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Maniero C, Ng SM, Collett G, Godec T, Siddiqui I, Antoniou S, Kumar A, Janmohamed A, Nair S, Kotecha A, Khan R, Khanji MY, Kapil V, Gupta J, Gupta AK. Differential impact of COVID-19 on mental health and burnout. Occup Med (Lond) 2024; 74:45-52. [PMID: 37040624 PMCID: PMC10875923 DOI: 10.1093/occmed/kqad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. AIMS To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. METHODS In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role. RESULTS At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors. CONCLUSIONS Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.
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Affiliation(s)
- C Maniero
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - S M Ng
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - G Collett
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - T Godec
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - I Siddiqui
- Wellbeing Hub, Newham Training Hub, London E15 1HP, UK
- Northeast London CCG, London E15 1DA, UK
- Woodgrange Medical Practice, London E7 0QH, UK
| | - S Antoniou
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - A Kumar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan WN1 1XX, UK
| | - A Janmohamed
- St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - S Nair
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Wales LL18 5UJ, UK
| | - A Kotecha
- Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, UK
| | - R Khan
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - M Y Khanji
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- UCLPartners, London W1T 7HA, UK
- Newham University Hospital, Barts Health NHS Trust, London E13 8SL, UK
| | - V Kapil
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - J Gupta
- South West London and St George’s Mental Health NHS Trust, London SW17 0YF, UK
| | - A K Gupta
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
- William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- The Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
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2
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Khan R, Hodges BD, Martimianakis MA. When I say … burnout. Med Educ 2023; 57:704-705. [PMID: 37051872 DOI: 10.1111/medu.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
In the world of wellness, 'burnout' might as well be a God term. But what do we really mean when we say, "I'm burned out." And is this one little word enough?
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Affiliation(s)
- R Khan
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - B D Hodges
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Chao S, Khan R, Lieberman J, Buren M. Propofol-induced myoclonus during maintenance of anaesthesia. Anaesth Rep 2023; 11:e12253. [PMID: 37937281 PMCID: PMC10626004 DOI: 10.1002/anr3.12253] [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] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Myoclonus is a known side effect of propofol and can interfere with surgery and possibly precipitate patient injury. Here, we report a 23-year-old patient undergoing an L5 osteoblastoma resection with a predominantly propofol-based anaesthetic who developed intra-operative myoclonus. Other adjuncts included ketamine, lidocaine and fentanyl infusions. The myoclonus did not improve after deepening the anaesthetic with propofol, opioid boluses or discontinuation of the lidocaine infusion. The myoclonus ceased after reducing the propofol infusion and increasing the ketamine and opioid infusions. The remainder of the intra-operative course was uneventful. This report details our intra-operative management of propofol-induced cortical reflex myoclonus and discusses our institution's experience with treating this phenomenon.
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Affiliation(s)
- S Chao
- Department of Anesthesia and Perioperative Care University of California San Francisco San Francisco California USA
| | - R Khan
- Department of Anesthesia and Perioperative Care University of California San Francisco San Francisco California USA
| | - J Lieberman
- Department of Anesthesia and Perioperative Care University of California San Francisco San Francisco California USA
| | - M Buren
- Department of Anesthesia and Perioperative Care University of California San Francisco San Francisco California USA
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Nandi D, Gajarski R, Zhao H, Tully K, Cantor R, Birnbaum B, Zangwill S, Khan R, Godown J, Kirklin J, Friedland-Little J. Impact of Anti-HLA Antibody Desensitization Strategies in Pediatric Heart Transplant Recipients: A PHTS-PHIS Linkage Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.102] [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: 04/05/2023] Open
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Staron-Ehlinger M, Beasley G, Hardin T, Baker J, Khan R. Association Between Donor-Derived Cell-Free DNA Levels and Cardiac Pressures in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1334] [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: 04/05/2023] Open
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Khan R, Kuenzig E, Tang A, Im J, Widdifield J, McCurdy J, Kaplan G, Benchimol E. A177 RISK OF VENOUS THROMBOEMBOLISM IN COVID-19 PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED MATCHED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991269 DOI: 10.1093/jcag/gwac036.177] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Venous thromboembolism (VTE), is associated with significant morbidity and mortality. Inflammation increases the risk of VTE, and it is a well-recognised complication of both inflammatory bowel disease (IBD) and COVID-19. Purpose To compare the risk of VTE among individuals with and without IBD following a positive COVID-19 test. Method Using health administrative data from Ontario, Canada we conducted a retrospective matched cohort study.All Ontario residents with a positive SARS-CoV-2 PCR test between January 1,2020 and December 30,2021 who had been diagnosed with IBD prior to their COVID-19 infection (identified using a validated algorithm) were matched to 5 individuals without IBD based on year of birth, sex, mean neighbourhood income quintile, date of positive COVID-19 test, and rural/urban residence. Individuals with a cancer diagnosis in the 5 years prior to their first COVID-19 positive test were excluded. Individuals were followed from positive COVID-19 PCR test until VTE event, death, migration out of Ontario or March 31, 2022.VTEs were identified from emergency department or hospitalization data using ICD-10 codes. Incidence rate of VTEs among individuals with IBD were assessed at 1, 6 and 12 months. Proportional cause-specific hazards models compared the risk of VTEs in people with and without IBD, treating death as a competing risk and controlling for vaccination status (2nd dose ≥14 days prior to positive COVID-19 test) and a history of VTE (VTE in the 5 years prior to infection). Result(s) There were 4293 people with IBD (44% Crohn’s disease, mean age ±SD 46.1±17.2 y) matched to 20,207 with out IBD (mean age 45.3±16.8 y) with a positive SARS-CoV-2 PCR test. Within 1 month of a positive COVID-19 test, the crude incidence rate of VTE in individuals with IBD was 4.77(95%CI, 4.75-4.80) per 100,000 person-days compared to 8.25(95%CI, 8.20-8.30) per 100,000 among people without IBD.Within 6 months, these rates were 1.86(95%CI, 1.86-1.87) and 2.12(95%CI, 2.11-2.12) per 100,000 person-days among people with and without IBD, respectivley. Within 12 months, these rates were 1.59(95% CI, 1.58-1.59) and 1.42(95% CI, 1.42-1.42) per 100,000 person-days among people with and without IBD, respectively.After adjusting for vaccination status and history of VTE there was no difference in the risk of VTE for people with and without IBD (HR 1.08, 95%CI, 0.64 to 1.83). Conclusion(s) IBD patients with COVID-19 were not more likely to experience a VTE infection compared with the general popluation. The risk of VTE was highest soon after COVID-19 and declined thereafter. 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
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto,ICES
| | - E Kuenzig
- Child Health Evaluative Sciences, SickKids Research Institute
| | - A Tang
- Child Health Evaluative Sciences, SickKids Research Institute
| | - J Im
- Child Health Evaluative Sciences, SickKids Research Institute
| | - J Widdifield
- ICES,Institute of Health Policy, Management and Evaluation, University of Toronto
| | - J McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Toronto, Canada
| | - E Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, University of Toronto,ICES,Child Health Evaluative Sciences, SickKids Research Institute,Institute of Health Policy, Management and Evaluation, University of Toronto
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7
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Fujiyoshi MRA, Fujiyoshi Y, Gimpaya N, Bechara R, Jeyalingam T, Calo NC, Forbes N, Khan R, Atalla M, Toshimori A, Shimamura Y, Tanabe M, Mosko J, Inoue H, Grover S. A114 UNIFIED MAGNIFYING ENDOSCOPIC CLASSIFICATION (UMEC) FOR GASTROINTESTINAL LESIONS: A NORTH AMERICAN EDUCATION STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991233 DOI: 10.1093/jcag/gwac036.114] [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
Abstract
Background
Magnification endoscopy and magnification narrow-band imaging are image enhanced endoscopy technologies that may allow for the diagnosis of advanced neoplasia in the GI tract on the basis of imaging characteristics. Recently, the Unified Magnifying Endoscopic Classification (UMEC) has been developed, which unified the criteria for the esophagus, stomach, and colon. UMEC divides optical diagnosis into one of the three categories: non-neoplastic, intramucosal neoplasia, and deep submucosal invasive cancer.
Purpose
The objective of this study is to educate North American endoscopists on the use of the UMEC schema, and to ascertain performance of the UMEC framework among North American endoscopists.
Method
Using UMEC, five North American endoscopists (>1000 procedures) without prior training in magnifying endoscopy independently diagnosed previously collected endoscopic image set of the esophagus, stomach, and colon. The endoscopists were trained on the use of UMEC via an eleven-minute training video with exemplars of each element of UMEC from esophagus, stomach, and colon. All endoscopists were blinded to white-light and non-magnifying NBI findings as well as histopathological diagnosis. The diagnostic performance of UMEC was assessed while using the gold standard histopathology as a reference.
Result(s)
A total of 299 gastrointestinal lesions (77 esophagus, 92 stomach, and 130 colon) were assessed using UMEC. For esophageal squamous cell carcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 65.2% (95% CI: 50.9–77.9) to 87.0% (95% CI: 75.3–94.6), 77.4% (95% CI: 60.9–89.6) to 96.8% (95% CI: 86.8–99.8), and 75.3% to 87.0%, respectively. For gastric adenocarcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 94.9% (95% CI: 85.0–99.1) to 100%, 52.9% (95% CI: 39.4–66.2) to 92.2% (95% CI: 82.7–97.5), and 73.3% to 93.3%, respectively. For colorectal adenocarcinoma, the sensitivity, specificity, and accuracy for all 5 endoscopists ranged from 76.2% (95% CI: 62.0–87.3) to 83.3% (95% CI: 70.3–92.5), 89.7% (95% CI: 82.1–94.9) to 97.7% (95% CI: 93.1–99.6), and 86.8% to 90.7%, respectively.
Image
Conclusion(s)
UMEC is a simple and practical classification that can be used to introduce and educate endoscopists to magnification narrow-band imaging and optical diagnosis.
