‘Immunising’ physicians against availability bias in diagnostic reasoning: a randomised controlled experiment

BackgroundDiagnostic errors have often been attributed to biases in physicians’ reasoning. Interventions to ‘immunise’ physicians against bias have focused on improving reasoning processes and have largely failed.ObjectiveTo investigate the effect of increasing physicians’ relevant knowledge on their susceptibility to availability bias.Design, settings and participantsThree-phase multicentre randomised experiment with second-year internal medicine residents from eight teaching hospitals in Brazil.InterventionsImmunisation: Physicians diagnosed one of two sets of vignettes (either diseases associated with chronic diarrhoea or with jaundice) and compared/contrasted alternative diagnoses with feedback. Biasing phase (1 week later): Physicians were biased towards either inflammatory bowel disease or viral hepatitis. Diagnostic performance test: All physicians diagnosed three vignettes resembling inflammatory bowel disease, three resembling hepatitis (however, all with different diagnoses). Physicians who increased their knowledge of either chronic diarrhoea or jaundice 1 week earlier were expected to resist the bias attempt.Main outcome measurementsDiagnostic accuracy, measured by test score (range 0–1), computed for subjected-to-bias and not-subjected-to-bias vignettes diagnosed by immunised and not-immunised physicians.ResultsNinety-one residents participated in the experiment. Diagnostic accuracy differed on subjected-to-bias vignettes, with immunised physicians performing better than non-immunised physicians (0.40 vs 0.24; difference in accuracy 0.16 (95% CI 0.05 to 0.27); p=0.004), but not on not-subjected-to-bias vignettes (0.36 vs 0.41; difference −0.05 (95% CI −0.17 to 0.08); p=0.45). Bias only hampered non-immunised physicians, who performed worse on subjected-to-bias than not-subjected-to-bias vignettes (difference −0.17 (95% CI −0.28 to −0.05); p=0.005); immunised physicians’ accuracy did not differ (p=0.56).ConclusionsAn intervention directed at increasing knowledge of clinical findings that discriminate between similar-looking diseases decreased physicians’ susceptibility to availability bias, reducing diagnostic errors, in a simulated setting. Future research needs to examine the degree to which the intervention benefits other disease clusters and performance in clinical practice.Trial registration number68745917.1.1001.0068.

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Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Visceral Medicine ◽

10.1159/000514196 ◽

2021 ◽

pp. 1-11

Author(s):

Bing-Jie Xiang ◽

Min Jiang ◽

Ming-Jun Sun ◽

Cong Dai

Keyword(s):

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Bowel Disease ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Inflammatory Bowel

Objective: Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. Methods: We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Results: Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. Conclusion: Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

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Ethnic Differences in the Smoking-Related Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab047 ◽

2021 ◽

Author(s):

Daniele Piovani ◽

Claudia Pansieri ◽

Soumya R R Kotha ◽

Amanda C Piazza ◽

Celia-Louise Comberg ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Latin American ◽

Bowel Disease ◽

Meta Analysis ◽

Study Data ◽

Future Research ◽

Related Risk ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background and aims The association between smoking and inflammatory bowel disease (IBD) relies on old meta-analyses including exclusively non-Jewish White populations. Uncertainty persists regarding the role of smoking in other ethnicities. Methods We systematically searched Medline/PubMed, Embase and Scopus for studies examining tobacco smoking and the risk of developing IBD, i.e., Crohn’s disease (CD) or ulcerative colitis (UC). Two authors independently extracted study data and assessed each study’s risk-of-bias. We examined heterogeneity and small-study effect, and calculated summary estimates using random-effects models. Stratified analyses and meta-regression were employed to study the association between study-level characteristics and effect estimates. The strength of epidemiological evidence was assessed through prespecified criteria. Results We synthesized 57 studies examining the smoking-related risk of developing CD and UC. Non-Jewish White smokers were at increased risk of CD (29 studies; RR: 1.95, 95% CI: 1.69‒2.24; moderate evidence). No association was observed in Asian, Jewish and Latin-American populations (11 studies; RR: 0.97; 95% CI: 0.83–1.13), with no evidence of heterogeneity across these ethnicities. Smokers were at reduced risk of UC (51 studies; RR: 0.55, 95% CI: 0.48–0.64; weak evidence) irrespectively of ethnicity; however, cohort studies, large studies and those recently published showed attenuated associations. Conclusions This meta-analysis did not identify any increased risk of CD in smokers in ethnicities other than non-Jewish Whites, and confirmed the protective effect of smoking on UC occurrence. Future research should characterize the genetic background of CD patients across different ethnicities to improve our understanding on the role of smoking in CD pathogenesis.

