Mentoring disparities in gastroenterology: the path forward
Rabinowitz, Loren Galler; Grinspan, Lauren Tal; Zylberberg, Haley M; Kim, Michelle Kang; Kwah, Joann; Williams, Renee
Survey Finds Gender Disparities Impact Both Women Mentors and Mentees in Gastroenterology
Rabinowitz, Loren Galler; Grinspan, Lauren Tal; Zylberberg, Haley M; Dixon, Rebekah; David, Yakira N; Aroniadis, Olga C; Chiang, Austin; Christie, Jennifer; Fayad, Nabil F; Ha, Christina; Harris, Lucinda A; Ko, Cynthia W; Kolb, Jennifer; Kwah, Joann; Lee, Linda; Lieberman, David; Raffals, Laura E; Rex, Douglas K; Shah, Shailja C; Siddiqui, Uzma D; Smith, Michael S; Wallace, Michael; Williams, Renee; Woods, Karen; Crowe, Sheila E; Kumta, Nikhil A; Kim, Michelle Kang; Greenwald, David A
INTRODUCTION/BACKGROUND:Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives. METHODS:A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis. RESULTS:Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored. DISCUSSION/CONCLUSIONS:Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction.
Induction with Biologic Therapy Improves Disability from Inflammatory Bowel Disease [Meeting Abstract]
Castillo, G; Guttentag, A; Kwah, J; Al-Ani, A; Sharma, B; Chen, L A; Sultan, K; Axelrad, J E
INTRODUCTION: Inflammatory bowel disease (IBD) can have a detrimental effect on patients' functional capacity. Recently, a self-report version of the IBD Disability Index (IBD-DI) was developed to assess how disease burden affects patients' ability to work and maintain relationships. There have been few studies tracking IBD-DI over time or with treatment of disease.
METHOD(S): We prospectively identified patients with Crohn's disease (CD) and ulcerative colitis (UC) starting a new biologic agent (anti-TNF, anti-integrin, or anti IL12/23). Patients were surveyed at induction of therapy and 60 days after, approximating the start of maintenance. Surveys included clinical disease activity indices [Harvey Bradshaw Index (HBI), Simple Clinical Colitis Activity Index (SCCAI), partial Mayo Score] and scales that assessed depression (PHQ-9), quality of life [Short IBD Questionnaire (SIBDQ)]), illness perception [Brief Illness Perception Questionnaire (BIPQ)], and IBD-DI (with higher sores indicating more disability). We reviewed baseline colonoscopies (simple endoscopic and Mayo endoscopic subscore), biomarkers of inflammation (ESR, CRP, calprotectin), comorbidities, and IBD history.
RESULT(S): 61 patients (35 males and 26 females) completed the induction survey and 35 completed survey 2. The mean age was 34 years, 59% had CD, 41% had UC, and 38% were non-white (Table 1). There was a strong correlation between the IBD-DI and the HBI, SIBDQ, and PHQ-9 (r = 0.62, 0.81, 0.82, P < 0.001; Table 2). There was a moderate correlation with SCCAI (r = 0.53, P < 0.01), Mayo and pMayo (r = 0.44, r = 0.39, P < 0.001), and with the domains of the BIPQ assessing illness effect on wellbeing, symptoms and emotions (P < 0.001). The IBD-DI did not correlate with baseline biomarkers of inflammation or endoscopic scores. There were no statistically significant differences in IBD-DI scores between males and females or between patients with CD or UC (Table 3). There was a statistically significant improvement in IBD-DI scores from survey 1 to survey 2 (mean 33.9 out of 100 to 27.1, P < 0.001).
CONCLUSION(S): In this prospective cohort, there was a strong correlation between IBD-DI and indices of disease activity, depression, and quality of life. There was an improvement in IBD-DI scores after induction with biologics. This is the first study to assess this metric longitudinally and with treatment of disease using the self-report IBD-DI. Future studies must track the IBD-DI during maintenance therapy and assess how it relates to therapeutic response
Sexual Dysfunction Correlates with Disease Activity, Quality of Life Metrics, and Improves after Induction with Biologic Therapy [Meeting Abstract]
Castillo, G; Kwah, J; Al-Ani, A; Guttentag, A; Sharma, B; Chen, L A; Sultan, K; Friedman, S; Axelrad, J E
INTRODUCTION: Utilizing recently-developed inflammatory bowel disease (IBD)-specific scales, we aimed to correlate sexual dysfunction (SD) with clinical and psychosocial IBD metrics, and track SD longitudinally, specifically in patients initiating biologic therapies.