Please acknowledge all funding agencies by checking the applicable boxes below
CAG
Disclosure of Interest
M. R. A. Fujiyoshi Grant / Research support from: 2022 CAG/AbbVie Education Research Grant, Y. Fujiyoshi: None Declared, N. Gimpaya: None Declared, R. Bechara: None Declared, T. Jeyalingam: None Declared, N. Calo: None Declared, N. Forbes: None Declared, R. Khan: None Declared, M. Atalla: None Declared, A. Toshimori: None Declared, Y. Shimamura: None Declared, M. Tanabe: None Declared, J. Mosko: None Declared, H. Inoue: None Declared, S. Grover: None Declared
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Affiliation(s)
- M R A Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - Y Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - N Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - R Bechara
- Division of Gastroenterology, Kingston General and Hotel Dieu Hospital, Queen's University , Kingston
| | - T Jeyalingam
- Division of Gastroenterology, University Health Network, University of Toronto , Toronto
| | - N C Calo
- Division of Gastroenterology, University of Ottawa , Ottawa
| | - N Forbes
- Division of Gastroenterology, University of Calgary , Calgary , Canada
| | - R Khan
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - M Atalla
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - A Toshimori
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - Y Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - M Tanabe
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - J Mosko
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , Toronto , Canada
| | - H Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital , Tokyo , Japan
| | - S Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto , 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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Zhao AY, Gimpaya N, Lisondra J, Fujiyoshi R, Fujiyoshi Y, Khan R, Tham D, Scaffidi MA, Bansal R, Walsh C, Grover SC. A119 DEVELOPMENT AND EVALUATION OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991154 DOI: 10.1093/jcag/gwac036.119] [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 Polypectomy is an essential skill for endoscopists to acquire. As polyps are encountered ad hoc during colonoscopies, exposure to polypectomy in clinical training may vary. There is a need to deliver a curriculum that standardizes exposure to polypectomy while remaining cost-effective for endoscopy programs worldwide. Purpose To develop low-cost simulated polyps that can be incorporated into endoscopic training programs, and to evaluate their perceived realism and useability for polypectomy training. Method We designed 3D molds based on the Paris classification, a validated rubric for polyp morphology. The polyps are depicted in Figure 1. Using low-cost materials, we created gel-based polyps compatible with physical colonic simulators. Current versions of the polyps were finalized based on visual realism and durability. Expert (performed >1000 procedures) and novice (<25 procedures) endoscopists were invited to perform simulated polypectomies and evaluate the realism of the polyps. Using a 7-point Likert scale (“strongly disagree” to “strongly agree”), we administered a survey adapted from the Direct Observed Polypectomy Skills (DOPyS) checklist to evaluate the polyps on practicality of design and useability for training. Additionally, the simulator’s resemblance to human polypectomy was assessed through a scale with 1 indicating “low resemblance” and 7 indicating “high resemblance”. The ease of identifying morphology was also evaluated, with 1 indicating “difficult” and 7 indicating “easy”. Result(s) The survey was completed by 11 expert endoscopists and 10 novices. The median score submitted by experts on the polyps’ useability in training the technique for mobilization of the polyp was 7 (IQR 6-7). Experts rated the simulator’s practicality in teaching cold snare or electrocautery techniques with a median score of 6 (IQR 6-7). Lastly, the ability of the simulator to develop skills in identifying and treating the residual polyp was assessed by expert endoscopists, giving it a median score of 6 (IQR 6-7). The simulators were tested on similarity to human polypectomy, with the median score of expert groups being 5 (IQR 5-6), and novice groups being 6 (IQR 6-6). Both groups were asked to rate if morphology could be identified using the simulator; the median score of expert groups being 6 (IQR 6-7), and 6.5 for novice endoscopists (IQR 5-7). Image ![]()
Conclusion(s) The development of simulated polyps with differing morphologies using low-cost and common materials with high realism is feasible. These polyps may potentially be integrated into different endoscopic training programs. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest A. Zhao: None Declared, N. Gimpaya: None Declared, J. Lisondra: None Declared, R. Fujiyoshi: None Declared, Y. Fujiyoshi: None Declared, R. Khan Grant / Research support from: Rishad Khan has received research grants from AbbVie (2018) and Ferring Pharmaceuticals (2019) and research funding from Pendopharm (2019). , D. Tham: None Declared, M. Scaffidi: None Declared, R. Bansal: None Declared, C. Walsh: None Declared, S. Grover Shareholder of: Samir C. Grover has equity in Volo Healthcare., Grant / Research support from: Samir C. Grover has received research grants and personal fees from AbbVie and Ferring Pharmaceuticals, personal fees from Takeda, education grants from Janssen.
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Affiliation(s)
- A Y Zhao
- Division of Gastroenterology, St. Michael's Hospital
| | - N Gimpaya
- Division of Gastroenterology, St. Michael's Hospital
| | - J Lisondra
- Division of Gastroenterology, St. Michael's Hospital
| | - R Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - Y Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Khan
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
| | - D Tham
- Division of Gastroenterology, St. Michael's Hospital
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital
| | - R Bansal
- Division of Gastroenterology, St. Michael's Hospital
| | - C Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children,Department of Pediatrics, University of Toronto Faculty of medicine,The Wilson Centre, University of Toronto, Toronto, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael's Hospital,Department of Medicine, University of Toronto
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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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12
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Khan R, Nijhawan A, Shick C, Salazar S, Pourmoussa A, Saxena A, Hasan M, Schiro B. Abstract No. 181 Evaluation of Carotid Artery Stenosis Using 3D/4D Vessel Cast. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.238] [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: 02/26/2023] Open
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13
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Mariappan P, Johnston A, Trail M, Hamid S, Hollins G, Dreyer B, Ramsey S, Padovani L, Guerrero Enriquez J, Simpson H, Hasan R, Sharpe C, Thomas B, Bhatt J, Ahmad I, Nandwani G, Chaudhry A, Boden A, Khan R, Maresca G, Dimitropoulos K, Graham C, Hendry D. Can repeat TURBT in patients presenting with High Grade Ta Urothelial Carcinoma be more nuanced? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00752-2] [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: 02/12/2023]
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14
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Obiechina N, Michael A, Gill A, Carey P, Shah G, Nehikhare I, Khan R, Slavica M, Khan T, Rahman S, Mushtaq W, Brar H, Senthilselvan S, Mukherjee B, Nandi A. 1251 FRAILTY PREVALENCE AND RISK OF SARCOPENIA IN OLDER HEART FAILURE (HF) INPATIENTS. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.044] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Abstract
Introduction
Both frailty and HF are common in the elderly population. Elderly HF patients have an increased risk of frailty and elderly frail patients are at a higher risk of developing HF. Frailty is an independent predictor of mortality in cardiovascular disease. Sarcopenia (defined as decreased muscle mass and muscle strength and/or performance) is also prevalent in HF patients and may progress to cardiac cachexia. HF may induce sarcopenia and sarcopenia may contribute to the poor prognosis of HF.
Aims
Methods
A cross-sectional, retrospective analysis of consecutive patients, 60 years and over, admitted with HF to a UK hospital. Data was manually extracted from anonymized electronic records. The Rockwood Clinical Frailty Scale (CFS) was used for assessment for frailty and the SARC-F tool was used for screening for sarcopenia. Patients with medical history of HF but did not present with decompensated HF were excluded. Also, patients with incomplete data were excluded. The IBM SPSS 28 statistical package was used for statistical analysis. Descriptive statistics and risk estimates were calculated.
Results
163 patients were analysed; 82 males and 81 females. The mean age was 81.4 years (SD 9.69). 71.5 % of patients were frail while 28.5 % were non-frail. The risk of sarcopenia was 10.9 times greater in the frail than in the non-frail patients (OR = 10.9; 95% C.I 4.85 – 24.67). There was a lower risk of sarcopenia in male patients than in the female patients (OR =0.45; 95% C.I 0.22 – 0.94).
Conclusions
Frailty is prevalent in older heart failure inpatients. It significantly increases the risk of sarcopenia in these patients. Women are at higher risk of sarcopenia than men. More research is needed into frailty and sarcopenia in.
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Affiliation(s)
| | | | - A Gill
- Queen's Hospital , Burton on Trent, UK
| | - P Carey
- Queen's Hospital , Burton on Trent, UK
| | - G Shah
- Queen's Hospital , Burton on Trent, UK
| | | | - R Khan
- Queen's Hospital , Burton on Trent, UK
| | - M Slavica
- Queen's Hospital , Burton on Trent, UK
| | - T Khan
- Queen's Hospital , Burton on Trent, UK
| | - S Rahman
- Queen's Hospital , Burton on Trent, UK
| | - W Mushtaq
- Queen's Hospital , Burton on Trent, UK
| | - H Brar
- Queen's Hospital , Burton on Trent, UK
| | | | | | - A Nandi
- Queen's Hospital , Burton on Trent, UK
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15
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Shah G, Nehikhare I, Obiechina N, Michael A, Gill A, Carey P, Khan R, Slavica M, Khan T, Rahman S, Mushtaq W, Brar H, Senthilselvan S, Mukherjee M, Nandi A. 1242 CO-MORBIDITY, FRAILTY AND EJECTION FRACTION IN OLDER HEART FAILURE INPATIENTS. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.007] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Co-morbidities and frailty are common in older heart failure patients. The aim of this study is to explore the relationship between co-morbidity, frailty and ejection fraction (EF) in older heart failure inpatients
Methods
A cross-sectional, observational, retrospective analysis of consecutive patients aged 60 years and over who were admitted with heart failure in a UK hospital. Patients with incomplete data were excluded. The Carlson’s comorbidity index (CCI) was used to compute comorbidity and the Rockwood Clinical Frailty Scale (CFS) was used to measure frailty. The EF was calculated as the midpoint of the ranges measured by echocardiography. IBM SPSS 28 software was used for statistical analysis. Descriptive statistics were used to measure baseline characteristics and Pearson’s correlation coefficient and linear regression were used to calculate correlation.
Results and discussion
101 patients were analysed; 48 males and 53 females. Mean age was 81.2 years(SD 9.98). Mean CCI was 6.97(SD 1.63) and mean CFS was 5.09(SD 1.14). There was statistically significant positive correlation between CCI and CFS (r= 0.232; p= .01). There was statistically significant inverse correlation between CCI and EF (r= -.277; p=. 005). When taking into account the level of frailty the correlation between CCI and EF was much stronger in non-frail than in frail patients (r= -.612; p=. 035 and r= -.216; p= .047 respectively). There was no correlation between CFS and EF (r= .095; p=.26). This was not surprising as HFpEF is the most common type of HF in the elderly. HFpEF patients are more likely to have more comorbidities and to be more frail compared to HFrEF patients.
Conclusion
There was a positive correlation between multi-morbidity and frailty in older inpatients admitted with heart failure. There was statistically significant inverse correlation between CCI and ejection fraction but there was no correlation between frailty and ejection.
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Affiliation(s)
- G Shah
- Queen's Hospital , Burton on Trent, UK
| | | | | | | | - A Gill
- Queen's Hospital , Burton on Trent, UK
| | - P Carey
- Queen's Hospital , Burton on Trent, UK
| | - R Khan
- Queen's Hospital , Burton on Trent, UK
| | - M Slavica
- Queen's Hospital , Burton on Trent, UK
| | - T Khan
- Queen's Hospital , Burton on Trent, UK
| | - S Rahman
- Queen's Hospital , Burton on Trent, UK
| | - W Mushtaq
- Queen's Hospital , Burton on Trent, UK
| | - H Brar
- Queen's Hospital , Burton on Trent, UK
| | | | | | - A Nandi
- Queen's Hospital , Burton on Trent, UK
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16
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Khan W, Rahman A, Zaman S, Kabir M, Khan R, Ali W, Ahmad S, Shabir S, Jamil S, Ríos-Escalante PDL. Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan. BRAZ J BIOL 2023; 83:e244966. [DOI: 10.1590/1519-6984.244966] [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] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract Dengue fever (DF) is increasingly recognized as one of the world’s major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.
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Affiliation(s)
- W. Khan
- University of Malakand, Pakistan
| | | | - S. Zaman
- University of Malakand, Pakistan
| | - M. Kabir
- University of Sargodha, Pakistan
| | - R. Khan
- University of Malakand, Pakistan
| | - W. Ali
- University of Malakand, Pakistan
| | - S. Ahmad
- University of Malakand, Pakistan
| | - S. Shabir
- Agriculture University Faisalabad, Pakistan
| | - S. Jamil
- Rawalpindi Women University, Pakistan
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17
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Amer S, Aboeldalyl S, Tarbox R, Shawki H, Ibrahim E, Seyam E, Khan R. P-658 NLRP3 Inflammasome and polycystic ovarian syndrome – a possible novel association. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.607] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is NLRP3 inflammasome expression in subcutaneous adipose tissue (SAT) and peripheral blood monocytes upregulated in women with polycystic ovarian syndrome (PCOS) compared to healthy controls?