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P702 F-calprotectin use in inflammatory bowel disease is characterized by improved diagnostic accuracy, less patient harm and decreased costs, compared with conventional serological markers and colonoscopy. A cost-effectiveness study in Italy

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.826 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S440-S440

Author(s):

B. Mascialino ◽

A. Vora

Keyword(s):

Inflammatory Bowel Disease ◽

Cost Effectiveness ◽

Diagnostic Accuracy ◽

Bowel Disease ◽

Effectiveness Study ◽

Serological Markers ◽

Patient Harm ◽

Inflammatory Bowel ◽

Cost Effectiveness Study

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Codesign and implementation of an equity-promoting national health literacy programme for people living with inflammatory bowel disease (IBD): a protocol for the application of the Optimising Health Literacy and Access (Ophelia) process

BMJ Open ◽

10.1136/bmjopen-2020-045059 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045059

Author(s):

Melanie Hawkins ◽

Wayne Massuger ◽

Christina Cheng ◽

Roy Batterham ◽

Gregory T Moore ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Health Literacy ◽

Bowel Disease ◽

Phase 1 ◽

Qualitative Interviews ◽

Local Health ◽

Literacy Programme ◽

Sustainable Solutions ◽

University Of Technology ◽

Inflammatory Bowel

IntroductionNon-government organisations (NGOs) often represent people who are underserved or experiencing vulnerability. Crohn’s & Colitis Australia (CCA) is aware that many Australians with inflammatory bowel disease (IBD) are not reached by current communication and engagement activities. The aim of the CCA IBD project is to implement the Optimising Health Literacy and Access (Ophelia) process over 3 years to collaboratively codesign ways to improve delivery of information, services and resources for people with IBD and their carers.Methods and analysisHealth literacy and other data for phase 1 will be collected using the Health Literacy Questionnaire, eHealth Literacy Questionnaire, IBD-related questions and qualitative interviews with people with IBD and their carers to ascertain their lived experience. Quantitative data will be analysed using descriptive statistics and cluster analysis. Identified clusters will be combined with qualitative data to develop vignettes (narratives of people’s experiences of living with IBD) for stakeholder workshops to generate ideas for useful, accessible and sustainable solutions for identified health literacy needs. Selection and testing of health literacy actions happens in phase 2 and implementation and evaluation in phase 3 (2021–2023). Outcomes of this project include giving voice to people living with IBD, their carers and frontline healthcare practitioners. Genuine codesign informs the development and implementation of what is needed and wanted to improve access to and availability and quality of information and resources that support people to manage their health. There is potential for other NGOs to use the CCA Ophelia model in other health contexts to improve engagement with and understanding of the needs of the people they serve and to reduce health inequalities and improve health outcomes.Ethics and disseminationEthics approval for Ophelia phase 1 has been obtained from the Human Research Ethics Committee of Swinburne University of Technology (Ref: 20202968–4652) and by the South West Sydney Local Health District Research and Ethics Office for the purposes of questionnaire recruitment at Liverpool Hospital (Ref: 20202968–4652). Dissemination of the study findings will be the national codesign process and ownership development across the CCA community and through the genuine engagement of clinicians and relevant managers across Australia. The model and process will be directly distributed to international IBD associations and to other NGOs. It will also be disseminated through publication in a peer-reviewed journal, conference presentations and public reports on the CCA and Swinburne University of Technology website.

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The Role of Adipose Tissue in the Pathogenesis and Therapeutic Outcomes of Inflammatory Bowel Disease

Cells ◽

10.3390/cells8060628 ◽

2019 ◽

Vol 8 (6) ◽

pp. 628 ◽

Cited By ~ 7

Author(s):

Eder ◽

Adler ◽

Dobrowolska ◽

Kamhieh-Milz ◽

Witowski

Keyword(s):

Inflammatory Bowel Disease ◽

Adipose Tissue ◽

Bowel Disease ◽

Future Research ◽

Therapeutic Outcomes ◽

Mesenteric Fat ◽

Energy Store ◽

Inflammatory Bowel ◽

The One

Abstract: Though historically regarded as an inert energy store, adipose tissue is a complex endocrine organ, which is increasingly implicated in the pathogenesis of inflammatory bowel disease (IBD). Accumulating evidence points to visceral adipose tissue and specifically to its mesenteric component, or “creeping fat” as impacting on the disease course through its immunomodulatory properties. On the one hand, mesenteric fat acts as a physical barrier to inflammation and is involved in controlling host immune response to translocation of gut bacteria. On the other hand, however, there exists a strong link between visceral fat and complicated course of the disease with unfavorable therapeutic outcomes. Furthermore, “creeping fat” appears to play different roles in different IBD phenotypes, with the greatest pathogenetic contribution probably to an ileal form of Crohn’s disease. In this review, we summarize and discuss the existing literature on the subject and identify high-priority areas for future research. It may be that a better understanding of the role of mesenteric fat in IBD will determine new therapeutic targets and translate into improved clinical outcomes.

