Scoville, Elizabeth

Abstract Background Extraintestinal manifestations (EIMs) of inflammatory bowel diseases (IBDs) are a common and debilitating feature of disease, occurring in up to 40% of patients with IBD, yet predicting who may develop them is difficult. The goal of our study was to better characterize which patients may be at highest risk of developing not only 1 EIM, but also multiple EIMs, across both diseases. Methods A retrospective study of participants enrolled in the SPARC IBD (Study of Prospective Adult Research Cohort with IBD) registry was performed, and demographic and clinical data were analyzed. A total of 1211 patients with data available on EIMs were included, and differences among variables with vs without EIMs were assessed. Results A total of 329 participants with at least 1 EIM were identified, compared with 882 participants without any EIMs. Crohn’s disease patients and women were more likely to have 2 or more EIMs (P = .005 and P ≤ .001, respectively). Participants with ocular manifestations were likeliest to have at least 2 EIMs (P ≤ .001). Even when diagnosis was controlled for, involvement of the right colon (P = .021) was predictive of IBD-associated arthritis across both diseases in a multivariate generalized linear model. Conclusions This is the first comprehensive large-cohort assessment of how EIMs relate to one another at the individual vs systems levels. Further, our analysis is the first to recognize specific locations of colon involvement associated with EIMs of IBD, regardless of IBD type. These results are important in identifying patients at risk of developing future EIMs and may help with risk stratification when choosing treatments.

Abstract Background Clinical and molecular subcategories of inflammatory bowel disease (IBD) are needed to discover mechanisms of disease and predictors of response and disease relapse. We aimed to develop a study of a prospective adult research cohort with IBD (SPARC IBD) including longitudinal clinical and patient-reported data and biosamples. Methods We established a cohort of adults with IBD from a geographically diverse sample of patients across the United States with standardized data and biosample collection methods and sample processing techniques. At enrollment and at time of lower endoscopy, patient-reported outcomes (PRO), clinical data, and endoscopy scoring indices are captured. Patient-reported outcomes are collected quarterly. The quality of clinical data entry after the first year of the study was assessed. Results Through January 2020, 3029 patients were enrolled in SPARC, of whom 66.1% have Crohn’s disease (CD), 32.2% have ulcerative colitis (UC), and 1.7% have IBD-unclassified. Among patients enrolled, 990 underwent colonoscopy. Remission rates were 63.9% in the CD group and 80.6% in the UC group. In the quality study of the cohort, there was 96% agreement on year of diagnosis and 97% agreement on IBD subtype. There was 91% overall agreement describing UC extent as left-sided vs extensive or pancolitis. The overall agreement for CD behavior was 83%. Conclusion The SPARC IBD is an ongoing large prospective cohort with longitudinal standardized collection of clinical data, biosamples, and PROs representing a unique resource aimed to drive discovery of clinical and molecular markers that will meet the needs of precision medicine in IBD.

The increasing dependence on radiologic diagnostic modalities in clinical practice has necessitated innovative teaching methods that introduce radiology into early medical curriculum. At Mayo Medical School cadaveric CT images are integrated into the first year gross anatomy course. Using post‐preservation, non‐contrast full body CT scans of their cadavers, medical students are able to correlate radiologic images to their dissection specimen. The AquariusNET thin client software used to view the images provides students numerous options for image manipulation including standard and oblique sagittal and coronal images and three‐dimensional renderings. Students are requested to record interesting findings from the imaging studies as part of an autopsy report. They are also provided with daily radiology learning objectives that require them to visualize specific anatomic structures. At the end of the course, students were comfortable accessing the cadaver CT data, correlating gross and CT anatomy and appreciating relationships of anatomic structures. They enjoyed interactions with radiology faculty and were more prepared to evaluate radiologic examinations. Grant Funding Source : Department of Anatomy

Teaching assistants (TA's) are an important resource in facilitation of 1st year courses at Mayo Medical School. Formal student teaching positions are available to 3rd students seeking opportunities to develop and refine peer teaching skills. While the Gross Anatomy course has traditionally utilized TA's as peer teachers the role of the TA has not been formally defined. Student evaluations as well as structured faculty and TA interviews were used to quantitatively assess how well TAs perceived their achievement of those goals compared to student and faculty perception. Expectations of TA's role include peer teaching through formal delivery of briefing sessions, group supervision during laboratory sessions, preparation of prosections, organization of review and informal practical examination sessions. TA's may extend their interaction with students through tutoring and participate in medical education‐based research projects. Furthermore, TA's are role players in assessment of student course performance. TA perception of their ability to meet expectations matched faculty and student perceptions. Student evaluations showed TA's to be one of the most highly rated resources in their teaching and learning and valued TA's for their capacity to relate to them, provide hands‐on clinical applications for basic science concepts, emotional support, time commitment to tutoring and assistance in the laboratory. Grant Funding Source : Mayo Medical School

OBJECTIVE Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits. RESEARCH DESIGN AND METHODS Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT). RESULTS Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time. CONCLUSIONS BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being.