months of discharge. Further work is required to define optimal medical management of persons admitted with ASUC who are failing biologic therapies. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | - L Targownik
- Gastroenterology, University of Toronto,Gastroenterology, Mount Sinai Hospital, Toronto, Canada
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Sabrie N, Seleq S, Homsi H, Khan R, Gimpaya N, Bansal R, Scaffidi M, Lightfoot D, Grover S. A128 GLOBAL TRENDS IN TRAINING AND CREDENTIALING GUIDELINES FOR GASTROINTESTINAL (GI) ENDOSCOPY: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991236 DOI: 10.1093/jcag/gwac036.128] [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 Credentialing in GI endoscopy is not a universally standardized process. National guidelines may provide a framework for local training, however in certain settings, training committees set minimal competency requirements that must be met before a clinician can be accredited to practice independently. There is a paucity of literature assessing the inter-societal and geographic variability in guidelines and training requirements in endoscopy. Purpose To systematically review the available credentialing guidelines proposed by different GI endoscopy societies and affiliated training committees internationally. Method We conducted a systematic review according to the PRISMA guidelines. A comprehensive literature search was performed for credentialing guidelines for GI endoscopy from inception until January 2022. Two reviewers screened and one reviewer abstracted data using a pre-defined data collection form. Result(s) From the 653 records obtained from our search, 20 credentialing guidelines from 12 different GI societies were ultimately included in the review. These guidelines encompassed the following procedures and outlined the following key-performance indicators; a) Colonoscopy: the recommended minimum number of procedures performed ranged from 150-275 with a minimum cecal intubation and adenoma detection rate of 85-90% and 20-30% respectively; b) EGD: the minimum number of procedures prior to credentialing ranged from 130-1000, the minimum duodenal intubation rate ranged from 95-100%, and the range for minimum number of upper GI bleeds managed was 20-45 (in addition to other procedural KPIs); c) ERCP: the recommended minimum number of procedures prior to credentialing ranged from 100-300 cases with a minimum selective duct cannulation rate of 80-90%. Guidelines for flexible sigmoidoscopy, EUS and capsule endoscopy were also obtained. Image ![]()
Conclusion(s) There is a general concordance amongst the various international GI societies with regards to minimum procedural volume and performance in key procedural tasks prior to credentialing, however the use of validated education assessment tools was lacking in the majority of guidelines. Additional KPI’s need to be explored for less routinely performed procedures such as EUS and capsule endoscopy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | - R Khan
- University of Toronto,Gastroenterology
| | | | | | | | | | - S Grover
- Gastroenterology,Gastroenterology, University of Toronto, Toronto, Canada
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Sabrie N, Jogendran R, Khan R, Scaffidi M, Gimpaya N, Lightfoot D, Grover S. A115 THE PERFORMANCE OF NATURAL LANGUAGE PROCESSING IN INTERPRETING COLONOSCOPY REPORTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991314 DOI: 10.1093/jcag/gwac036.115] [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 Screening colonoscopy is integral in the effort to identify and remove potentially cancerous lesions. Important quality indicators include the adenoma detection rate and more recently, the sessile/serrated adenoma detection rate. Natural language processing (NLP) is a computer-based linguistic technique that leverages artificial intelligence to abstract meaningful information from text. This tool carries the potential to automate the task of analyzing large volumes of colonoscopy and pathology reports to generate data on key performance metrics. Purpose The aim of this study is to systematically review the available literature on the performance of NLP in identifying the presence of an adenoma or a sessile/serrated adenoma in colonoscopy reports. Method We performed a systematic review and meta-analysis according to PRISMA recommendations. A comprehensive literature query was conducted on MEDLINE, EMBASE, CINAHL, and CDSR, through July 2022. Studies were included if they evaluated the performance of NLP in extracting data from colonoscopy reports. Our primary outcome was the performance of NLP models in correctly identifying an adenoma reported in a colonoscopy report. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the sensitivity and specificity of our primary outcome using a univariate analysis first, followed by a bivariate analysis. Using the open-source package ‘mada’ which is written in R, we generated a summary estimate and a summary receiver operating characteristic curve. Result(s) From the 1030 unique studies obtained from our literature search, 13 studies met the inclusion criteria. Eligible studies were used for our meta-analysis. In the univariate analysis, the pooled sensitivity and specificity for detecting an adenoma by the NLP systems was 0.978 (95% CI 0.938-0.992) and 0.997 (95% CI 0.984-0.999), respectively. Similarly, in univariate analysis, the pooled sensitivity and specificity for detecting a sessile/serrated adenoma by the NLP systems was 0.984 (95% CI 0.929-0.996) and 1.0 (95% CI 0.998-1.000), respectively. In the bivariate analysis, the summary estimates for the sensitivity and specificity of the NLP system in detecting an adenoma were 0.973 (95% CI 0.929-0.990) and 0.992 (95%CI 0.978-0.997) respectively. For detecting a sessile/serrated adenoma, the summary estimates for sensitivity and specificity were 0.964 (95% CI 0.895-0.988) and 0.998 (95% CI 0.995-0.999) respectively. Conclusion(s) NLP models have excellent performance in extracting quality metric data from colonoscopy reports. Based on the available literature, we suggest integration of NLP in quality improvement efforts in colonoscopy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | - R Khan