Summary answer
NLRP3 expression was upregulated in subcutaneous adipose tissue but not in peripheral blood mononuclear cells (PBMCs) of women with PCOS compared to controls.
What is known already
Emerging evidence strongly suggests that PCOS is a chronic inflammatory condition. Inflammasomes are multiprotein complexes, which act as intracellular regulators of inflammation. It is now well established that NLRP3 inflammasome plays a central role in obesity-induced inflammation and insulin resistance. Given the close link between obesity and PCOS, it is plausible to hypothesize that the NLRP3 inflammasome may play a role in PCOS-related chronic inflammation and insulin resistance. This hypothesis has never been investigated before.
Study design, size, duration
This lab-based study involved reproductive age women (age 18–45years; BMI≤40kg/m2) who were diagnosed with PCOS (n = 24) according to the Rotterdam criteria. A healthy control group of non-PCOS women (n = 13) of similar age and BMI was included. Ethics approval was obtained, and all participants signed a written, informed consent. SAT biopsies were obtained during routine gynaecological surgery through the abdominal skin incision. Blood samples were obtained during surgery or during clinic visits.
Participants/materials, setting, methods
Blood samples were processed to separate plasma and to isolate peripheral blood mononuclear cells (PBMCs). SAT and PBMCs were analysed using qPCR and Western Blot (WB) to measure the relative gene and protein expression levels of NLRP3, CYP17, Caspase-1, IL-1β and IL-18 in both groups. ELISA was used to measure concentrations of Caspase-1, IL-1β and IL-18 in the plasma.
Main results and the role of chance
NLRP3 gene expression in SAT was significantly (p = 0.038) higher in PCOS women (2.08±3.5 (n = 12)) compared to controls (0.77±2.9 (n = 8)). Both groups were matched for age (PCOS, 29.4±3.7 vs controls, 30.3±4.0) and BMI (PCOS, 25.4±3.2 vs controls, 26.9±4.3). CYP17 expression was significantly (p = 0.001) higher in PCOS women (4.8±0.1) versus controls (1.5±1.6). There was a moderate positive correlation (r²=0.576, P < 0.05) between SAT NLRP3 and CYP17 expressions.
NLRP3 gene expression in PBMCs were not significantly (p < 0.05) different between non-obese PCOS (-2.64±1.55 (n = 4)), obese PCOS (-2.847±1.85 (n = 8)) and non-PCOS women (0.000±2.67 (n = 5)).
Using WB in PBMCs, NLRP3 band had a mean molecular weight of 72.59±5.43kDa with no significant difference between groups, with a trend towards higher levels in PCOS. Using ELISA in PBMCs, NLRP3 levels were not significantly (p = 0.3) different between PCOS (1.53±1.32pg/ml (n = 12)) vs controls (1.03±0.583 (n = 5)).
Gene expression levels of Caspase-1, IL-1b and IL-18 in PBMCs were not significantly (P > 0.05) different between groups.
Plasma IL-1β levels were significantly (p < 0.05) higher in PCOS (51.64±91.00ng/ml) vs. controls (0.47±0.93ng/ml). Plasma IL-18 concentrations were not significantly different between PCOS (3.79±0.53μg/ml) vs. controls (4.08±0.21μg/ml).
Limitations, reasons for caution
One limitation of this study is the lack of data on the protein expression of NLRP3 in the adipose tissue. There was also no data on other inflammasome components in the SAT analysis e.g. Caspase-1. However, all these data were available for the PBMCs.
Wider implications of the findings
The novel and interesting finding of an increase in NLRP3 in adipose tissue of PCOS women suggests that this inflammasome may play a central role in this common condition. Our study may therefore pave the way to further research to help understand the role of inflammation in PCOS
Trial registration number
N/A
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Affiliation(s)
- S Amer
- University of Nottingham , Gynaecology, Derby, United Kingdom
| | - S Aboeldalyl
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology , Minia, Egypt
| | - R Tarbox
- University of Nottingham, Academic Unit of Translational Medical Sciences , Derby, United Kingdom
| | - H Shawki
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology , Minia, Egypt
| | - E.M Ibrahim
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology , Minia, Egypt
| | - E Seyam
- University of Minia- Faculty of medicine, Obstetrics and Gynaecology , Minia, Egypt
| | - R Khan
- University of Nottingham, Academic Unit of Translational Medical Sciences , Derby, United Kingdom
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18
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Pathmanathan K, Mubin M, Sevilla C, Zaman M, Chan R, Hussain M, Brown E, McDevitt G, Khan R, Nandi A, Mukherjee B, Obiechina N. 970 FRAILTY IS INVERSELY CORRELATED WITH SERUM ALBUMIN IN ACUTE HIP FRACTURE. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.027] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Frailty and sarcopenia have been shown to significantly increase the risk of falls, traumatic hip fractures and all-cause mortality in the elderly. The assessment of frailty using a validated clinical frailty scale such as that proposed by Rockwood et al., therefore, continues to remain an important step in determining post-operative prognosis in patients undergoing hip fracture surgery. The purpose of this study was to examine the relationship between frailty and serum albumin—an independent biochemical predictor of survival in hip fracture patients (1).
Method
This retrospective cross-sectional study analysed 190 patients, aged above 60 years, admitted to Queen’s Hospital Burton (QHB) between the 1st January and 28th December 2019 with a newly diagnosed hip fracture. Pre-operative serum albumin levels (g/L) and Rockwood clinical frailty scores (rCFS) were recorded from electronic medical records (EMR). Using the SPSS 27 statistical package, Pearson’s correlation co-efficient and linear regression analysis were carried out using these variables.
Results
A total of 190 patients were included in the study (57 male, 133 female). Mean patient age was 82.2 ± 8.47 years. More than 50% of patients had a Rockwood CFS ≥5. Mean serum albumin (g/L) was 37.3 ± 6.56. A statistically significant inverse correlation was demonstrated between pre-operative serum albumin levels and Rockwood CFS (r = −0.243, p < 0.001).
Conclusion
This study showed how serum albumin, a negative acute phase reactant and marker of chronic malnutrition, is inversely associated with frailty in hip fracture patients and the important role of Rockwood CFS and pre-operative serum albumin levels in the prognostication of hip fractures in the elderly. References 1) Bohl D, Shen M, Hannon C, Fillingham Y, Darrith B, Della Valle C. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. Journal of Bone and Joint Surgery. 2017;99(24):2110–2,118.
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Affiliation(s)
- K Pathmanathan
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - M Mubin
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - C Sevilla
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - M Zaman
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - R Chan
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - M Hussain
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - E Brown
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - G McDevitt
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - R Khan
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - A Nandi
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - B Mukherjee
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
| | - N Obiechina
- Department of Elderly Medicine; University Hospitals Derby and Burton NHS Foundation Trust
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Obiechina N, Nandi A, Mubin M, Khan R, Chan R, Pathmanathan K, Titheridge L, Tse N, Kachala P, Rahman S, Mukherjee B. 975 RELATIONSHIP BETWEEN HAND GRIP STRENGTH (HGS) AND 10 YEAR PROBABILITY OF MAJOR OSTEOPOROTIC FRACTURES IN OLDER. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.031] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
HGS has been shown to be associated with adverse outcomes in a wide range of conditions. It has also been found to be associated with bone mineral density and is inversely associated with risk of osteoporotic fractures. The aim of this study was to determine the association between HGS and 10 year probability of sustaining a major osteoporotic fractures in older inpatient and to evaluate the effect of gender on this association.
Method
This was a cross-sectional, observational analysis of older patients admitted into hospital between September and November 2021. HGS was measured in these patients using the JAMAR hydraulic hand held dynamometer. The Southampton protocol was used. The FRAX UK tool (without BMD) was used to calculate 10 year probability of major osteoporotic fractures. Patients were included if they were 60 years and above. Younger patients were excluded as were stroke patients. Patients with incomplete data were excluded from analysis. The SPSS 27 package was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics. Pearson’s correlation coefficient and linear regression were used to calculate correlation.
Results
104 patients were analysed—41 males and 63 females. Mean age was 83 years (SD 8.2). Grip strength was inversely correlated with FRAX UK in predicting 10 year probability of major osteoporotic fractures in all patients, male patients and female patients (r = −0.452; p < 0.001, r = −0.351; p = 0.02 and r = −0.271; p = 0.03 respectively).
Conclusion
Grip strength is negatively associated with increased probability of major osteoporotic fractures in older inpatients. Reference(s) Ma Y, Fu L, Jia L, et al. Muscle strength rather than muscle mass is associated with osteoporosis in older Chinese adults. J Formos Med Assoc. 2018;117(2):101–108. doi:10.1016/j.jfma.2017.03.004
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Affiliation(s)
- N Obiechina
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - A Nandi
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - M Mubin
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - R Khan
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - R Chan
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - K Pathmanathan
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - L Titheridge
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - N Tse
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - P Kachala
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - S Rahman
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - B Mukherjee
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
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Nandi A, Obiechina N, Mubin M, Khan R, Mukherjee B. 974 ASSOCIATION BETWEEN NOTTINGHAM HIP FRACTURE SCORE AND FRAILTY IN ELDERLY ACUTE HIP FRACTURE PATIENTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.030] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Nottingham Hip Fracture Score (NHFS) is a well validated risk stratification tool that has been shown to predict 30 day mortality in elderly patients with acute hip fractures. A lot of older patients that sustain hip fractures are frail. The Rockwood Clinical Frailty Scale (CFS) has been validated as a tool to screen for frailty in acutely ill patients and has been shown to predict outcomes in acutely ill elderly patients. The aim of this study was to determine if there is any correlation between the NHFS and CFS in elderly patients with acute hip fractures and to evaluate the effect of gender on this correlation.
Method
A retrospective, cross-sectional analysis was carried out on patients admitted with acute hip fractures between January and December 2019 in a single centre trauma and orthopaedic unit. Data was extracted from anonymized electronic patient records. Patients were included if they were 60 years and above; those less than 60 were excluded. Patients with missing data were excluded from analysis. NHFS and CFS were calculated in these patients. SPSS 27 IBM software was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics and spearman’s correlation co-efficient and linear regression were used to determine correlation.
Results
A total of 268 patients were analysed—65 males and 202 females. Mean age was 83 years (SD 8.5). There was statistically significant positive correlation between NHFS and CFS in all patients, male patients and female patients (r = 0.589; p < 0.001, r = 0.603; p < 0.001, and r = 0.599; p < 0.001 respectively).
Conclusion
NHFS is positively correlated with CFS in elderly acute hip fracture patients. Reference(s) Doherty W.J, Stubbs T.A et al. Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score. Journal of the American Medical Directors Association;22(3):663–669.e2.
