P018 How to Improve Transition of Pediatric IBD Patients Through Use of EMR.

BACKGROUND: Despite major medical advances in the IBD world, the incidence of Pediatric Inflammatory Bowel Disease (IBD) continues to increase. This patient population is at risk for higher rates of complications from their chronic disease. The transition from pediatric to adult care is crucial as this population is at an increased risk for loss to follow up, delays in receipt of appropriate medical care, poor adherence, and increased emergency department visits and hospital admissions. To address these issues at our academic center, we piloted an EMR template with the goal of improving the process from both the patient and provider perspectives. We present our review of what we learned from this process and how it shaped our final product. METHODS: This study was an IRB-approved prospective cohort assessment performed at our academic tertiary care center from 2018-2021. An EMR template was designed as a comprehensive summary based on components of the medical record that adult gastroenterology (GI) providers identified as critical to successful transition of care. This template was then integrated into pediatric GI office notes provided to the adult GI team at the start of transition. A 7-question survey was distributed to pediatric providers to assess ease of use and provider perceptions of the template. RESULTS: A total of 64 patients transitioned following implementation of the template and 19 (29.7%) of those had a template in their chart upon transition. Audit of charts revealed that of the 13 pediatric GI providers, only one was actively using the template. Twelve (92%) of the 13 pediatric GI providers responded. Barriers to template use included: ease of use, lack of included narrative history, lack of auto-populated data and accessibility. Subsequently, stakeholders from our Pediatric and Adult IBD centers met to create a universal progress note that would provide one cohesive patient summary. The conception of this medical document now occurs in the pediatric setting; it will accompany the patient through their medical journey and be a permanent part of their medical record. CONCLUSION: Adult and Pediatric Gastroenterologists all agree that effective transition of IBD care is critical to the patient's well-being. However, adult and pediatric providers may have differing views of the importance of certain aspects of the psychosocial and preventative care components of IBD management. In our institution, we are able to provide IBD care to patients for their entire life span. To the benefit of patients, this is becoming more common at academic centers, making the use of a universal IBD template critical for excellent continuity of care. As a result of our inter-departmental meetings, we were able to learn why different aspects mattered at different stages of a patient's life. This allowed us to create a flexible template to incorporate these changing priorities. We believe that our current IBD progress note is a functional mesh of those factors and is less cumbersome than a separate template required by adult providers. Most importantly, it presents a united front, and demonstrates to patients that their care is a continuum within our institution.

Role of Nose to Pelvis Imaging in the Evaluation of Foreign Body Ingestion: A Case of Magnet Ingestion in a 2-Year-Old.

Foreign body ingestion (FBI) of small-rare-earth-magnets (SREM) sets are associated with high morbidity and mortality, as these tend to cause significant mucosal injury. Current clinical guidelines for the evaluation of FBI do not include imaging of the nose and neck. A 2-year-old patient presented with known SREM ingestion, with location confirmed in the right lower quadrant on imaging at the time of initial evaluation. Subsequent imaging involving the neck revealed additional magnets lodged in the patient's hypopharynx, which were missed on initial evaluation. This case highlights the importance of considering advanced imaging of the nose and neck to uncover extraintestinal foreign bodies.

Unexpectedly High Prevalence of Cystoisospora belli Infection in Acalculous Gallbladders of Immunocompetent Patients.

Objectives: Indications for cholecystectomy have changed dramatically over the past three decades. Cystoisospora belli has been reported in cholecystectomy specimens of immunocompetent patients. The present study was designed to determine the prevalence and clinical association of C belli in the gallbladder. Methods: The study included retrospective review of cholecystectomy specimens (n = 401) removed for various indications, and a prospective cohort of cholecystectomy specimens (n = 22) entirely submitted for histologic evaluation. Correlations of presence of C belli with age, sex, clinical indication, and abnormalities of preoperative laboratory values were assessed by Fisher exact test. Results: C belli was identified in 39/401 (9.7%) of the retrospective cohort, and 6/22 (27.3%) of the entirely submitted specimens. The presence of C belli showed no correlation with age, sex, clinical indication, or laboratory abnormalities. Conclusions: C belli resides in a latent state in the gallbladder and may be best considered a commensal organism.

The prevalence of abnormal metabolic parameters in obese and overweight children.

BACKGROUND: This retrospective study aimed to determine the prevalence of abnormal metabolic parameters in obese children and its correlation to the degree of obesity determined by body mass index (BMI). METHODS: In total, 101 children seen at the Pediatric Gastroenterology Obesity Clinic at Stony Brook Children's University Hospital were enrolled in the study. The degree of obesity was characterized according to the following formula: (patient's BMI/BMI at 95th percentile) × 100%, with class I obesity >100%-120%, class II obesity >120%-140%, and class III obesity >140%. A set of metabolic parameters was evaluated in these patients. Frequency distributions of all study variables were examined using the χ(2) test of independence. Mean differences among the obesity classes and continuous measures were examined using 1-way analysis of variance. RESULTS: Within our study population, we found that 80% of our obese children had a low high-density lipoprotein (HDL) cholesterol level, 58% had elevated fasting insulin levels, and 32% had an elevated alanine aminotransferase (ALT) level. Class II obese children had a 2-fold higher ALT value when compared with class I children (P = .036). Fasting insulin, ALT, HDL cholesterol, and triglyceride levels trended with class of obesity. CONCLUSION: Obese children in classes II and III are at higher risk for developing abnormal laboratory values. We recommend obese children be further classified to reflect the severity of the obesity since this has predictive significance for comorbidities. Obesity classes I, II, and III could help serve as a screening tool to help communicate risk assessment.