Background Inflammatory Bowel Disease (IBD) is a chronic, debilitating collection of diseases with significant impairment to patient quality of life and hospital burden. Patients with acute flare of their disease are managed with IV corticosteroids and ultimately transitioned to an oral equivalent. Despite no formal guideline recommendation, some patients remain in hospital on oral corticosteroids, primarily for observation. Given that each day spent in hospital carries significant costs, examining this observatory period is warranted. The utility of the observatory period for patients recently switched to oral corticosteroids has not yet been studied and may be unnecessarily increasing hospital stays and costs to the Canadian medical system. Purpose - Analyse the efficacy of the in-hospital period for patients on oral corticosteroids after an acute IBD flare in preventing recurrence in the 14 and 28 days post discharge. - Assess the relationship between length of the in-hospital “observatory” period with future hospital burden. Method - This retrospective cohort study identified patients with known IBD who were admitted to Royal Columbian Hospital under the Gastroenterology service primarily for acute flare of their disease from June 1, 2020 to June 30th, 2022. Patients were identified through the clinic EMR (Plexia) and hospital information was accessed via the Fraser Health Health Records Department. This study acheived ethics approval by the Fraser Health Research Ethics Board (Event: 2022376). - Inclusion criteria are as follows: - Age > 18 years old - Prior diagnosis of IBD as per CAG guidelines - Acute IBD flare is primary reason for hospitalization - Hospital management includes IV corticosteroids and discharge medications include a tapering course of oral corticosteroid. - Exclusion criteria are as follows: - Patients found to be non-compliant on outpatient medication regimen (i.e tapering dose of PO prednisone). - Patients with a complicated course in management (concurrent illness that impacted hospital stay). Result(s) -20 patients were identified, with 60 total hospital admissions. -35 visits included an observatory period, with 6 less than 24hr (1 hospital re-presentation), and 29 greater than 24hr (3 hospital re-presentations). -25 visits did not have an observatory period. -The relative risk of patients without an observatory period returning to hospital within 14 and 28 days compared to those with an observatory period was 4.2 and 1.75, respectively. Conclusion(s) These preliminary results suggest an increased relative risk for those without an in-hospital observatory period for short term re-hospitalization. However, we hypothesize this will significantly change once we have broadened our date range and increased our total number of hospitalizations, which is planned prior to the poster presentation date. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
knowledge, none are available on-market, and none have opened their designs for inspection and further development. Open-source medical devices carry several advantages over traditionally developed hardware, which include but are not limited to: improved pace of innovation; modifiability for more specific uses; improved repairability; lower cost; and low potential for vendor lock-in [7]. METHODSThe hematuria monitor (HM) is built with openness and expandability as core principles. The device uses the Arduino open-hardware platform, a popular, easy-to-use development environment that makes it ideal for prototyping devices. HM was also built with secondary goals of being easy to construct, and to keep potential cost-per-unit low. Instructions available on our published openhardware.io page include editable CAD files for 3D-printable enclosures (Figure 1), circuit schematics, code, and data from validation.The processing unit for HM is an Arduino Nano V3.0. The spectral sensing module is a white LED mounted opposite an AS7262 spectrophotometer, passing incident light through a catheter outflow tube latched inside the spectrophotometer shroud (Figure 2), resulting in a reading of transmitted light at the spectrophotometer inversely proportional to the level of hematuria.The current implementation of HM uses a lookup table to estimate outflow colour based on readings from the violet (450nm) wavelength of light, as internal tests demonstrated the greatest sensitivity/reliability of this wavelength on the selected spectrophotometer to differentiate grades of hematuria (not shown). Flow rate is detected through rate-of-change calculations from a load cell from which the catheter outflow bag is mounted. Readout data is displayed via a small screen. We conducted initial laboratory validation of the HM with known serial dilutions of known-hematocrit pig's blood, sealed within portions of catheter outflow bag tubing (Figure 3). 8 dilutions were measured in quintuplicate, ranging from 0-1mL in 10mL saline. The range of these dilutions were corresponding to Lee et al.'s Hematuria Grading Scale (HGS) values of 0-10 [3]. A correlation coefficient analysis was undertaken. We also proceeded to validate the colorimetric function of the device in a ward setting, on twenty patients undergoing CBI. 40 pictures were taken of the spectrophotometer shroud clamped on CBI effluent tubes beside a copy of the HGS, which were rated by three blinded raters on a scale of 0 to 10. These were simplified to an ordinal score from 0 to 5 to match the device readout. The mode of the three human-read grades was taken and compared with device readouts via weighted Kappa. Testing was done under UBC Clinical Ethics Board certificate H20-02012.
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