Adequate tissue acquisition for the diagnosis of gastric submucosal masses (GSMs) has been challe... more Adequate tissue acquisition for the diagnosis of gastric submucosal masses (GSMs) has been challen ging for gastroenterologists. The use of standard biopsy forceps generally recovers non-diagnostic overlying mucosa. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) provides a significant improvement, but is often still inadequate for diagnosis. The aim of the current study was to assess the efficacy of a novel jumbo biopsy unroofing technique (JUT) for tissue acquisition in GSM. This prospective study recruited patients who were referred for EUS for the evaluation of GSM between 2006 and 2009. All patients underwent EUS with FNA when feasible followed by JUT. The primary outcome was diagnostic yield of JUT. A total of 93 patients were enrolled, 72 of whom were included in the investigation; 16 patients were excluded with no evidence of a submucosal mass or extrinsic compression, and five patients were further excluded by pathology confirming mucosal lesions. Of the 72 jumbo biopsies 66 (92%) provided diagnostic tissue without significant complications and 42 (58%) had lesions amenable to FNA. Although 34 of the 42 lesions were deemed adequate at the time of on-site cytological evaluation, only 28 (67%) provided sufficient tissue for final diagnosis. More importantly, only 37/72 (52%) of all patients had lesions that required any further intervention. Utilization of JUT is safe and effective for diagnosis of GSM. The data suggest that the jumbo biopsy unroofing technique should be considered as an initial diagnostic strategy for GSMs found during upper endoscopy.
Objective To assess whether an individual’s degree of psychological resilience can be determined ... more Objective To assess whether an individual’s degree of psychological resilience can be determined from physiological metrics passively collected from a wearable device. Materials and Methods Data were analyzed in this secondary analysis of the Warrior Watch Study dataset, a prospective cohort of healthcare workers enrolled across 7 hospitals in New York City. Subjects wore an Apple Watch for the duration of their participation. Surveys were collected measuring resilience, optimism, and emotional support at baseline. Results We evaluated data from 329 subjects (mean age 37.4 years, 37.1% male). Across all testing sets, gradient-boosting machines (GBM) and extreme gradient-boosting models performed best for high- versus low-resilience prediction, stratified on a median Connor-Davidson Resilience Scale-2 score of 6 (interquartile range = 5–7), with an AUC of 0.60. When predicting resilience as a continuous variable, multivariate linear models had a correlation of 0.24 (P = .029) and RMS...
Background The quality of life of persons living with inflammatory bowel disease (IBD) is impacte... more Background The quality of life of persons living with inflammatory bowel disease (IBD) is impacted by the physical and psychosocial burdens of disease, as well as by their satisfaction with the quality of care they receive. We sought to better understand 1) the drivers of satisfaction with treatment, including treatment goals, treatment selection, and attributes of patient/health care professional (HCP) interactions, and 2) how IBD symptoms affect aspects of daily life and overall quality of life. Methods Two online questionnaires were accessed via MyCrohnsAndColitsTeam.com. The Treatment Survey assessed desired treatment outcomes, past and present therapies, and experiences with the patient’s primary treating HCP. The Quality of Life survey assessed respondents’ most problematic IBD symptoms and their influence on family and social life, work, and education. Respondents had Crohn’s disease (CD) or ulcerative colitis (UC), were 19 years or older, and resided in the US. All responses...
Background The IBD-Self-Efficacy Scale (IBD-SES) is an outcome measurement scale used in various ... more Background The IBD-Self-Efficacy Scale (IBD-SES) is an outcome measurement scale used in various countries, with psychometric properties that predicted psychological distress and showed moderate correlation with QOL. Although the 29-item IBD-SES is useful, a shorter instrument would increase the likelihood of usage. In this study, we aimed to develop a substantially shorter, but still as valid version of IBD-SES. Methods A total of 919 patients, 482 from a specialized IBD clinic (UC: 184, CD: 298) and 437 online (UC: 255, CD: 182), were used for psychometric assessment. The original 29-item IBD-SES was reduced using three major analytic steps (assessed ceiling or floor effect, correlation between items, test-retest reliability). The shorter version was evaluated on construct validity by confirmatory factor analysis, criterion validity by Pearson’s correlation coefficients with original version, and internal consistency by Cronbach’s alpha coefficient. Results In the item reduction p...
