A115 SYSTEMATIZATION AND MODERNIZATION OF AN ANTI-SMOKING PROGRAM IN CROHN’S DISEASE
Notice bibliographique
Résumé
There is a well-established relationship between smoking and disease activity in Crohn’s. The impact of smoking on Crohn’s disease includes increased risk of relapse, disease complications, need for surgery, hospitalization, and flare severity. Despite clear evidence that smoking has a negative impact on Crohn’s disease, research has shown that patients with Crohn’s disease are often unaware of this fact. Furthermore, studies have demonstrated that gastroenterologists do not frequently discuss the importance of smoking cessation or offer cessation strategies to patients. Studies exploring the effect of smoking cessation in Crohn’s patients have found that cessation results in reduced rates of disease flares and the need for steroids and immunosuppression therapy when compared to active smokers. This highlights the importance of smoking cessation in Crohn’s disease, and that it should be an integral part of the management plan for Crohn’s patients. The aim of this study was to evaluate if a comprehensive standardized process for identifying and targeting patients with Crohn’s disease would change management, starting with improved documentation of smoking status in Crohn’s patients, and further progressing to targeted patient education. A standardized anti-smoking program was implemented into the offices of two gastroenterologists. This process change began at patient intake utilizing a patient questionnaire, non-MD EMR input of smoking status, targeted patient intervention using “Smoking and Crohn’s Disease” information pamphlets, and EMR smart-phrases to rapidly document smoking intervention. After 20 months, a chart review was performed on 50 patients from these two offices as well as 200 charts from the offices of an additional ten local gastroenterologists. The rates of smoking status documentation as well as discussion about smoking cessation were compared. Of the charts reviewed from the offices that implemented the standardized anti-smoking program intervention, 96% had a documented smoking status, compared to 57% of the charts in the non-intervention group (p = < 0.001). In the intervention group, smoking cessation strategies were discussed with 75% of smokers while there was no documented smoking cessation discussion in the non-intervention group (p = 0.077). Having a standardized and comprehensive anti-smoking program and process leads to an increase in documentation rates and discussion about smoking cessation strategies in Crohn’s disease. Table 1. Smoking status documentation Group A: Offices without a standardized process for smoking documentation (N=10). Group B: Offices with a standardized process for smoking documentation (N=2). Table 1. Smoking status documentation Group A: Offices without a standardized process for smoking documentation (N=10). Group B: Offices with a standardized process for smoking documentation (N=2). Image 1. Smoking information for Crohn’s patients. None
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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 | 0,007 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 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 ».