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Affiliation(s)
- A Nandi
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - N Obiechina
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - M Mubin
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - R Khan
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
| | - B Mukherjee
- Department of Elderly Care Medicine; University Hospitals of Derby & Burton NHS Foundation Trust
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21
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George E, Khan R, Powari M, Dorey N. Pre-tracheal Ectopic Thymoma: A diagnostic challenge in Endobronchial Ultrasound-guided Transbronchial Needle Aspiration cytology. Cytopathology 2022; 33:445-448. [PMID: 35445470 DOI: 10.1111/cyt.13133] [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] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Ectopic thymomas (ETs) are rare thymic neoplasms that arise from atypical anatomical sites1 and present a diagnostic challenge for clinicians as they can be mistaken for other pathological entities on fine needle aspiration (FNA) cytology.2 Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) sampling of mediastinal and para-tracheal lymph nodes is commonly performed to diagnose and stage lung malignancies. International literature search of thymic lesions diagnosed on EBUS-TBNA yielded only four cases although none in an ectopic location. In this report we describe a case of a patient who presented with an ectopic thymoma that was diagnosed by EBUS-TBNA from a station 4R location. Subsequent histology confirmed the diagnosis and subtyped as well as staged the tumour. We discuss the role of cytology in the diagnosis of this rare tumour from an unusual site, the potential pitfalls and highlight the importance of considering ET as a differential diagnosis in the context of unexplained mediastinal lymphadenopathy.
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Affiliation(s)
- E George
- Department of Pathology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - R Khan
- Department of Pathology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - M Powari
- Department of Pathology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - N Dorey
- Department of Oncology, Torbay and South Devon, NHS Foundation Trust, Torbay, UK
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22
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Pollack B, Popiel P, Drugge E, Bibi M, Pollack S, Friedman R, Alishahian L, Bielawski A, Sacks A, Lebron K, Phillips D, Rubino S, Toaff M, Khan R, Khan E, Marioutina M, Gorgy M, Grimes C. Impact of permanent versus absorbable suture in vaginal suspension surgery for apical pelvic organ prolapse. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.135] [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: 11/24/2022]
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23
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Elsolh K, Neary E, Seleq S, Gimpaya N, Scaffidi M, Khan R, Grover S. A104 PATIENT AND PUBLIC INVOLVEMENT (PPIN) IN IBD RESEARCH - A SCOPING REVIEW. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.103] [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
Over the past 10 years, interest in patient and public involvement (PPIn) in research has grown. Several arguments support the engagement of patients as partners in the research process. Patients with lived experience of a condition can offer their knowledge to study design as experience-based experts, helping researchers incorporate patient-pertinent outcomes. PPIn has also been shown to boost patient enrolment and retention in clinical trials. Benefits, challenges, and best practices of PPIn have been examined in other fields. However, to date, no study has examined PPIn in inflammatory bowel disease (IBD) research. Many factors amenable to research involvement may impact IBD patients’ quality of life, including disease morbidity, complications, and efficacy/side effects of therapy.
Aims
This review aims to characterize methods of PPIn in IBD research and highlight themes relating to best practices, benefits, and challenges.
Methods
We ran a systematic search on MEDLINE, EMBASE, and Cochrane for all IBD research studies in which IBD patients were involved in the research process. PPIn included but was not limited to patient input in one of the following 3 stages: Study Design (prioritization of research topics, outcome selection, study tool development), Study Execution (recruitment, data collection & analysis), and Dissemination of Research. After abstract and full-text screening, 14 studies were selected.
Results
Patients were recruited for PPIn through IBD and patient organizations (7/14), outpatient clinics (4/14), tertiary care sites (2/14), and pre-existing patient advisory groups (1/14). The majority of studies (11/14) engaged patients in the development of study materials, which included a physical activity intervention for stoma patients, an IBD pregnancy decision aid, and a quality of life questionnaire. Two studies interviewed patients to determine comprehensibility of survey items and guide revisions. One study involved patients in data analysis and manuscript development. Most consultations were open-ended, including focus groups (8/14) and semi-structured interviews (3/14). According to study authors, PPIn helps guide IBD research priorities by focusing on patient-relevant issues. Authors also cited the role of PPIn in designing patient-friendly study tools. One challenge reported by 2 studies was that PPIn requires patients to have access to high-quality information and requires a significant time commitment, which may contribute to demographic biases.
Conclusions
The majority of IBD studies engaged patients in an open-ended format and were engaged in study design, particularly in developing study materials. Authors recommend continuous involvement of patients throughout the research process to address their research priorities.
Funding Agencies
None
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Affiliation(s)
- K Elsolh
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - E Neary
- Medicine, Queen’s University, Kingston, ON, Canada
| | - S Seleq
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - M Scaffidi
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Grover
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
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24
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Gupta S, Seleq S, Gimpaya N, Khan R, Scaffidi M, Grover S. A140 INTEROBSERVER RELIABILITY OF THE PARIS CLASSIFICATION FOR SUPERFICIAL GASTROINTESTINAL TRACT NEOPLASMS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Can Assoc Gastroenterol 2022. [DOI: 10.1093/jcag/gwab049.139] [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
The Paris classification is an international classification system that characterizes the morphology of superficial gastrointestinal tract neoplasms. Given its ability to predict the risk of submucosal invasion, this tool plays an important role in the preliminary endoscopic assessment of early gastrointestinal neoplastic lesions. Despite its international prevalence, there are no pooled reliability analyses to assess agreement amongst endoscopists using this classification system.
Aims
To systematically review and meta-analyze the interobserver reliability (IOR) of the Paris classification system.
Methods
We conducted a systematic review and meta-analysis according to the PRISMA recommendations. A comprehensive literature query was conducted on biomedical databases through December 2020. Studies were included if they quantitively evaluated the IOR of the Paris classification with at least 5 endoscopists participating in the study cohort. Two authors independently screened studies and abstracted data using an a priori designed data collection form. We pooled the results of studies which provided IOR with kappa statistics and confidence intervals using DerSimonian and Laird random effects models. Risk of bias was independently assessed by two study authors using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) tool.
Results
From an initial 1541 studies, 5 were included in the qualitative review and 3 reported data that allowed for a quantitative analysis of the primary outcome, representing a total of 28 endoscopists. All three of these studies were high quality. The IOR for the Paris classification amongst all endoscopists was 0.541 (95% CI, 0.466–0.617). There was no significant improvement (p=0.551) in the IOR of the Paris classification system following an educational training intervention (pre-education pooled kappa, 0.498; 95% CI, 0.429–0.567 compared to post-education pooled kappa, 0.530; 95% CI, 0.451–0.608).
Conclusions
Interobserver reliability of the Paris classification is moderate with no significant improvement following educational intervention.
Funding Agencies
None
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Affiliation(s)
- S Gupta
- University of Toronto, Toronto, ON, Canada
| | - S Seleq
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Scaffidi
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Khan R, Salim M, Tanuseputro P, Hsu A, Coburn N, Talarico R, James P. A257 PANCREATIC CANCER TREATMENT AND END OF LIFE OUTCOMES: A POPULATION BASED COHORT STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859383 DOI: 10.1093/jcag/gwab049.256] [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
Patients with pancreatic cancer face challenging decisions regarding treatment choices following their diagnosis and often lack data on end-of-life (EOL) outcomes. Without the available information, older patients may be undertreated, dying earlier than they would have with treatment, while others may be overtreated and exposed to aggressive measures with harmful side effects.
Aims
To describe survival and EOL outcomes among pancreatic cancer patients based on index cancer treatment, disease stage, and patient characteristics.
Methods
We conducted a population based cohort study in Ontario, Canada of patients who died from April 2010 to December 2017 and were diagnosed with pancreatic cancer prior to death. We used administrative databases to collect data on demographics, baseline health status, treatments, and outcomes. The primary exposure was index cancer treatment (no treatment, radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy). The primary outcomes were mortality, health care encounters per 30 days in the last six months of life, and palliative care visits per 30 days within the last six months of life. Secondary outcomes were location of death (institution vs. community), hospitalization within the last 30 days of life, and receipt of chemotherapy within the last 30 days of life. We estimated the association between the exposure and outcomes using multivariable models, adjusting for demographics, comorbidities, and cancer stage. Hazard ratios, adjusted mean differences, and odds ratios were reported with 95% confidence intervals.
Results
Our cohort included 9950 adults with a median age at diagnosis of 78. 56% received no index treatment, 5% underwent radiation, 27% underwent chemotherapy alone, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. In the multivariable regression (Table and Figure), radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy were all associated with decreased mortality and fewer healthcare encounters. All groups except radiation were associated with fewer palliative care visits. All treatment groups were associated with lower odds of institutional death and hospitalization within the last 30 days of life, and higher odds of chemotherapy within the last 30 days of life.
Conclusions
Our data, the first to provide EOL outcome estimates based on index cancer treatment, can help patients make initial treatment decisions after a diagnosis of pancreatic cancer.
Multivariable regression analyses predicting primary and secondary outcomes
Association between index cancer treatment and primary outcomes.
Funding Agencies
CIHR
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Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Salim
- University Health Network, Toronto, ON, Canada
| | - P Tanuseputro
- Department of Medicine in Ottawa, Ottawa, ON, Canada
| | - A Hsu
- University of Ottawa Department of Family Medicine, Ottawa, ON, Canada
| | - N Coburn
- University of Toronto Division of General Surgery, Toronto, ON, Canada
| | - R Talarico
- ICES (Formerly Institute for Clinical and Evaluative Sciences), Ottawa, ON, Canada
| | - P James
- University Health Network, Toronto, ON, Canada
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26
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Seleq S, Khan R, Gimpaya N, Vargas JI, Amin S, Bilal M, Bollipo S, Charabaty A, de-Madaria E, Hashim A, Kral J, Pawlak KM, Sandhu DS, Lui RN, Sanchez-Luna S, Siau K, Mosko J, Grover S. A32 DEVELOPMENT AND VALIDATION OF THE TORONTO UPPER GASTROINTESTINAL CLEANING SCORE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859122 DOI: 10.1093/jcag/gwab049.031] [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: 11/12/2022] Open
Abstract
Abstract
Background
High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings.
Aims
To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability.
Methods
An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1).
Results
Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability.
Conclusions
We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings.
