Safety of Infliximab in Children with IBD: The Experience of an Academic Center in WV

BACKGROUND: The immune-modulating drug, infliximab, is approved for Inflammatory Bowel Disease (IBD) treatment in children. Chronic therapy with infliximab is associated with the development of early and delayed infusion reactions. We reviewed our experience with infliximab treatment and its side effects in a cohort of children diagnosed with IBD who were treated in our clinic. METHODS: A retrospective analysis of all IBD children treated with infliximab in our center from 2006-2011 was performed. The demographic, chronological and clinical data were recorded. The infliximab infusion was given at 5mg/ kg according to a standard protocol after pre-treatment with low dose steroid and diphenhydramine. RESULTS: Of 30 IBD patients (23 CD/7 UC) receiving 454 infusions (341 CD/113 UC), six (20%) patients experienced early infusion reactions. Two (6.7%) patients had a delayed reaction; of those, both required intestinal resection. CONCLUSION: Our study is the first to address the safety of infliximab infusion reactions in children in the state of WV. Our results lend support to the use and safety of infliximab in children with moderate to severe IBD

Developing an Online Critical Care Electroencephalography Curriculum for Epilepsy and Neurophysiology Fellows

Purpose: This project aims to create an Electroencephalography (EEG) curriculum that synthesizes the teachings of current publications and faculty expertise within a single digital platform. The goal is to remedy the unmet need for a centralized resource for learners to use when learning EEG interpretation. Methods: The target learner population is epilepsy and neurophysiology fellows. The platform will be accessible from any computer, tablet, or phone, allowing for mobile, self-paced learning to take place. To date, the curriculum outline has been designed with extensive literature review and collaboration from other institutions, and two pilot modules have been completed using the story-board platform Articulate. Data about efficacy and usefulness will be collected via learner feedback forms when the program goes live. Results and Conclusions: We anticipate that fellows will appreciate the streamlined approach to learning high-yield topics in EEG interpretation. The hope is that the platform will save users time currently spent sifting through textbooks and publications because it incorporates a conglomerate of resources, including qualitative input from experts across the country. That time, in turn, can be spent with more targeted interactions with their teachers (the platform serves as a complement to the existing face-to-face instruction). Learning activities for progress-evaluation will be embedded within each module of the platform with the goal of allowing learners to self-identify areas of improvement to help focus studying efforts. Further results and conclusions will be recorded and updated as progress continues to be made

Improving Sensitivity to and Inclusivity of LGBT Older Adults in an Urban Geriatric Practice

CHA’s overall goal is to improve the care delivered to LGBT older adults. Step 1: Needs assessment with provider and staff survey (Fall 2020)Step 2: Implementation of SAGE training and provider education (Fall/Winter 2020) Step 3 (this study): Needs assessment with community-dwelling LGBT older adults (Spring 2021

Incidental Findings on LDCT for Lung Cancer Screening: Prevalence and Clinical Management

Objectives To define the frequency of incidental findings on low-dose CT (LDCT) scans among patients undergoing lung cancer screening. To determine the current reporting methods for incidental findings and measure the frequency of clinical follow-up

Cannabis as a Medical Therapy

Objectives Why are we where we are? What evidence exists in what spaces? What we think happens vs what our patients are actually doin

The Financial and Psychosocial Impact of Medicinal Cannabis

Introduction: Therapeutic utilization of medicinal cannabis for symptom management in oncology patients is a burgeoning area of research focus. We hypothesize that medicinal cannabis use can result in subjective improvements in quality of life (QOL) metrics for cancer patients. Methods: Adult palliative care patients at a medical oncology clinic are consented to the study after being certified to access medicinal cannabis. After three months, subjective changes in QOL, including well-being, financial burden, pain, chemotherapy induced nausea and vomiting (CINV), and other categories are recorded via telephone interview. Responses are documented with a numerical Likert scale (from 1-5, with a score of 1 = greatly decreased satisfaction, and 5 = greatly increased satisfaction; a score of 3 is no change from baseline). Scores \u3e3.5 were deemed meaningful in terms of improvement. Results: An aggregate of 35 patient scores showed meaningful increases in subjective satisfaction across most metrics. Satisfaction with CINV symptoms showed the most marked improvement, with an average score of 3.63. While pain scores were similar at 3.53, more general QOL metrics were lower, at 3.46. Most patients did not find the cost to be burdensome, with an average score of 3.03. Discussion: The initial 35 interviews of our desired n of 120 suggest that medicinal cannabis may provide analgesic, antiemetic, and anxiolytic benefits for cancer patients. We anticipate that additional interviews will follow this pattern. If so, our study could bolster the evidence that therapeutic use of medicinal cannabis may be helpful for patients undergoing cancer treatment

Research Submission Abdominal Migraine: An Under-Diagnosed Cause of Recurrent Abdominal Pain in Childrenh ead_1855 707..712