- University of Toronto,Gastroenterology
| | | | | | | | - S Grover
- Gastroenterology,Gastroenterology, University of Toronto, Toronto, Canada
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Khan R, Homsi H, Gimpaya N, Sabrie N, Gholami R, Bansal R, Scaffidi M, Lightfoot D, James P, Siau K, Forbes N, Wani S, Keswani R, Walsh C, Grover S. A117 VALIDITY EVIDENCE FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY COMPETENCY ASSESSMENT TOOLS: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991253 DOI: 10.1093/jcag/gwac036.117] [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 Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is essential to ensure trainees possess the skills needed for independent practice. Traditionally, ERCP training has used the apprenticeship model, whereby novices learn skills under the supervision of an expert. A growing focus on procedural quality, however, has supported the implementation of competency-based medical education models which require documentation of a trainee’s competence for independent practice. Observational assessment tools with strong evidence of validity are critical to this process. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. Purpose To conduct a systematic review of ERCP assessment tools and identify tools with strong evidence of validity using a unified validity evidence framework Method We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. Result(s) From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one on simulated ERCP, and one on simulated and clinical ERCP. Validity evidence scores ranged from 2-12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality was strong, with scores ranging from 10-12.5 (maximum 13.5). Conclusion(s) The BESAT, ERCP DOPS, and TEESAT have strong validity evidence compared to other assessments. Integrating tools into training may help drive learners’ development and support competency decision-making. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- R Khan
- Western University, London
| | | | | | | | | | | | | | | | - P James
- University Health Network, Toronto, Canada
| | - K Siau
- University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - N Forbes
- University of Calgary, Calgary, Canada
| | - S Wani
- University of Colorado Anschutz Medical Campus, Aurora
| | - R Keswani
- Northwestern University, Chicago, United States
| | - C Walsh
- The Hospital for Sick Children, Toronto, Canada
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Sabrie N, Khan R, Seleq S, Homsi H, Gimpaya N, Bansal R, Scaffidi MA, Lightfoot D, Grover SC. Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review. Endosc Int Open 2023; 11:E193-E201. [PMID: 36845269 PMCID: PMC9949985 DOI: 10.1055/a-1981-3047] [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] [Received: 07/22/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background and study aims Credentialing, the process through which an institution assesses and validates an endoscopist's qualifications to independently perform a procedure, can vary by region and country. Little is known about these inter-societal and geographic differences. We aimed to systematically characterize credentialing recommendations and requirements worldwide. Methods We conducted a systematic review of credentialing practices among gastrointestinal and endoscopy societies worldwide. An electronic search as well as hand-search of World Endoscopy Organization members' websites was performed for credentialing documents. Abstracts were screened in duplicate and independently. Data were collected on procedures included in each document (e. g. colonoscopy, ERCP) and types of credentialing statements (procedural volume, key performance indicators (KPIs), and competency assessments). The primary objective was to qualitatively describe and compare the available credentialing recommendations and requirements from the included studies. Descriptive statistics were used to summarize data when appropriate. Results We screened 653 records and included 20 credentialing documents from 12 societies. Guidelines most commonly included credentialing statements for colonoscopy, esophagogastroduodenoscopy (EGD), and ERCP. For colonoscopy, minimum procedural volumes ranged from 150 to 275 and adenoma detection rate (ADR) from 20 % to 30%. For EGD, minimum procedural volumes ranged from 130 to 1000, and duodenal intubation rate of 95 % to 100%. For ERCP, minimum procedural volumes ranged from 100 to 300 with selective duct cannulation success rate of 80 % to 90 %. Guidelines also reported on flexible sigmoidoscopy, capsule endoscopy, and endoscopic ultrasound. Conclusions While some metrics such as ADR were relatively consistent among societies, there was substantial variation among societies with respect to procedural volume and KPI statements.