Funding Agencies
None
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Affiliation(s)
- S Seleq
- St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- St Michael’s Hospital, Toronto, ON, Canada
| | - J I Vargas
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - S Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, Miami, FL
| | - M Bilal
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Boston, MA
| | - S Bollipo
- Gastroenterology Department, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia, Newcastle, New South Wales, Australia
| | - A Charabaty
- Division of Gastroenterology, Johns Hopkins-Sibley Memorial Hospital, Washington, DC, Washington, DC
| | - E de-Madaria
- Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain, Alicante, Spain
| | - A Hashim
- Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - J Kral
- Institution for Clinical and Experimental Medicine, Prague, Czech Republic, Prague, Czechia
| | - K M Pawlak
- Hospital of the Ministry of Interior and Administration, Szczecin, Poland, Szczecin, Poland
| | - D S Sandhu
- Division of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, Cleveland, Ohio, Cleveland, OH
| | - R N Lui
- Division of Gastroenterology and Hepatology, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, China
| | - S Sanchez-Luna
- Division of Gastroenterology and Hepatology, The University of New Mexico, Albuquerque, NM
| | - K Siau
- Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, Birmingham, United Kingdom
| | - J Mosko
- St Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St Michael’s Hospital, Toronto, ON, Canada
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Scaffidi M, Gimpaya N, Pattni C, Genis S, Khan R, Li J, Bansal R, Grover S. A89 PERCEPTIONS OF NON-TECHNICAL SKILLS IN GASTROINTESTINAL ENDOSCOPY: A THEMATIC ANALYSIS OF FOUR FOCUS GROUPS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859238 DOI: 10.1093/jcag/gwab049.088] [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 Nontechnical skills (NTS), which involve an individual’s cognitive, attitudinal, and social skills that supplement task expertise, are an essential component in the practice of gastrointestinal endoscopy. There is a growing body of literature that highlights the association between these skills and patient outcomes. To date, however, these skills have not been adequately defined within the context of gastrointestinal endoscopy. Aims To define the domain and corresponding characteristics of NTS in GI endoscopy. Methods We conducted a qualitative study at a tertiary-care academic center in Toronto, Ontario. Specifically, we held four focus groups with physician endoscopists, nurses who work in an endoscopy unit, and patients who have had previous endoscopies, in order to ascertain their input on the role of NTS in gastrointestinal endoscopy. The three groups were interviewed independently and there was one focus group of both physicians and nurses that was used for validation of our initial thematic framework. Data from the focus groups was collected using a combination of field notes and discussion transcriptions. Three authors independently generated codes from these data. Using these codes, a thematic network analysis was used to identify emerging themes. The primary outcome of this study was the development of a cohesive thematic network of NTS in endoscopy, including their characteristics and examples. Results The four focus groups included a total of 34 participants, including 15 physician endoscopists, 15 nurses, and 4 patients. Using thematic network analysis, we identified six dimensions of NTS using the first three focus groups: communication; professionalism; teamwork; leadership; decision-making; and situational awareness. Additional topics related to the practice and evaluation of NTS were identified. In particular, there is a degree of subjectivity in the appraisal of NTS due to the nuances among individual practice, aside from egregious errors of NTS (e.g. unprofessional behaviours). The use of video recordings was suggested as a way to capture signs of good NTS, such as appropriate levels of calmness during procedures and attention to patient comfort. Finally, patient involvement can be useful for evaluating communication and professionalism based on patient comprehension and the nature of the therapeutic relationship. Conclusions Our findings provide the first cohesive framework of NTS in gastrointestinal endoscopy that is anchored in real world experiences with relevant stakeholders – physicians, nurses, and patients. Future research should consolidate these findings into an assessment tool for NTS in order to evaluate and provide feedback to endoscopists who are both in training and in practice. Funding Agencies CAG
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Affiliation(s)
- M Scaffidi
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - C Pattni
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Genis
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St. Michael’s Hospital, Toronto, ON, Canada
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Tham D, Gimpaya N, Gholami R, Pattni C, Seleq S, Bansal R, Fujiyoshi MA, Ramkissoon A, Lisondra J, Ariaratnam J, Scaffidi M, Khan R, Grover S. A25 CRITICAL APPRAISAL OF GI ENDOSCOPY CLINICAL PRACTICE GUIDELINES DURING THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859207 DOI: 10.1093/jcag/gwab049.024] [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
Clinical Practice Guidelines (CPGs) are integral during a pandemic, offering guidance to clinicians through uncertainty. Existing literature has established that the need for rapid publication of CPGs during previous infectious disease outbreaks resulted in less rigorous guidelines. CPGs were rapidly developed since the onset of the pandemic in December 2019, providing guidance in gastrointestinal (GI) endoscopy, an area where COVID-19 may pose risk of transmission.
Aims
To evaluate the quality of GI endoscopy guidelines developed during the COVID-19 pandemic and to compare these with (a) endoscopy CPGs developed prior to the pandemic; (b) CPGs for other endoscopic topics unrelated to COVID-19; and, (c) non-endoscopic CPGs published during the pandemic.
Methods
We systematically searched Medline, Embase and Scopus for CPGs published by GI societies from January 1, 2018 to December 31, 2020. A grey literature search was conducted. Two authors screened full-texts. In this interim analysis, CPGs were grouped based on publication year: before 2020, or 2020. Endoscopy CPGs published in 2020 were categorized as COVID or non-COVID related. Two authors independently assessed the CPGs using the AGREE II tool, consisting of six domains for evaluating guidelines. A domain score of 60 was set as a threshold to indicate good quality.
Results
There were 70 endoscopy guidelines and 27 CPGs focused on other GI topics. The mean overall scores were 69% (±12%) for endoscopy CPGs published before 2020 (n=28), and 51% (±23%) for CPGs published in 2020 (n=42). For individual AGREE II domains, mean scores for pre-2020 CPGs ranged from 33.11 (±17.39) in Applicability to 81.55 (±10.37) in Clarity of Presentation. For CPGs published during COVID-19, mean domain scores ranged from 34.18 (±10.52) in Applicability to 75.26 (±13.85) in Clarity of Presentation. 21 of 42 CPGs published in 2020 were related to COVID. Mean overall scores were 35% (±20%) for COVID-related CPGs and 67% (±13%) for non-COVID-19 CPGs. For COVID-19 CPGs, scores ranged from 27.88 (±20.31) in Rigour of Development to 69.58 (±10.81) in Scope and Purpose. For non-COVID CPGs, the scores ranged from 37.30 (±8.93) in Applicability to 84.52 (±5.93) in Clarity of Presentation.
Conclusions
The difference in overall scores between COVID-19 endoscopy CPGs and non-COVID endoscopy CPGs may suggest that the urgency to disseminate COVID-19 information decreased CPG quality or completeness of reporting. This interim analysis is limited by the lack of distinction between peer-reviewed CPGs and non-peer reviewed recommendations. Given the importance of CPGs in clinical decision making, it is important to ensure that the rapid development of guidelines does not compromise quality and rigour.
Funding Agencies
None
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Affiliation(s)
- D Tham
- St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Gholami
- St. Michael’s Hospital, Toronto, ON, Canada
| | - C Pattni
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Seleq
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | | | - J Lisondra
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - M Scaffidi
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- St. Michael’s Hospital, Toronto, ON, Canada
| | - S Grover
- St. Michael’s Hospital, Toronto, ON, Canada
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Verma Y, Bansal R, Gimpaya N, Scaffidi M, Khan R, Grover S. A99 PHARMACEUTICAL INDUSTRY FUNDING TO GASTROINTESTINAL PATIENT ADVOCACY ORGANIZATIONS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859379 DOI: 10.1093/jcag/gwab049.098] [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: 11/13/2022] Open
Abstract
Background Patient advocacy organizations (PAOs) are not-for-profit organizations that aim to support families and individuals afflicted by illnesses. PAOs play a significant role in guiding health policy, providing education to patients, lobbying, and supporting research. Previous studies have demonstrated that PAOs may receive financial payments from pharmaceutical and medical device manufacturers. This may create a risk of conflict of interest. Aims To assess the prevalence and transparency of financial donations from industry to gastrointestinal patient advocacy groups based in the United States (US). Methods We conducted a cross-sectional study to determine the prevalence of industry donations to PAOs. Data was extracted from the Kaiser Health News (KHN) Database, a database that tracked payments from pharmaceutical companies to PAOs in 2015. After an initial list of 1215 PAOs was obtained from the database, authors extracted the annual revenues, websites and mission statements for each PAO. Authors individually screened each organization’s mission statement and website to determine whether their primary scope of focus included gastroenterology. A final list of 11 PAOs with annual revenues surpassing $500,000 USD was included for descriptive analysis. From this list, the annual reports and websites of each group were reviewed to determine the extent of transparency of PAOs disclosing financial relationships with industry sponsors. The primary outcome of our study was the total amount of funding that each PAO received from pharmaceutical companies. The secondary outcome was the self-reported amount of funding stated on each PAO’s website and annual report. Results From our analysis of 11 PAOs, 9 (81%) organizations received payments from pharmaceutical companies. The median dollar value of donations received was $31,052 USD (IQR=$25 to $302,550). The total dollar value of donations received was $4,059,433 USD. Across the 9 PAOs that received donations, 5 (56%) organizations disclosed a financial relationship with a pharmaceutical company on their website and 2 (22%) disclosed the value of industry donations within a range. No group specified an exact amount of funding received. Conclusions Our results demonstrate that a majority of US based gastrointestinal PAOs receive funding from pharmaceutical companies. Furthermore, our results show that many PAOs that receive industry funding do not disclose this amount on their website or annual reports. Given their role in providing patient centered support, it is important for PAOs to disclose financial relationships with industry so as to not produce a conflict of interest. Funding Agencies None
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Affiliation(s)
- Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
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Buysse J, Khan R, Aldoss O, Vijayakumar N, Karimi M, Mohammad Nijres B. Massive perinatal left ventricle infarction treated with tissue plasminogen activator: No ECMO - A case report. J Neonatal Perinatal Med 2022; 15:367-372. [PMID: 34806621 DOI: 10.3233/npm-210793] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Neonatal myocardial infarction due to coronary thrombus is a rare cause of acute heart failure and is associated with high morbidity and mortality. We present a rare case of a full-term newborn who developed coronary artery thrombus treated with intracoronary recombinant tissue plasminogen activator infusion while undergoing therapeutic hypothermia. Also, we describe a unique treatment strategy to support systemic circulation sparing the patient from neonatal extracorporeal membrane oxygenation and its complications. Neonatal myocardial infarction should be suspected and ruled out in sick newborns.
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Affiliation(s)
- J Buysse
- Division of Cardiology, Department of Pediatrics, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
| | - R Khan
- Division of Cardiology, Department of Pediatrics, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
| | - O Aldoss
- Division of Cardiology, Department of Pediatrics, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
| | - N Vijayakumar
- Division of Critical Care, Department of Pediatrics, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
| | - M Karimi
- Department of Surgery, Section of Cardiothoracic Surgery, Congenital Cardiac Surgery, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
| | - B Mohammad Nijres
- Division of Cardiology, Department of Pediatrics, Stead Family Children's Hospital, The University of Iowa, Iowa City, IA, USA
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31
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Khan R, Naidoo N, Lazarus L. Unique vascular patterns of the internal iliac artery and its clinical import in pelvic surgery. Translational Research in Anatomy 2021. [DOI: 10.1016/j.tria.2021.100151] [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: 10/20/2022] Open
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32
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Rahman HU, Khan W, Mehmood SA, Ahmed S, Yasmin S, Ahmad W, Haq ZU, Shah MIA, Khan R, Ahmad U, Khan AA, De Los Ríos Escalante P. Prevalence of cestodes infection among school children of urban parts of Lower Dir district, Pakistan. BRAZ J BIOL 2021; 82:e242205. [PMID: 34644726 DOI: 10.1590/1519-6984.242205] [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] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Tapeworms of zoonotic importance have been described as a leading public health problem. Current research was aim to assess the prevalence of tapeworms among 5-12years school children residing in district Lower Dir, Pakistan from January 2019-December 2019. The wet mount preparation in saline/iodine/methods were used for stool examination. Data was analyzed using appropriate descriptive, static methods. Of the 400 children studied 71.7% were infected with one or more species of intestinal parasites. Single infection of cestode species was found in 69 individuals with 17.2% prevalence and multiple parasitic infections were identified in 19.7% (n=79/400) individuals. The multiple infection were comprised as 10% (n=40) double, 6.75% (n=27) triple and 3% (n=12) quadruple. A total of 9 species of helminths and one species of protozoan infection. Among the helminths Ascaris lumbricoides was the most prevalent 33.1% (n=95), Taenia saginata 22.6% (n=65), hookworm 19.8% (n=57), Hymenolepis nana 18.8% (n=54), Enterobius vermicularis and Hymenolepis diminuta 1.39% (n=4each), Trichuris trichura 1.04% (n=3), Toxocara spp 0.69% (n=2) and Schistosoma japonicum 0.34% (n=1) were reported. One protozoan species was Cryptosporidium spp 0.69% (n=2) in current study. In case of A.lumbricoides, hookworm, E.vermicularis, T.trichura, T.saginata, H.nana and H.diminuta the male children of below 8 years of age were highly infected. Other infections are reported in the same prevalence with slight difference if any. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children and the need for development of effective poverty control programs because deworming alone is not adequate to control parasitic infections.