Objective.-Our objective was to demonstrate that, despite recognition by both the gastroenterology and headache communities, abdominal migraine (AM) is an under-diagnosed cause of chronic, recurrent, abdominal pain in childhood in the USA. Background.-Chronic, recurrent abdominal pain occurs in 9-15% of all children and adolescents. After exclusion of anatomic, infectious, inflammatory, or other metabolic causes, "functional abdominal pain" is the most common diagnosis of chronic, idiopathic, abdominal pain in childhood. Functional abdominal pain is typically categorized into one, or a combination of, the following 4 groups: functional dyspepsia, irritable bowel syndrome, AM, or functional abdominal pain syndrome. International Classification of Headache Disorders-(ICHD-2) defines AM as an idiopathic disorder characterized by attacks of midline, moderate to severe abdominal pain lasting 1-72 hours with vasomotor symptoms, nausea and vomiting, and included AM among the "periodic syndromes of childhood that are precursors for migraine." Rome III Gastroenterology criteria (2006) separately established diagnostic criteria and confirmed AM as a well-defined cause of recurrent abdominal pain. Methods.-Following institutional review board approval, a retrospective chart review was conducted on patients referred to an academic pediatric gastroenterology practice with the clinical complaint of recurrent abdominal pain. ICHD-2 criteria were applied to identify the subset of children fulfilling criteria for AM. Demographics, diagnostic evaluation, treatment regimen and outcomes were collected. Results.-From an initial cohort of 600 children (ages 1-21 years; 59% females) with recurrent abdominal pain, 142 (24%) were excluded on the basis of their ultimate diagnosis. Of the 458 patients meeting inclusion criteria, 1824 total patient office visits were reviewed. Three hundred eighty-eight (84.6%) did not meet criteria for AM, 20 (4.4%) met ICHD-2 formal criteria for AM and another 50 (11%) had documentation lacking at least 1 criterion, but were otherwise consistent with AM (probable AM). During the observation period, no children seen in this gastroenterology practice had received a diagnosis of AM. Conclusion.-Among children with chronic, idiopathic, recurrent abdominal pain, AM represents about 4-15%. Given the spectrum of treatment modalities now available for pediatric migraine, increased awareness of cardinal features of AM by pediatricians and pediatric gastroenterologists may result in improved diagnostic accuracy and early institution of both acute and preventative migraine-specific treatments

Narrative Medicine: A Reflective Writing Workshop Series for Interprofessional Healthcare Students at Thomas Jefferson University

Introduction: Narrative medicine (NM) teaches reflective writing and close reading to help healthcare professionals think critically about themselves and others in order to offer more effective, empathic care. Few reports of NM methods document its value to facilitating collaboration and communication across students of different professional backgrounds. This study examines the effects of NM workshops on Thomas Jefferson University interprofessional healthcare students, and their utility to achieving these aims: 1) supporting thoughtfulness, mindfulness, and curiosity; 2) supporting the development and use of narrative in understanding the lives/contexts for self and others; 3) improving interactions and communication with others in professional and clinical contexts; 4) supporting humanism and whole person care (including self-care). Methods: Six bi-weekly, one-hour long NM reflective writing workshops were offered as a voluntary elective for interprofessional healthcare students. Participants completed a post-series questionnaire. Closed-ended responses were summarized, open-ended questions were analyzed using qualitative content analysis. Results: Twelve participants completed the questionnaire (8 medical students of different years, 1 MD/PhD student, 2 nursing students, 1 occupational therapy student). All participants reported that main aims 1) and 2) were achieved. 92% of participants reported that main aims 3) and 4) were achieved. 83% found the narrative exercises valuable to facilitating relationships with others of different professional backgrounds in the workshops, and to facilitating or advancing relationships with peers/colleagues outside of the workshops. 83% found the exercises helpful to reducing divides between interprofessional students. Qualitative analysis facilitated the organization of codes into 4 thematic categories: change, understanding, reflection, difference. Discussion: A NM intervention providing consistent exposure to NM methods was successfully implemented. This was a feasible, effective method for promoting reflection, understanding of self/others, whole person care/self-care, and communication and collaboration amongst interprofessional healthcare students. Workshop objectives were achieved, and participants reported personal and professional value and utility in participation

The Impact of Outpatient Supportive Oncology on Cancer Care Cost and Utilization

Research Objective In patients with advanced cancer, interprofessional, non hospital-based care models of palliative care or Supportive Oncology (SO) have been shown in some studies to reduce symptom severity, hospital admissions, and healthcare costs. However, there is little consistency in the composition of SO programs or the degree of integration of social work, nutrition counseling, patient navigation, and nursing care services. There is limited research on quality of care and cost outcomes and current fee-for-service models do not cover the high costs of these non-billable services. We examine the impact of Interprofessional SO care on utilization and medical costs in patients with advanced cancer.https://jdc.jefferson.edu/medoncposters/1018/thumbnail.jp