P75 ‘IBD-Dermatology’: a novel and collaborative working model
Bibliographic record
Abstract
Introduction Skin disease occurs in 10% of patients with inflammatory bowel disease (IBD), most commonly in patients with active disease and a positive family history.1 Our gastroenterology-dermatology clinic (GDC) allows patients to be reviewed jointly by a gastroenterologist and dermatologist. In this study, we aimed to analyse clinical data from our patient cohort and survey patient satisfaction. Methods We reviewed the electronic health records of patients seen within the GDC and collected demographic and clinical data. We distributed an anonymous patient survey to those attending clinic in July 2023 to evaluate satisfaction following their appointment. Results Data was gathered from ten 3-monthly clinics between July 2021–October 2023 (105 appointments). Of forty-four patients attending the GDC (16:28 male: female, median age 36 (18–76)), 89% had IBD (Crohn’s disease (CD) n=32, ulcerative colitis (UC) n=7). Dermatological diagnoses included psoriasis (n=11, 25%), eczema (n=9, 20%), hidradenitis suppurativa (HS) (n=10, 23%, Hurley stage: I (n=2), II (n=2), III (n=2), scoring not documented (n=4)), cutaneous CD (n=9, 20%) and pyoderma gangrenosum (n=5, 11%). Three patients had overlapping cutaneous CD and HS. Four patients with psoriasis were paradoxical secondary to anti-TNF therapy. Most patients attended the clinic multiple times (median attendance=2 (1–9)). Twenty-four CD patients (75%) commenced biologic therapy. Twelve had therapy initiated for both the dermatological diagnosis and CD. Most common CD Montreal classifications were A2 (n=17, 53%), L2 and L3 (n=31, 97%), B1 (N=18, 58%), P (n=14, 44%). Proactive alteration of systemic therapy was undertaken in 32% (35/105) and investigations arranged in 37% (39/105) of appointments. Patient survey (n=10) responses were positive with a median satisfaction score of 50/50 (45–50). Patients particularly valued the proactive decision-making regarding related aspects of their care at one appointment. Conclusions The joint GDC model serves a complex group of patients with IBD and medical dermatological diagnoses. Following simultaneous review by a dermatologist and gastroenterologist in the GDC, prompt initiation of appropriate systemic therapy, particularly biologics, can be carried out, often aimed to address both speciality diagnoses. We encourage other centres to adopt such a model for patients with IBD and a relevant dermatological diagnosis to optimise patient care. Reference Vavricka SR, Brun L, Ballabeni P, et al. Am J Gastroenterol. 2011;106(1):110–9.
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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 | 0.014 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.010 |
| Scholarly communication | 0.014 | 0.011 |
| Open science | 0.003 | 0.015 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.017 | 0.007 |
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".