P-055 YI Thiopurine Methyltransferase Testing and Thiopurine Use in Inflammatory Bowel Disease Patients Amongst Gastroenterologists
Bibliographic record
Abstract
Inflammatory bowel disease (IBD) is a chronic disease that often requires immunosuppressive and/or immunomodulatory therapy, in particular thiopurines such as Azathioprine (AZA) and 6-Mercaptopurine (6-MP). Numerous guidelines and organizations such as the World Gastroenterology Organization, American College of Gastroenterology, American Gastroenterology Association, National Institute for Health and Clinical Excellence and Federal Drug Association recommend routine evaluation of thiopurine methyltransferase testing (TPMT) for enzyme levels in order to identify at-risk patients for thiopurine-induced leukopenia. Therefore, we administered an electronic survey to Gastroenterologists to evaluate practice patterns and guideline adherence in TPMT testing for thiopurine use in inflammatory bowel disease patients. We designed a 21-question electronic survey that was provided to the Canadian Association of Gastroenterology (CAG). The survey was distributed to all CAG members on July 14, 2014 via e-mail and subsequently posted on the CAG website. The survey was created using online software from www.surveymonkey.com and results were analyzed using online software. To date, there have been 38 respondents. Majority (68.4%) of the Gastroenterologists were in the 30-49 age range, 71.1% were male and 57.9% are practicing in academic institutions. The most commonly prescribed thiopurine is Azathioprine (92.1%) and the most influential prescribing factor is personal familiarity (60.5%). Only 44.7% of Gastroenterologists routinely order TPMT testing and 15.8% of Gastroenterologists were unaware TPMT testing was available in Canada. Amongst those that are aware, 55.3% are unaware which laboratories offer TPMT testing. Amongst Gastroenterologists, 29.0% order TPMT testing on all newly diagnosed IBD patients while 31.6% order it on IBD patients just prior to starting therapy with a thiopurine. The most common reason Gastroenterologists do not order TPMT testing is because they believe testing is not available locally (15.8%). Additionally, Gastroenterologists believe TPMT testing costs anywhere from $11 to over $200 and believe result take anywhere from 1 day to over 4 weeks to attain. Based on our survey and analysis of initial responses, there is considerable variability in practice patterns with TPMT testing for thiopurine use in IBD patients. We have highlighted that there are several misconceptions amongst TPMT testing. We believe that this data can aid in creating an educational initiative aimed at clarifying common misconceptions and provide greater adherence to current guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.015 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".