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Affiliation(s)
- H Ur Rahman
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - W Khan
- University of Malakand, Department of Zoology, Lower Dir, Pakistan
| | - S A Mehmood
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - S Ahmed
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - S Yasmin
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - W Ahmad
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - Z Ul Haq
- Hazara University Mansehra, Department of Zoology, Mansehra, Pakistan
| | - M I A Shah
- Abdul Wali Khan Unuversity Mardan, Department of Chemistry, Mardan, Pakistan
| | - R Khan
- University of Malakand, Department of Zoology, Lower Dir, Pakistan
| | - U Ahmad
- University of Malakand, Department of Zoology, Lower Dir, Pakistan
| | - A A Khan
- University of Malakand, Department of Zoology, Lower Dir, Pakistan
| | - P De Los Ríos Escalante
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Biológicas y Químicas, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales UC Temuco, Casilla, Temuco, Chile
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Goodman S, Bagai A, Tan M, Andrade J, Spindler C, Malek-Marzban P, Har B, Yip A, Paniagua M, Elbarouni B, Bainey K, Paradis J, Maranda R, Cantor W, Doucet M, Khan R, Eisenberg M, Dery J, Schwalm J, Madan M, Lam A, Hameed A, Noronha L, Cieza T, Matteau A, Roth S, So D, Lavi S, Glanz A, Gao D, Tahiliani R, Welsh R, Kim H, Robinson S, Daneault B, Chong A, Le May M, Ahooja V, Gregoire J, Nadeau P, Laksman Z, Heilbron B, Bonakdar H, Yung D, Yan A. ANTITHROMBOTIC THERAPIES IN CANADIAN ATRIAL FIBRILLATION PATIENTS WITH CONCOMITANT CORONARY ARTERY DISEASE: INSIGHTS FROM THE CONNECT AF+PCI-I AND -II PROGRAMS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.030] [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: 11/24/2022] Open
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Sweeney I, Al Assaf N, Khan R. Placental Swab in Supporting Diagnosis of Vertical Transmission in SARS-CoV-2 Positive Mothers. Ir Med J 2021; 114:409. [PMID: 34520644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Aims To review the evidence regarding the possibility of fetal vertical transmission in COVID-19 positive pregnant mothers by diagnosing through placental swabs. Methods The search terms 'pregnant COVID-19 positive mothers', 'fetal vertical transmission' and 'placental swabs' were used. 20 papers were selected. Results 183 COVID-19 positive pregnant women were identified whose 184 placentas and 185 neonates were also analysed by RT-PCR or immunohistochemistry and/or in situ hybridization for the presence of SARS-CoV-2 (one case of monochorionic diamniotic twins and one case of dichorionic diamniotic twins). 183 liveborn neonates were successfully delivered primarily via caesarean section (99%). 2 mothers did not deliver liveborn infants due to severe preeclampsia resulting in a termination of pregnancy and a miscarriage, both occurring in the second trimester. 9 neonates tested positive for SARS-CoV-2 (5%). We report no neonatal mortality after live birth and no maternal mortality. 17 placentas tested positive for SARS-CoV-2 out of a total of 184 tested (9%). Of these 17, 7 cases of SARS-CoV-2 were identified in the maternal, neonatal and placental tissue. Conclusion There is no concrete evidence of vertical transmission occurring between mother and infant. We propose further research investigating the effects of COVID-19 on pregnant women by using RT-PCR to test the mother, placenta, vaginal fluid, breast milk and infant for SARS-CoV-2 at various stages of transmission.
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Affiliation(s)
- I Sweeney
- School of Medicine, University of Limerick, Limerick, Ireland
| | - N Al Assaf
- Department of Neonatology, University Maternity Hospital Limerick, Limerick, Ireland
| | - R Khan
- Department of Neonatology, University Maternity Hospital Limerick, Limerick, Ireland
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Pressney I, Khoo M, Khan R, Abernethy P, Hargunani R, Saifuddin A. Morphology of the entering and exiting nerve as a differentiating feature of benign from malignant peripheral nerve sheath tumours of the brachial plexus. Skeletal Radiol 2021; 50:1557-1565. [PMID: 33410965 DOI: 10.1007/s00256-020-03689-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify if morphology of the entering and exiting nerve involved by a nerve sheath tumour in the brachial plexus can help differentiate between benign (B) and malignant (M) peripheral nerve sheath tumours (PNSTs). MATERIALS AND METHODS Retrospective review of 85 patients with histologically confirmed primary PNSTs of the brachial plexus over a 12.5-year period. Clinical data and all available MRI studies were independently evaluated by 2 consultant musculoskeletal radiologists blinded to the final histopathological diagnosis assessing for maximal lesion dimension, visibility and morphology of the entering and exiting nerve, and other well-documented features of PNSTs. RESULTS The study included 47 males and 38 females with mean age 46.7 years (range, 8-81 years). There were 73 BPNSTs and 12 MPNSTs. The entering nerve was not identified in 5 (7%), was normal in 17 (23%), was tapered in 38 (52%) and showed lobular enlargement in 13 (18%) BPNSTs compared with 0 (0%), 0 (0%), 2 (17%) and 10 (83%) MPNSTs respectively. The exiting nerve was not identified in 5 (7%), was normal in 20 (27%), was tapered in 42 (58%) and showed lobular enlargement in 6 (8%) BPNSTs compared with 4 (33%), 0 (0%), 2 (17%) and 6 (50%) MPNSTs respectively. Increasing tumour size, entering and exiting nerve morphology and suspected MRI diagnosis were statistically significant differentiators between BPNST and MPNST (p < 0.001). IOC for nerve status was poor to fair but improved to good if normal/tapered appearance were considered together with improved specificity of 81-91% for BPNST and sensitivity of 75-83%. CONCLUSIONS Morphology of the adjacent nerve is a useful additional MRI feature for distinguishing BPNST from MPNST of the brachial plexus.
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Affiliation(s)
- I Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - M Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - R Khan
- Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - P Abernethy
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - R Hargunani
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - A Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Ali MR, Islam MA, Hossain MF, Hossain SM, Khan R, Naher K, Tamim U, Nahid F. Depth-wise elemental contamination trend in sediment cores of the Sundarbans mangrove forest, Bangladesh. J Radioanal Nucl Chem 2021. [DOI: 10.1007/s10967-021-07739-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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37
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Li J, Hu M, Scaffidi MA, Gimpaya N, Bansal R, Verma Y, Elsolh K, Khan R, Grover SC. A104 PREVALENCE OF GHOST-AUTHORSHIP IN INDUSTRY-SPONSORED CLINICAL TRIALS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.102] [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
Ghost-authorship involves the exclusion of individuals who have made substantial contributions to the article from the author byline. Previous studies have found that ghost-authorship is highly prevalent in industry-sponsored clinical trials. Its prevalence, however, has yet to be investigated in trials of biologics in the management of inflammatory bowel disease (IBD).
Aims
To determine the prevalence of ghost-authorship in IBD biologic industry-sponsored clinical randomized controlled trials (RCTs).
Methods
Biologic medications indicated for ulcerative colitis (UC) or for Crohn’s disease (CD) were identified using the Food and Drug Agency (FDA) database. We identified the clinical trials on clinicaltrials.gov corresponding to the data presented at the time of FDA approval. Specifically, we included the first publication for each trial to report study results for our analysis. Two authors independently identified the presence of ghost-authorship, which we defined as the exclusion on the author byline of the included RCT publication of any individuals who assisted in the writing of the trial manuscript and/or performed the data analyses.
Results
We identified a total of 28 relevant RCTs on biologic medications (10 for UC and 18 for CD), which were matched to 20 publications. We found ghost-authorship in 70% of publications (n=14); 40% (n=8) involved manuscript and protocol writing assistance from sponsor staff; 35% (n=7) involved medical writers from external companies; 15% (n=3) involved both sponsor staff and medical writers assisting in manuscript writing; and 20% (n=4) involved individuals performing data analysis or interpretation.
Conclusions
We found that ghost-authorship in industry-sponsored IBD biologic clinical trials has a moderately high prevalence, with the most common being manuscript or protocol writing assistance. A lack of transparency regarding sponsor-affiliated and/or external contributors may negatively affect the trust placed in medical research. One limitation is that data was only extracted from publications. Further evidence on ghost-authorship may be found in study protocols and registrations, which will be investigated in the future.
Funding Agencies
None
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Affiliation(s)
- J Li
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M Hu
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
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Khan R, Zheng E, Wani SB, Scaffidi MA, Jeyalingam T, Gimpaya N, Anderson J, Grover SC, McCreath G, Walsh CM. A97 TOOLS FOR DIRECT OBSERVATION AND ASSESSMENT OF COLONOSCOPY: A SYSTEMATIC REVIEW OF VALIDITY EVIDENCE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.095] [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
An increasing focus on quality and safety in colonoscopy has led to broader implementation of competency-based educational systems that enable documentation of trainees’ achievement of the knowledge, skills, and attitudes needed for independent practice. The meaningful assessment of competence in colonoscopy is critical to this process. While there are many published tools that assess competence in performing colonoscopy, there is a wide range of underlying validity evidence. Tools with strong evidence of validity are required to support feedback provision, optimize learner capabilities, and document competence.
Aims
We aimed to evaluate the strength of validity evidence that supports available colonoscopy direct observation assessment tools using the unified framework of validity.
Methods
We systematically searched five databases for studies investigating colonoscopy direct observation assessment tools from inception until April 8, 2020. We extracted data outlining validity evidence from the five sources (content, response process, internal structure, relations to other variables, and consequences) and graded the degree of evidence, with a maximum score of 15. We assessed educational utility using an Accreditation Council for Graduate Medical Education framework and methodological quality using the Medical Education Research Quality Instrument (MERSQI).
Results
From 10,841 records, we identified 27 studies representing 13 assessment tools (10 adult, 2 pediatric, 1 both). All tools assessed technical skills, while 10 assessed cognitive and integrative skills. Validity evidence scores ranged from 1–15. The Assessment of Competency in Endoscopy (ACE) tool, the Direct Observation of Procedural Skills (DOPS) tool, and the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) had the strongest validity evidence, with scores of 13, 15, and 14, respectively. Most tools were easy to use and interpret and required minimal resources. MERSQI scores ranged from 9.5–11.5 (maximum score 14.5).
