A85 IMPROVING OUTCOMES IN THE PEDIATRIC TO ADULT CARE TRANSITION IN IBD (IMPACT IBD)
Notice bibliographique
Résumé
Pediatric-to-adult transition of care in Inflammatory Bowel Disease (IBD) can be challenging for patients between 18–25 and the lack of continuity of care is perceived to be causative in loss to follow-up, treatment disruption and poor clinical outcomes. The objective of this study was to determine whether regular email contact with a single IBD nurse could improve health outcomes when delivered during the last 3 months of pediatric care and the first 9 months of adult care. Patients were randomized in a 1:1 ratio to the intervention and control groups. Randomization was stratified by center (SickKids, McMaster) and anticipated post-transfer setting (academic vs. community). All individuals enrolled completed a baseline questionnaire (disease phenotype, medications, disease activity (Harvey Bradshaw Index (HBI), Pediatric Ulcerative Colitis Activity Index (PUCAI)), transition readiness (Transition Readiness Assessment Questionnaire (TRAQ), patient satisfaction (CACHE questionnaire), IBD knowledge (Crohn’s and Colitis Knowledge Questionnaire (CCK)). This was repeated every 6 months. MyHealth Passport was distributed twice. The IBD nurse interacted monthly with intervention patients and IBD educational modules were delivered every two months. This study was REB approved. We compared IBDQ, HBI, PUCAI, TRAQ, CACHE, CCK scores between groups. Paired Students t-test or the Wilcoxon ranksum test were used to assess for statistically significance (p-value of <0.05). 151 patients were recruited to the study (72 intervention, 74 control, 5 lost). 78% of the population was from SickKids. 76% of the population were transferred to an adult academic setting. 74% had Crohn’s Disease. 27% had perianal disease and 10% had pediatric growth delay. 86% of UC patients had pancolitis. The mean age was 17 with a mean age of diagnosis 13. 19% had prior surgery, 66% were on anti-TNF therapy and 93% had self-reported active familial psychosocial support. There was no significant difference at 12 months between intervention and control groups with respect to HBI, PUCAI, IBDQ, CACHE. At 12 months the intervention group scored lower on TRAQ (3.51 vs 3.61, p=0.02). At 12 months the intervention group scored higher on CCK (14.61 vs 13.57 p=0.05). When the difference between 12 month and baseline scores for each group were analysed, there was no difference in HBI, PUCAI, CACHE, CCK. The difference in IBDQ was larger in the control group (-31.90 vs -21.11, p<0.001). Standardized routine email interactions between an IBD nurse and patients does not reliably improve most traditional disease outcomes. It is unclear whether a longer duration of intervention, an in-person component to the intervention and/or a change in metrics are needed to improve impact. CCC
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».