Qualitative Research in Medicine and Healthcare, 2020
The Patient-Centered Medical Home model has gained popularity in primary care to provide early ef... more The Patient-Centered Medical Home model has gained popularity in primary care to provide early effective care to patients with chronic conditions. Prior research on specialty medical homes has been cross-sectional and focused on patient outcomes. The objective of this longitudinal qualitative study was to identify best practices in establishing a specialty medical home in Inflammatory Bowel Diseases (IBD Home). The multimethod study included direct observations of multidisciplinary team meetings (30 hours over one year) and in-depth interviews with individual team members (N=11) and referring physicians (N=6) around their participation in the IBD home. All interviews were professionally transcribed verbatim. Two researchers coded transcripts for themes using NVivo software. Weekly team meetings (N=9±3) included behavioral health providers, nurse practitioners, nurses, dietitians, a clinical pharmacist, and clinical coordinators. Physicians referred patients with psychosocial comorbi...
Background: Transition to adult-centered care requires adolescents with inflammatory bowel diseas... more Background: Transition to adult-centered care requires adolescents with inflammatory bowel disease (IBD) to acquire a set of independent self-management skills. Transition success can be affected by maturity, cognitive development, and many other factors. Our hypothesis was that parenting style would be associated with increased self-efficacy and therefore transitions readiness. Methods: A prospective cohort survey study of adolescents with IBD and their parents from October 2018 to October 2019 was performed. Participants completed the IBD-Self-Efficacy Scale- Adolescent questionnaire (IBD-SES-A) and the Transition Readiness Assessment Questionnaire (TRAQ). Parents completed the Parent Styles and Dimensions Questionnaire (PSDQ-short form). Demographic and disease information were also collected. Results: Sixty-nine participants were included for full analysis (36 males and 33 females); mean age was 18.2 years, and average age of IBD diagnosis 13 years. Overall, 83% of participants ...
ImportancePassive and non-invasive identification of SARS-CoV-2 infection remains a challenge. Wi... more ImportancePassive and non-invasive identification of SARS-CoV-2 infection remains a challenge. Widespread use of wearable devices represents an opportunity to leverage physiological metrics and fill this knowledge gap.ObjectiveTo determine whether a machine learning model can detect SARS-CoV-2 infection from physiological metrics collected from wearable devices.DesignA multicenter observational study enrolling health care workers with remote follow-up.SettingSeven hospitals from the Mount Sinai Health System in New York CityParticipantsEligibility criteria included health care workers who were ≥18 years, employees of one of the participating hospitals, with at least an iPhone series 6, and willing to wear an Apple Watch Series 4 or higher. We excluded participants with underlying autoimmune/inflammatory diseases, and medications known to interfere with autonomic function. We enrolled participants between April 29th, 2020, and March 2nd, 2021, and followed them for a median of 73 day...
Background Changes in autonomic nervous system function, characterized by heart rate variability ... more Background Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. Objective We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. Methods Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. Results Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P=.006). The mean amplitude of this ...
BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients ... more BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). After developing a PPR questionnaire for patients, we sought to develop and validate an IBS‐specific instrument to measure physician expectations of the PPR.MethodsWe conducted focus groups about PPRs among 15 clinicians who treat patients with IBS from community and academic centers. Qualitative analysis was used to generate the Patient‐Physician Relationship Scale ‐PhysicianResultsThe PPRS‐Physician contained 35 questions pertaining to interpersonal and psychosocial features considered desirable or undesirable in a relationship with IBS patients. 1113 physicians (22%) completed the survey. Physicians were predominantly middle‐aged (mean = 55.1 years), male (85.0%), white (74.5%), and practiced primarily within group settings (61.6%), with an average of 25.7% of their patients having IBS. Factor analysis revealed three relevant factors: interfering a...
Background: Although cognitive behavior therapies (CBTs) have shown great promise in the reductio... more Background: Although cognitive behavior therapies (CBTs) have shown great promise in the reduction of symptom burden from as well as anxiety around various gastrointestinal (GI) disorders, there are substantial issues involving the scalable delivery of such interventions within the clinical setting of a gastroenterology practice, leaving most patients without access to psychological care. Goals: This paper discusses the application of positive psychology principles and techniques for adoption by various GI providers to initiate early, effective psychological care for patients with GI disorders, saving CBTs for more complex cases. Study/Results: Authors provide a comprehensive framework of patient well-being known as REVAMP, which is consistent with CBT principles, and elaborate on research and interventions that can be adopted within the gastroenterology practice setting. Building positive resources can bolster patients with GI disorders against comorbid psychological and psychiatri...