Conclusions
The ACE, DOPS, and GiECAT have strong validity evidence compared to other assessments. Future studies should identify barriers to widespread implementation and report on use of these tools in credentialing purposes.
Funding Agencies
None
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Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Zheng
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S B Wani
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | - M A Scaffidi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Anderson
- Dept. of Gastroenterology, Cheltenham Hospital, Cheltenham, United Kingdom
| | - S C Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - G McCreath
- The Hospital for Sick Children, Toronto, ON, Canada
| | - C M Walsh
- The Hospital for Sick Children, Toronto, ON, Canada
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Bansal R, Khan R, Gimpaya N, Scaffidi MA, Elsolh K, Verma Y, Li J, Grover SC. A160 PREVALENCE OF OUTCOME SWITCHING AMONG PUBLISHED PHASE 3 INTERVENTIONAL TRIALS FOR INFLAMMATORY BOWEL DISEASE THERAPEUTICS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.158] [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
Outcome switching is a well-described form of inconsistent reporting in randomized clinical trials (RCTs), wherein pre-specified primary and/or secondary outcomes are changed between trial registration and the publication of results without explanation. This is of particular concern, as the selective publication of results that are favorable will insert bias into the trial’s results and may cast doubt on the veracity of its findings. While it has been investigated in other disciplines, the prevalence of outcome switching has yet to be described among RCTs for inflammatory bowel disease (IBD).
Aims
To determine the prevalence of correctly reported pre-specified primary and secondary outcomes in published phase 3 interventional RCTs for IBD.
Methods
We identified all phase 3 interventional trials for IBD with published results using clinicaltrials.gov. We included all results with an associated publication that detailed the results of the trial. We excluded registrations if: only an abstract of the results was available; trial results were only published as a pooled analysis; multiple trial segments were reported collectively; or a publication of the results could not be identified through clinicaltrials.gov or a custom search.
Two reviewers extracted all pre-specified primary and secondary outcomes for each trial using the clinical trial registration page that was dated before the commencement of the trial. These outcomes were compared to the outcomes reported in the corresponding journal articles. Any discrepancies were noted, and additional outcomes were extracted.
Results
We identified a total of 88 phase 3 interventional RCTs for IBD, of which 57 were matched to independent publications of their results. All trials pre-specified a primary outcome, and 50 (87.7%) pre-specified secondary outcomes. 10 (17.5%) of trials did not report some or all primary outcomes, and 19 (33.3%) trials had a change or alteration to the primary outcome. Of the trials that pre-specified secondary outcomes, 16 (28.1%) did not report all pre-specified secondary outcomes. 49 (86.0%) trials added 6 (IQR: 2–8) unspecified secondary outcomes on average.
Conclusions
Many phase 3 interventional RCTs in IBD either did not report some or all primary outcomes, or altered the primary outcome. Trials routinely reported additional outcomes that were not pre-specified and failed to note that they were added post hoc. Based on these results, we recommend improvements in the reporting of pre-specified outcomes and higher fidelity in order to maintain confidence in trial results.
Funding Agencies
None
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Affiliation(s)
- R Bansal
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Division of Gastroenterology, St. Michael’s Hospital, Toronto, ON, Canada
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Verma Y, Scaffidi MA, Gimpaya N, Panjwani A, Bansal R, Li J, Elsolh K, Khan R, Grover SC. A70 PREVALENCE OF SELF-PUBLICATION AMONG EDITORIAL BOARD MEMBERS OF GASTROENTEROLOGY JOURNALS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.068] [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
Editorial self-publication refers to the practice wherein editors publish research in journals to which they serve as editorial board members. The International Committee of Medical Journal Editors (ICMJE) has detailed recommendations against the practice of self-publication. There is evidence to suggest that editorial board membership may influence the decision to publish academic papers, which may contribute to publication bias. Despite this, there have been few attempts to characterize this practice in gastroenterology journals.
Aims
To determine the prevalence of original gastroenterology research articles published by editorial board members in their own journal.
Methods
We conducted a cross-sectional study to determine the prevalence of editorial board members publishing within their own journals. A list of the top 25 highest impact factor gastroenterology journals was created through InCites Journal reports. Journals were screened to determine eligibility based on whether their primary focus included gastroenterology research and whether archives with the names and affiliations of editorial board members were available. 10 journals were selected based on these criteria. For each journal, we extracted all original research articles published in 2019 using Web of Science (Clarivate Analytics ©). Articles classified as editorial material, meeting abstracts, reviews, and clinical practice guidelines were excluded. We cross-referenced the affiliations of all authors found in each publication with affiliations of editors disclosed on the journal website. For each editorial board member, we determined the number of publications within their own journal.
Results
We identified 844 editorial board members in the 10 journals included. Overall, 337 (39.9%) of the editors had a publication in their own journal, of which, 152 (18.0%) had more than one publication. Across all journals, the median number of editors with self-publication is 27 (IQR=20.3–49.8). The median number of editors with more than one self-publication is 16 (IQR=10.0–25.3). In total, 507 (60.1%) of all editors had no publications within their respective journals.
Conclusions
Despite recommendations against this practice, our results show a high number of research publications authored by editorial board members. These results demonstrate a potential risk for publication bias. However, this study was limited by the inability to investigate beyond the prevalence of self-publication. Furthermore, the explicit implications of our results remain unclear. Further research is required to evaluate factors such as disclosures and the review process associated with increased rates of self-publication as well as its impact on publication bias.
Funding Agencies
None
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Affiliation(s)
- Y Verma
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - N Gimpaya
- St. Michael’s Hospital, Toronto, ON, Canada
| | - A Panjwani
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- St. Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St. Michael’s Hospital, Toronto, ON, Canada
| | - K Elsolh
- St. Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- St. Michael’s Hospital, Toronto, ON, Canada
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Khan R, Elsolh K, Gimpaya N, Scaffidi MA, Bansal R, Grover SC. A89 CHARACTERISTICS AND CONFLICTS OF INTEREST AT FOOD AND DRUG ADMINISTRATION GASTROINTESTINAL DRUG ADVISORY COMMITTEE MEETINGS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.087] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The United States Food and Drug Administration (FDA) Gastrointestinal Drug Advisory Committee (GIDAC) is involved in gastrointestinal drug application reviews. Characteristics and conflicts of interest (COI) in GIDAC meetings are not well described.
Aims
To analyze FDA GIDAC meetings and characteristics that predict recommendations.
Methods
This was a cross-sectional study of all publicly available GIDAC meetings where proposed medications were voted on from 1998–2018. Data were collected on individual meetings and individual voting members at meetings. Predefined predictor variables included type of medication, medication sponsor, primary efficacy studies, and voting member characteristics (e.g. committee membership, COI). Univariate analyses were conducted at per-meeting and per-vote levels to assess for predictors of committee recommendation and individual votes respectively.
Results
Thirty-four meetings with 476 individual votes from 1998–2018 were included. Twenty-three (68%) proposals were recommended for approval and 25 (74%) received FDA approval. Most proposals involved >1 primary study (n=27, 79%). At least one voting member had a COI in 24 (71%) of 34 meetings. Twelve (35%) meetings had at least one sponsor COI. Among 476 individual votes, 74 (15.5%) involved a COI, with 33 (6.9%) sponsor COI. COI decreased significantly over time, with more COI in 1996–2000 and 2001–2005 compared to 2006–2010, 2011–2015, and 2016–2020 (p<0.01). There were no significant associations between pre-defined predictors, including COI, and committee level recommendations or individual votes (p>0.05 for all univariate analyses).
Conclusions
The GIDAC reviewed 34 proposals from 1998–2018. The majority were recommended for approval and later approved by the FDA, highlighting the GIDAC’s prominence in the regulatory process. COI are present among GIDAC panelists but decreasing over time and not associated with recommendations.
Funding Agencies
None
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Affiliation(s)
- R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - K Elsolh
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Gimpaya
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Bansal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - S C Grover
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Gimpaya N, Khan R, Gallinger ZR, Scaffidi MA, Al Abdulqader AK, Ahmed M, Gholami R, Ramkissoon A, James PD, Mosko J, Griller N, Bansal R, Grover SC. A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC. J Can Assoc Gastroenterol 2021. [PMCID: PMC7989228 DOI: 10.1093/jcag/gwab002.075] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19). Aims To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures. Methods Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool. Results Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox. Conclusions The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment. Funding Agencies SMHA AFP COVID-Related Innovation Funds
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Affiliation(s)
- N Gimpaya
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Z R Gallinger
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - M A Scaffidi
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | | | - M Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
| | - R Gholami
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - A Ramkissoon
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - P D James
- University Health Network, Toronto, ON, Canada
| | - J Mosko
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - N Griller
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - R Bansal
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
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Elsolh K, Tham D, Scaffidi MA, Bansal R, Li J, Verma Y, Gimpaya N, Khan R, Grover SC. A161 PREVALENCE OF FINANCIAL CONFLICTS OF INTEREST (FCOI) AMONG PROPENSITY-SCORE MATCHED RETROSPECTIVE STUDIES EVALUATING BIOLOGIC THERAPEUTICS FOR IBD. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.159] [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
Inflammatory Bowel Disease (IBD) studies have commonly relied on real-world evidence to evaluate different therapies. An emerging idea has been the use of propensity score matching as a statistical method to account for baseline characteristics in IBD patients. In retrospective studies, propensity score matching of patients helps reduce treatment assignment bias and mimic the effects of randomization. Recently, propensity-score matching has become an important tool in IBD studies comparing biologic therapeutics. Biologic medications are among the highest-grossing drugs worldwide, and their pharmaceutical producers make considerable payments to physicians to market them. In spite of this, there is a lack of evidence examining the role of undue industry influence among propensity-score matched comparative studies evaluating biologic therapeutics for IBD.
Aims
Given the documented association between IBD biologics and FCOI, we hypothesize a high burden of FCOI in propensity-score matched studies. The aim of this study was to evaluate the prevalence of disclosed & undisclosed financial conflicts of Interest (FCOI) in propensity-score matched comparison studies evaluating biologics for IBD.
Methods
We developed & ran a librarian-reviewed systematic search on EMBASE, MEDLINE, and Cochrane Library databases for all propensity-score matched retrospective studies comparing biologics for the treatment of IBD. Full-text retrieval & screening was performed on all studies in duplicate. 16 articles were identified. Industry payments to authors were only considered FCOI if they were made by a company producing a biologic that was included in the comparison study. Disclosed FCOI were identified by authors’ interests disclosures in full-texts. Any undisclosed FCOI among US authors were identified using the Centre for Medicare and Medicaid Services (CMS) Open Payments Database, which collects industry payments to physicians.
Results
Based on a preliminary analysis of 16 studies, there was at least one author with a relevant FCOI in 14 (88%) of the 16 studies. 14 studies (88%) had at least one disclosed FCOI, while 6 studies (37.5%) had at least one undisclosed FCOI. Among studies with disclosed FCOI, a mean of 40.2% (SD = 23.4%) of authors/study reported FCOI. Among studies with undisclosed FCOI, a mean of 18.8% (SD = 7.0%) of authors/study reported FCOI. The total dollar value of FCOIs was $1,974,328.3. The median conflict dollar value was $5,576.6 (IQR: $321.6 to $36,394.9).