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Affiliation(s)
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Canada,Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Samir Seleq
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Hoomam Homsi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Rishi Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | | | - David Lightfoot
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada
| | - Samir C. Grover
- Department of Medicine, University of Toronto, Toronto, Canada,Division of Gastroenterology, St. Michael’s Hospital, Toronto, Canada,The Centre for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, Toronto, Canada,Li Ka Shing Knowledge Institute, Toronto, Canada
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Abdel-Qadir H, Sabrie N, Leong D, Pang A, Austin PC, Prica A, Nanthakumar K, Calvillo-Argüelles O, Lee DS, Thavendiranathan P. Cardiovascular Risk Associated With Ibrutinib Use in Chronic Lymphocytic Leukemia: A Population-Based Cohort Study. J Clin Oncol 2021; 39:3453-3462. [PMID: 34464154 DOI: 10.1200/jco.21.00693] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Ibrutinib reduces mortality in chronic lymphocytic leukemia (CLL). It increases the risk of atrial fibrillation (AF) and bleeding and there are concerns about heart failure (HF) and central nervous system ischemic events. The magnitude of these risks remains poorly quantified. METHODS Using linked administrative databases, we conducted a population-based cohort study of Ontario patients who were treated for CLL diagnosed between 2007 and 2019. We matched ibrutinib-treated patients with controls treated with chemotherapy but unexposed to ibrutinib on prior AF, age ≥ 66 years, anticoagulant exposure, and propensity for receiving ibrutinib. Study outcomes were AF-related health care contact, hospital-diagnosed bleeding, new diagnoses of HF, and hospitalizations for stroke and acute myocardial infarction (AMI). The cumulative incidence function was used to estimate absolute risks. We used cause-specific regression to study the association of ibrutinib with bleeding rates, while adjusting for anticoagulation as a time-varying covariate. RESULTS We matched 778 pairs of ibrutinib-treated and unexposed patients with CLL (N = 1,556). The 3-year incidence of AF-related health care contact was 22.7% (95% CI, 19.0 to 26.6) in ibrutinib-treated patients and 11.7% (95% CI, 9.0 to 14.8) in controls. The 3-year risk of hospital-diagnosed bleeding was 8.8% (95% CI, 6.5 to 11.7) in ibrutinib-treated patients and 3.1% (95% CI, 1.9 to 4.6) in controls. Ibrutinib-treated patients were more likely to start anticoagulation after the index date. After adjusting for anticoagulation as a time-varying covariate, ibrutinib remained positively associated with bleeding (HR, 2.58; 95% CI, 1.76 to 3.78). The 3-year risk of HF was 7.7% (95% CI, 5.4 to 10.6%) in ibrutinib-treated patients and 3.6% (95% CI, 2.2 to 5.4) in controls. There was no significant difference in the risk of ischemic stroke or AMI. CONCLUSION Ibrutinib is associated with higher risk of AF, bleeding, and HF, but not AMI or stroke.
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Affiliation(s)
- Husam Abdel-Qadir
- Division of Cardiology and Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.,Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.,ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto
| | - Nasruddin Sabrie
- Division of Cardiology and Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Pang
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Peter C Austin
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anca Prica
- Department of Medicine, University of Toronto.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kumaraswamy Nanthakumar
- Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto.,The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, Toronto, Ontario, Canada
| | - Oscar Calvillo-Argüelles
- Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.,ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto
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Sabrie N, Leong D, Prica A, Austin P, Pang A, Fang J, Calvillo-Arguelles O, Lee D, Thavendiranathan P, Abdel-Qadir H. INCREASED RISK OF ADVERSE CARDIOVASCULAR EVENTS ASSOCIATED WITH IBRUTINIB USE IN CHRONIC LYMPHOCYTIC LEUKEMIA: A PROPENSITY-MATCHED POPULATION-BASED COHORT STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31041-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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