Leighton, Jonathan A.

Abstract Background While biologic and small molecule therapies have expanded treatment options for moderate to severe ulcerative colitis (UC), prior research revealed that only 26% of patients in routine practice would have qualified for pivotal randomized controlled trials (RCTs) due to stringent eligibility criteria. This study aimed to evaluate contemporary clinical trial eligibility for UC patients in a tertiary care setting based on more recently approved therapies. Methods We performed a retrospective cohort study of adult patients with moderate to severe UC (total Mayo score ≥6) seen between January 2022 and February 2023. Inclusion and exclusion criteria from seven phase III RCTs conducted between 2012 and 2022 (eg, VARSITY, UNIFI, OCTAVE, LUCENT) were applied to determine patient eligibility and identify reasons for ineligibility. Results Of 150 patients (mean age 44.9 years; 55.7% male), only 42.7% were eligible for at least one RCT. The most common exclusion factor was current or prior medication use, followed by anemia, dysplasia, and disease extent. Trial eligibility did not significantly differ by age, gender, or disease duration. Conclusions Despite modest improvements since 2012, over half of real-world UC patients remain ineligible for current RCTs. Expanding inclusion criteria, especially regarding prior medication exposure, and adopting more inclusive trial designs may enhance external validity. Addressing disparities in trial access and participation remains essential to ensuring equitable representation and improving clinical applicability of RCT findings.

Patient complaints are valuable sources of information for quality improvement and provide an avenue for patient self-advocacy. This paper outlines the development and implementation of a novel training program, termed CODE (Compassion, Operational Support, De-escalation, Empowerment), for patient experience complaint management staff. The program consists of 2 core tracks: procedural training on operational systems and resources, and interpersonal communication training. A dual-track framework ensures practical knowledge to access resources to assist complainants is paired with communication for empathy and human connection. The CODE program's dual-track structure is a key strength, bridging the gap between operational efficiency and compassionate communication. By emphasizing both procedural knowledge and interpersonal skills, it equips healthcare professionals to manage patient complaints successfully. The CODE program represents a novel approach for healthcare institutions seeking to optimize patient experience and complaint-handling performance.

Engaging employees in providing exemplary patient experience has been challenging for healthcare leaders in recent years given the pressures of the regulatory environment, increases in staff burnout and rising patient expectations. Amid these challenges, addressing patient experience remains a top priority for healthcare organizations. A novel intervention has been applied at Mayo Clinic with the goal of improving both employee engagement and patient experience. Previous efforts to teach service excellence involved customer service trainings, sometimes purchased through outside vendors. This new initiative is based on our organizational culture and values, input from our employees and patients, and considers the changing needs of a contemporary healthcare workforce. It leverages management practices shown to boost an employee's sense of equity, achievement, and camaraderie. It also highlights staff motivation to do their best work by involving them in conversations about the essential ingredients that make up both exceptional employee and patient experiences.

Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.