Conclusions
We found a high burden of undisclosed FCOI (37.5%) among authors of propensity-score matched studies evaluating IBD biologics. Given the potential for undue industry influence stemming from such payments, authors should ensure better transparency with industry relationships.
Funding Agencies
None
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Affiliation(s)
- K Elsolh
- St Michael’s Hospital, Toronto, ON, Canada
| | - D Tham
- St Michael’s Hospital, Toronto, ON, Canada
| | | | - R Bansal
- St Michael’s Hospital, Toronto, ON, Canada
| | - J Li
- St Michael’s Hospital, Toronto, ON, Canada
| | - Y Verma
- St Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- University of Toronto, Hamilton, ON, Canada
| | - S C Grover
- St Michael’s Hospital, Toronto, ON, Canada
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Gholami R, Gimpaya N, Khan R, Scaffidi MA, Bansal R, Ramkissoon A, Alabdulqader A, Grover SC. A71 RECOMMENDATION REVERSALS IN GASTROENTEROLOGY CLINICAL PRACTICE GUIDELINES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.069] [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
Clinical practice guidelines are evidence-based resources designed to inform clinical decision making. Often, superior evidence will support the inclusion of novel procedures and practices to replace older recommendations. Recommendation reversals occur when (a) superior quality evidence emerges to suggest the harm or non-beneficence of prior recommendations, and (b) that recommendation is not supplanted by a newer one.
Aims
The primary objective of this study was to describe the content, frequency and rationale for recommendation reversals in CPGs published by gastroenterological societies.
Methods
For this meta-epidemiologic study, we considered two criteria to define a recommendation reversal: (a) the more recent CPG makes a recommendation that contradicts a previously accepted practice; and (b) the prior recommendation is not replaced by any novel intervention. We searched CPGs published by 20 major GI societies from 1991- 2019. Guidelines were included if had at least two iterations with the same title and used a valid evidence rating system (such as GRADE). Explicit recommendations which reported definite levels of evidence and strength of recommendation were extracted.
Results
We identified 1022 clinical guidelines from GI societies over 28 years. 292 CPGs were included for data synthesis. 5985 explicit statements were extracted. 12 reversals were confirmed and are summarized in the Table. Six reversals (50.0%) occurred due to studies reporting non-beneficence and 3 (25.0%) occrred due to studies reporting harm. Three recommendations (25.0%) were reversed due to new clinical trials; 3 (25.0%) due to systematic reviews or meta-analyses; and 2 to conform with CPGs of other societies (16.7%).
Conclusions
We describe recommendation reversals made in gastroenterology CPGs, and the reasons thereof. Investigation of recommendation reversals allows for the identification of low-value medical practices. This reinforces the need for GI CPG committees to (1) iteratively review guidelines to re-evaluate recommendations made on low-quality evidence and; (2) refrain from making recommendations when evidence for the same is weak.
Funding Agencies
None
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Affiliation(s)
- R Gholami
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - N Gimpaya
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Khan
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - M A Scaffidi
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - R Bansal
- McMaster University Faculty of Health Sciences, Richmond Hill, ON, Canada
| | - A Ramkissoon
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - A Alabdulqader
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - S C Grover
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
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Khan R, Naz I, Hussain S, Khan RAA, Ullah S, Rashid MU, Siddique I. Phytochemical management of root knot nematode (Meloidogyne incognita) kofoid and white chitwood by Artemisia spp. in tomato (Lycopersicon esculentum L.). BRAZ J BIOL 2020; 80:829-838. [PMID: 31800766 DOI: 10.1590/1519-6984.222040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/12/2019] [Indexed: 12/26/2022] Open
Abstract
In vitro and screen house experiments were conducted to investigate the effectiveness of thirteen phytochemicals from Artemisia elegantissimia and A. incisa on root knot nematode, Meloidogyne incognita in tomato (Lycopersicon esculentum L.) cv. Rio Grande. A positive control (Carbofuran) and negative control (H2O) were also used for comparison. Effectiveness of phytochemicals against juveniles (J2s) mortality and egg hatch inhibition were evaluated after 24, 48 and 72 hours of incubation at three concentrations viz; 0.1, 0.2 and 0.3 mg/mL in vitro conditions. Amongst thirteen phytochemicals, Isoscopletin (Coumarin), Carbofuran and Apigenin (Flavonoid) showed the highest mortality and egg hatch inhibition of M. incognita at all intervals. Inhibition of eggs and J2s mortality were the greatest (90.0%) and (96.0%) at 0.3 mg/mL concentration. Application of phytochemicals caused reduction in number of galls, galling index, and egg masses on tomato plant and enhanced plant growth parameters under screen house conditions. Gall numbers (1.50), galling index (1.00), number of juveniles (4.83) and egg masses (4.00) were greatly reduced and plant growth parameters such as; plant height (28.48 cm), fresh (72.13 g) and dry shoot weights (35.99 g), and root fresh (6.58 g) and dry weights (1.43 g) were increased significantly by using Isoscopletin. In structure activity relationship, juveniles of M. incognita, exhibited variations in their shape and postures upon death when exposed to different concentrations of phytochemicals of Artemisia spp. The present study suggests that Artemisia based phytochemicals possess strong nematicidal effects and can be used effectively in an integrated disease management program against root knot nematodes.
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Affiliation(s)
- R Khan
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - I Naz
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S Hussain
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - R A A Khan
- Institute of Vegetable and Flowers, Graduate School of Chinese Academy of Agricultural Sciences, Beijing, P.R. China
| | - S Ullah
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M U Rashid
- Department of Chemistry, Faculty of Arts & Basic Sciences, Balochistan University of Information Technology, Engineering and Management Sciences, Pakistan
| | - I Siddique
- Department of Plant Pathology, The University of Agriculture, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Srivastava AK, Dwivedi N, Dhand C, Khan R, Sathish N, Gupta MK, Kumar R, Kumar S. Potential of graphene-based materials to combat COVID-19: properties, perspectives, and prospects. Mater Today Chem 2020; 18:100385. [PMID: 33106780 PMCID: PMC7577689 DOI: 10.1016/j.mtchem.2020.100385] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/18/2020] [Accepted: 10/16/2020] [Indexed: 05/19/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new virus in the coronavirus family that causes coronavirus disease (COVID-19), emerges as a big threat to the human race. To date, there is no medicine and vaccine available for COVID-19 treatment. While the development of medicines and vaccines are essentially and urgently required, what is also extremely important is the repurposing of smart materials to design effective systems for combating COVID-19. Graphene and graphene-related materials (GRMs) exhibit extraordinary physicochemical, electrical, optical, antiviral, antimicrobial, and other fascinating properties that warrant them as potential candidates for designing and development of high-performance components and devices required for COVID-19 pandemic and other futuristic calamities. In this article, we discuss the potential of graphene and GRMs for healthcare applications and how they may contribute to fighting against COVID-19.
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Affiliation(s)
- A K Srivastava
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - N Dwivedi
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - C Dhand
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - R Khan
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - N Sathish
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - M K Gupta
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - R Kumar
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
| | - S Kumar
- CSIR-Advanced Materials and Processes Research Institute, Bhopal, 462026, India
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Ikomi A, Mannan S, Simon G, Khan R, Smith S, Robbins J, Kavanagh U, Crone D. Diagnosis of gestational diabetes during the pandemic: what is the risk of falling through the net? Diabet Med 2020; 37:1782-1784. [PMID: 32585723 PMCID: PMC7362157 DOI: 10.1111/dme.14346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/26/2022]
Affiliation(s)
- A. Ikomi
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Mannan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - G. Simon
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - R. Khan
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - S. Smith
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - J. Robbins
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - U. Kavanagh
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
| | - D. Crone
- Department of Obstetrics and GynaecologyBasildon University Hospital, Mid and South Essex NHS Foundation TrustBasildonUK
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Khan M, Khalid MH, Kamran M, Khan R. Symplectic Computations of Fast Ion Trajectory and Radial Diffusion Coefficient in MHD Perturbed Tokamak. J Fusion Energ 2020. [DOI: 10.1007/s10894-020-00236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
This cohort study examines the association of Ramadan fasting with clinical outcomes in patients with myasthenia gravis.
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Affiliation(s)
| | | | - Walaa Kamel
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait City, Kuwait
- Department of Neurology, Beni-Suef University, Beni-Suef, Egypt
| | - R. Khan
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait City, Kuwait
| | - Jasem Youssef Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Sabah Medical Area, Kuwait City, Kuwait
- Health Sciences Centre, Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Nazarian A, Bishay K, Gholami R, Scaffidi MA, Khan R, Cohen-Lyons D, Griller N, Satchwell JB, Baker J, Irvine EJ, Grover SC. A243 FACTORS ASSOCIATED WITH POOR QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN CLINICAL REMISSION: A CROSS-SECTIONAL STUDY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.242] [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
Inflammatory bowel disease (IBD) is associated with a substantial burden on quality of life (QoL). Functional gastrointestinal disorders such as irritable bowel syndrome (IBS) as well as depression and anxiety are more common in patients with IBD as compared with the general population. Although poorer QoL is correlated with IBS, depression and anxiety in individuals with IBD at times of IBD diagnosis and disease activity, it is unclear what, if any, impact these may have on overall quality of life at times of disease remission.
Aims
We aimed to identify factors associated with poor QoL among Canadian patients with IBD in clinical remission.
Methods
We conducted a prospective, cross-sectional study to determine whether fatigue, depression, anxiety and IBS were associated with lower QoL in patients with IBD in clinical remission. We enrolled patients at a single academic tertiary care center with inactive IBD. All eligible patients completed a series of questionnaires that included questions on demographics, disease activity, anxiety, depression, and the presence of irritable bowel syndrome (IBS) symptoms. Stool samples for fecal calprotectin (FC) were also collected to assess for subclinical inflammation. The primary outcome measure was QoL assessed by the short inflammatory bowel disease questionnaire (SIBDQ), with planned subgroup comparisons for fatigue, anxiety, depression and IBS symptoms.
Results
Ninety-three patients were eligible for inclusion in this study. The median SIBDQ scores were lower in patients with anxiety (P<0.001), depression (P=0.004), IBS symptoms (P<0.001), and fatigue (P=0.018).
Conclusions
In this cross-sectional study, we found that anxiety, depression, fatigue, and IBS-like symptoms were all independently associated with lower QoL among patients with inactive IBD. Importantly, subclinical inflammation as defined by a positive fecal calprotectin in the absence of clinical symptoms did not have an adverse effect on QoL. The findings of this study suggest that patients with IBD would likely benefit from screening for depression, anxiety, fatigue and IBS. Further research is warranted to determine if targeted treatment of these conditions, specifically in patients with quiescent IBD would lead to improved outcomes.
Funding Agencies
None
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Affiliation(s)
| | - K Bishay
- University of Toronto, Toronto, ON, Canada
| | - R Gholami
- University of Toronto, Toronto, ON, Canada
| | | | - R Khan
- University of Toronto, Toronto, ON, Canada
| | | | - N Griller
- University of Toronto, Toronto, ON, Canada
| | - J B Satchwell
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - J Baker
- Gastroenterology, St Michael’s Hospital, Toronto, ON, Canada
| | - E J Irvine
- University of Toronto, Toronto, ON, Canada
| | - S C Grover
- University of Toronto, Toronto, ON, Canada
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