METHOD(S): We surveyed Crohn's disease (CD) and ulcerative colitis (UC) patients starting a biologic agent (anti-TNF, anti-integrin, or anti-IL12/23) at induction of therapy and 60 days after. Surveys included the IBD- Female and Male Sexual Dysfunction Scales (IBD-FSDS and MSDS), the PROMIS Brief Sexual Function and Satisfaction Profile, as well as disease activity indices [Harvey-Bradshaw index (HBI), partial Mayo score], and scales for depression [Patient Health Questionnaire-9 (PHQ-9)], quality of life (QoL) [Short IBD Questionnaire (SIBDQ)], functional disability [IBD-Disability Index (IBDDI)], and illness perception [Brief Illness Perception Questionnaire (BIPQ)]. We reviewed baseline colonoscopies [simple endoscopic score (SES) and Mayo endoscopic subscore (MES)], biomarkers of inflammation (ESR, CRP, calprotectin), comorbidities, and IBD history.
RESULT(S): 61 patients (35 males and 26 females) completed survey 1 and 35 completed survey 2. The mean age was 34 years, 59% had CD, 41% had UC, and 38% were non-white. At induction, there was a high degree of SD as measured by the MSDS and FSDS (mean MSDS 9, FSDS 15). Initial SD scores were strongly correlated with PROMIS scores (r = 0.82, P < 0.001) and MES (r = 0.74, P < 0.001), and moderately correlated with the HBI (r = 0.48, P = 0.003) and Mayo score (0.46, P = 0.03). SD also correlated with the SIBDQ (r = 0.54, P < 0.001), PHQ-9 (r = 0.41, P < 0.001), IBDDI (r = 0.46, P < 0.001), and with domains of the BIPQ assessing illness effect on emotions and wellbeing (r = 0.58, P < 0.001; r = 0.50, P < 0.001). SD did not correlate with baseline biomarkers of inflammation (Table 2). FSDS scores improved from survey 1 to 2 (mean 18.2 to 11.3, P = 0.01). MSDS scores also numerically improved (10.1 to 8.5), but did not reach significance (Table 3). HBI, SCCAI and pMayo scores improved with a clinically significant response seen in 22% of patients.
CONCLUSION(S): In this prospective observational cohort, SD scores correlated with depression, QoL metrics, and disease activity, but did not correlate with biomarkers of inflammation. There was a moderate improvement in disease activity and SD scores after induction therapy with biologics, but a degree of SD persisted. Further studies must track this effect during maintenance therapy
Innumerable Nodular Lesions in the Duodenum
Agrawal, Manasi; Levine, Calley; Kwah, Joann
Proximal Small Bowel Angiodysplasia (AD) Is More Strongly Associated With Melena Than Is Hematochezia [Meeting Abstract]
Luther, Sanjana; Hong, Simon; Brandt, Lawrence J.; Kwah, Joann
Diarrhea: Always Keep an Open Mind and Be a Skeptic [Meeting Abstract]
Izzy, Manhal; Kwah, Joann; Brandt, Lawrence J.
The Occupational Hazards of Being a Lumberjack [Meeting Abstract]
Tow, Clara; Kwah, Joann
Benign Gastric Emphysema in the Setting of Malignant Gastric Outlet Obstruction [Meeting Abstract]
Tow, Clara; Kwah, Joann
Whites and blacks have similar risk of metachronous advanced colorectal neoplasia
Kwah, Joann; Schroy, Paul C; Jacobson, Brian C; Calderwood, Audrey H
BACKGROUND:Current guidelines for surveillance of colonic neoplasia are based on data from predominantly white populations, yet whether these recommendations are applicable to blacks is unknown. AIM/OBJECTIVE:To define the prevalence of advanced colorectal neoplasia (ACN) among whites and blacks undergoing surveillance colonoscopy. METHODS:This was a retrospective, cross-sectional analysis of asymptomatic, average-risk non-Hispanic white (N = 246) and non-Hispanic black (N = 203) patients with colorectal neoplasia who underwent baseline screening colonoscopy between January 1, 2000, and December 31, 2007, and a surveillance colonoscopy before December 31, 2010, at an academic safety-net hospital. The main outcome measure was the prevalence of ACN, defined as a tubular adenoma or sessile serrated adenoma (SSA) â‰¥ 10 mm, any adenoma with villous histology or high-grade dysplasia, any serrated lesion with dysplasia, or invasive cancer at surveillance. RESULTS:During a median follow-up of 4.3 years, the overall prevalence of ACN at surveillance was similar among blacks and whites (11.3 vs. 9.8 %; P = 0.59) with an odds ratio of 1.18 (95 % CI 0.65-2.16) [corrected]. Blacks and whites with non-advanced neoplasia had similar rates of ACN at the 1-3, 4-5, and >5 year follow-up intervals. Blacks with ACN or multiplicity at baseline had higher rates of ACN at the 1- to 3-year interval compared with whites, but the difference was non-significant (26.7 vs. 12.5 %; P = 0.32). No interval cancers were observed for either group. CONCLUSIONS:The overall prevalence of ACN was similar between non-Hispanic blacks and non-Hispanic whites undergoing surveillance in a safety-net healthcare setting suggesting that current surveillance guidelines are appropriate for both blacks and whites.