Adequate tissue acquisition for the diagnosis of gastric submucosal masses (GSMs) has been challe... more Adequate tissue acquisition for the diagnosis of gastric submucosal masses (GSMs) has been challen ging for gastroenterologists. The use of standard biopsy forceps generally recovers non-diagnostic overlying mucosa. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) provides a significant improvement, but is often still inadequate for diagnosis. The aim of the current study was to assess the efficacy of a novel jumbo biopsy unroofing technique (JUT) for tissue acquisition in GSM. This prospective study recruited patients who were referred for EUS for the evaluation of GSM between 2006 and 2009. All patients underwent EUS with FNA when feasible followed by JUT. The primary outcome was diagnostic yield of JUT. A total of 93 patients were enrolled, 72 of whom were included in the investigation; 16 patients were excluded with no evidence of a submucosal mass or extrinsic compression, and five patients were further excluded by pathology confirming mucosal lesions. Of the 72 jumbo biopsies 66 (92%) provided diagnostic tissue without significant complications and 42 (58%) had lesions amenable to FNA. Although 34 of the 42 lesions were deemed adequate at the time of on-site cytological evaluation, only 28 (67%) provided sufficient tissue for final diagnosis. More importantly, only 37/72 (52%) of all patients had lesions that required any further intervention. Utilization of JUT is safe and effective for diagnosis of GSM. The data suggest that the jumbo biopsy unroofing technique should be considered as an initial diagnostic strategy for GSMs found during upper endoscopy.
Objective To assess whether an individual’s degree of psychological resilience can be determined ... more Objective To assess whether an individual’s degree of psychological resilience can be determined from physiological metrics passively collected from a wearable device. Materials and Methods Data were analyzed in this secondary analysis of the Warrior Watch Study dataset, a prospective cohort of healthcare workers enrolled across 7 hospitals in New York City. Subjects wore an Apple Watch for the duration of their participation. Surveys were collected measuring resilience, optimism, and emotional support at baseline. Results We evaluated data from 329 subjects (mean age 37.4 years, 37.1% male). Across all testing sets, gradient-boosting machines (GBM) and extreme gradient-boosting models performed best for high- versus low-resilience prediction, stratified on a median Connor-Davidson Resilience Scale-2 score of 6 (interquartile range = 5–7), with an AUC of 0.60. When predicting resilience as a continuous variable, multivariate linear models had a correlation of 0.24 (P = .029) and RMS...
Background The quality of life of persons living with inflammatory bowel disease (IBD) is impacte... more Background The quality of life of persons living with inflammatory bowel disease (IBD) is impacted by the physical and psychosocial burdens of disease, as well as by their satisfaction with the quality of care they receive. We sought to better understand 1) the drivers of satisfaction with treatment, including treatment goals, treatment selection, and attributes of patient/health care professional (HCP) interactions, and 2) how IBD symptoms affect aspects of daily life and overall quality of life. Methods Two online questionnaires were accessed via MyCrohnsAndColitsTeam.com. The Treatment Survey assessed desired treatment outcomes, past and present therapies, and experiences with the patient’s primary treating HCP. The Quality of Life survey assessed respondents’ most problematic IBD symptoms and their influence on family and social life, work, and education. Respondents had Crohn’s disease (CD) or ulcerative colitis (UC), were 19 years or older, and resided in the US. All responses...
Background The IBD-Self-Efficacy Scale (IBD-SES) is an outcome measurement scale used in various ... more Background The IBD-Self-Efficacy Scale (IBD-SES) is an outcome measurement scale used in various countries, with psychometric properties that predicted psychological distress and showed moderate correlation with QOL. Although the 29-item IBD-SES is useful, a shorter instrument would increase the likelihood of usage. In this study, we aimed to develop a substantially shorter, but still as valid version of IBD-SES. Methods A total of 919 patients, 482 from a specialized IBD clinic (UC: 184, CD: 298) and 437 online (UC: 255, CD: 182), were used for psychometric assessment. The original 29-item IBD-SES was reduced using three major analytic steps (assessed ceiling or floor effect, correlation between items, test-retest reliability). The shorter version was evaluated on construct validity by confirmatory factor analysis, criterion validity by Pearson’s correlation coefficients with original version, and internal consistency by Cronbach’s alpha coefficient. Results In the item reduction p...