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Anti- Saccharomyces cerevisiae antibodies in Japanese patients with inflammatory bowel disease: diagnostic accuracy and clinical value

Journal of Gastroenterology ◽

10.1007/s005350300020 ◽

2003 ◽

Vol 38 (2) ◽

pp. 121-126 ◽

Cited By ~ 28

Author(s):

Takashi Hisabe ◽

Toshiyuki Matsui ◽

Toshihiro Sakurai ◽

Yuji Murakami ◽

Hiroshi Tanabe ◽

...

Keyword(s):

Saccharomyces Cerevisiae ◽

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Bowel Disease ◽

Japanese Patients ◽

Clinical Value ◽

Inflammatory Bowel

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Detection of Lawsonia intracellularis in a dog with inflammatory bowel disease using nested PCR and serology

Veterinární Medicína ◽

10.17221/5757-vetmed ◽

2012 ◽

Vol 48 (No. 4) ◽

pp. 108-112 ◽

Cited By ~ 2

Author(s):

K. Tomanová ◽

J. Klimeš ◽

J. Smola ◽

R. Husník

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Nested Pcr ◽

Clinical Symptoms ◽

Chronic Diarrhoea ◽

Lawsonia Intracellularis ◽

Nested Polymerase Chain Reaction ◽

Pcr Product ◽

Laboratory Examinations ◽

Inflammatory Bowel

A nested polymerase chain reaction (PCR) assay and serological examinations were used to detect the presence of Lawsonia intracellularis in a two and a half years old German smooth-coated cocker spaniel with clinical symptoms of chronic diarrhoea and histologically proven inflammatory bowel disease. Fourteen rectal swabs taken over a period of two weeks and eight biopsy specimens taken over a period of six months were used for laboratory examinations. Using the nested PCR, the DNA of L. intracellularis was found in a total of 2 cases, i.e. one rectal swab and one biopsy specimen of the duodenum six months later. The species specificity of the nested PCR product was confirmed by sequencing. The presence of specific IgG antibodies against L. intracellularis was demonstrated by the IFAT in five samples of blood serum taken over a period of seven months.

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Analytical performance and diagnostic accuracy of six different faecal calprotectin assays in inflammatory bowel disease

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2016-1012 ◽

2017 ◽

Vol 55 (10) ◽

Cited By ~ 21

Author(s):

Matthijs Oyaert ◽

An Boel ◽

Julie Jacobs ◽

Stefanie Van den Bremt ◽

Maxime De Sloovere ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Diagnostic Accuracy ◽

Disease Control ◽

Bowel Disease ◽

Clinical Decision Making ◽

Clinical Decision ◽

Analytical Performance ◽

Likelihood Ratios ◽

Faecal Calprotectin ◽

Inflammatory Bowel

AbstractBackground:We evaluated the analytical performance of six different faecal calprotectin immunoassays together with their diagnostic accuracy in the discrimination between functional and organic bowel disorders.Methods:The faecal samples were obtained from inflammatory bowel disease patients (n=27) at the time of diagnosis [Crohn’s disease (n=15), colitis ulcerosa (n=12)], gastroenterologic disease control patients (n=52) and rheumatologic disease control patients (n=26). All individuals included in the study underwent a concurrent ileocolonoscopy. Analytical performance (imprecision, accuracy, carry-over, correlation and agreement) and diagnostic accuracy (sensitivity, specificity, likelihood ratios) of the different assays were evaluated.Results:All methods demonstrated good analytical performance, but within-run and total imprecision varied depending on the assay methodology used. Using Passing Bablok and Bland-Altman analyses, low quantitative agreement was observed between the assays. All assays showed excellent diagnostic accuracy, with areas under the receiver operating characteristic curves (ROC) ranging from 0.974 to 0.998. The AUCs were not significantly different between assays (p>0.05). Diagnostic sensitivity at the cut-off at a fixed specificity of 75% ranged from 95.2% to 100%. Introduction of multiple result intervals increased the clinical interpretation of all the assays.Conclusions:Analytical and diagnostic performance of the evaluated faecal calprotectin assays is good, but numerical values differ substantially between the assays necessitating the use of different clinical cut-offs. Introduction of multiple result intervals aids in clinical decision-making.

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