Qualitative Research in Medicine and Healthcare, 2020
The Patient-Centered Medical Home model has gained popularity in primary care to provide early ef... more The Patient-Centered Medical Home model has gained popularity in primary care to provide early effective care to patients with chronic conditions. Prior research on specialty medical homes has been cross-sectional and focused on patient outcomes. The objective of this longitudinal qualitative study was to identify best practices in establishing a specialty medical home in Inflammatory Bowel Diseases (IBD Home). The multimethod study included direct observations of multidisciplinary team meetings (30 hours over one year) and in-depth interviews with individual team members (N=11) and referring physicians (N=6) around their participation in the IBD home. All interviews were professionally transcribed verbatim. Two researchers coded transcripts for themes using NVivo software. Weekly team meetings (N=9±3) included behavioral health providers, nurse practitioners, nurses, dietitians, a clinical pharmacist, and clinical coordinators. Physicians referred patients with psychosocial comorbi...
Background: Transition to adult-centered care requires adolescents with inflammatory bowel diseas... more Background: Transition to adult-centered care requires adolescents with inflammatory bowel disease (IBD) to acquire a set of independent self-management skills. Transition success can be affected by maturity, cognitive development, and many other factors. Our hypothesis was that parenting style would be associated with increased self-efficacy and therefore transitions readiness. Methods: A prospective cohort survey study of adolescents with IBD and their parents from October 2018 to October 2019 was performed. Participants completed the IBD-Self-Efficacy Scale- Adolescent questionnaire (IBD-SES-A) and the Transition Readiness Assessment Questionnaire (TRAQ). Parents completed the Parent Styles and Dimensions Questionnaire (PSDQ-short form). Demographic and disease information were also collected. Results: Sixty-nine participants were included for full analysis (36 males and 33 females); mean age was 18.2 years, and average age of IBD diagnosis 13 years. Overall, 83% of participants ...
ImportancePassive and non-invasive identification of SARS-CoV-2 infection remains a challenge. Wi... more ImportancePassive and non-invasive identification of SARS-CoV-2 infection remains a challenge. Widespread use of wearable devices represents an opportunity to leverage physiological metrics and fill this knowledge gap.ObjectiveTo determine whether a machine learning model can detect SARS-CoV-2 infection from physiological metrics collected from wearable devices.DesignA multicenter observational study enrolling health care workers with remote follow-up.SettingSeven hospitals from the Mount Sinai Health System in New York CityParticipantsEligibility criteria included health care workers who were ≥18 years, employees of one of the participating hospitals, with at least an iPhone series 6, and willing to wear an Apple Watch Series 4 or higher. We excluded participants with underlying autoimmune/inflammatory diseases, and medications known to interfere with autonomic function. We enrolled participants between April 29th, 2020, and March 2nd, 2021, and followed them for a median of 73 day...
Background Changes in autonomic nervous system function, characterized by heart rate variability ... more Background Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. Objective We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. Methods Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. Results Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P=.006). The mean amplitude of this ...
BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients ... more BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). After developing a PPR questionnaire for patients, we sought to develop and validate an IBS‐specific instrument to measure physician expectations of the PPR.MethodsWe conducted focus groups about PPRs among 15 clinicians who treat patients with IBS from community and academic centers. Qualitative analysis was used to generate the Patient‐Physician Relationship Scale ‐PhysicianResultsThe PPRS‐Physician contained 35 questions pertaining to interpersonal and psychosocial features considered desirable or undesirable in a relationship with IBS patients. 1113 physicians (22%) completed the survey. Physicians were predominantly middle‐aged (mean = 55.1 years), male (85.0%), white (74.5%), and practiced primarily within group settings (61.6%), with an average of 25.7% of their patients having IBS. Factor analysis revealed three relevant factors: interfering a...
Background: Although cognitive behavior therapies (CBTs) have shown great promise in the reductio... more Background: Although cognitive behavior therapies (CBTs) have shown great promise in the reduction of symptom burden from as well as anxiety around various gastrointestinal (GI) disorders, there are substantial issues involving the scalable delivery of such interventions within the clinical setting of a gastroenterology practice, leaving most patients without access to psychological care. Goals: This paper discusses the application of positive psychology principles and techniques for adoption by various GI providers to initiate early, effective psychological care for patients with GI disorders, saving CBTs for more complex cases. Study/Results: Authors provide a comprehensive framework of patient well-being known as REVAMP, which is consistent with CBT principles, and elaborate on research and interventions that can be adopted within the gastroenterology practice setting. Building positive resources can bolster patients with GI disorders against comorbid psychological and psychiatri...
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