xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06030882</url>
    </required_header>
    <id_info>
      <org_study_id>50757</org_study_id>
      <nct_id>NCT06030882</nct_id>
    </id_info>
    <brief_title>Improving Patient Outcomes Through the Implementation of an IBD Biologic Care Pathway</brief_title>
    <official_title>Improving Patient Outcomes Through the Implementation of a Standardized Biologic Care Pathway in the Treatment and Management of Inflammatory Bowel Disease Pathway in the Treatment and Management of Inflammatory Bowel Disease</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Jennifer Jones</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
      <collaborator>
        <agency>Nova Scotia Health Authority</agency>
        <agency_class>Other</agency_class>
      </collaborator>
    </sponsors>
    <source>Nova Scotia Health Authority</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Inflammatory Bowel Disease (IBD) includes a group of chronic inflammatory conditions of the&#xD;
        gastrointestinal system and is composed of Crohn's disease and ulcerative colitis. As an&#xD;
        immune-mediated disease, IBD treatment options include the use of biologic medicines&#xD;
        including anti-tumor necrosis alpha factor (also called anti-TNFs) medication. Despite&#xD;
        biologic medicines being an important part of IBD management, there is inconsistency in the&#xD;
        way these medications are used. Implementation of evidence-based, standardized biologic care&#xD;
        pathways (BCP) can improve treatment related outcomes. Previous research has shown that using&#xD;
        a clinical care pathway, such as a BCP, is a feasible method to support clinical decision&#xD;
        making and may improve disease-related outcomes for patients. The researchers propose a&#xD;
        prospective study to determine how well a BCP can be incorporated into clinical practice,&#xD;
        improve patient health outcomes, and reduce healthcare system redundancies. Also, the impact&#xD;
        of a BCP on outcomes for patients treated with the help of a standardized BCP compared to&#xD;
        those in patients treated without the use of a BCP will be studied. The results of this study&#xD;
        will inform how best to incorporate evidence-based BCPs into real-world practice and support&#xD;
        the wide-spread adoption of BCPs in clinical practice.&#xD;
      </textblock>
    </brief_summary>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">October 2023</start_date>
    <completion_date type="Anticipated">October 2024</completion_date>
    <primary_completion_date type="Anticipated">October 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Health Services Research</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>EQ5D Score</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of &lt;0 represents the worst possible health status.</description>
    </primary_outcome>
    <primary_outcome>
      <measure>EQ5D Score</measure>
      <time_frame>week 50</time_frame>
      <description>General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of &lt;0 represents the worst possible health status.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Emergency room visits</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>Number of emergency room visits</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Emergency room visits</measure>
      <time_frame>month 12</time_frame>
      <description>Number of emergency room visits</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>inpatient hospitalization,</measure>
      <time_frame>week 0</time_frame>
      <description>Number of inpatient hospitalizations</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>inpatient hospitalization,</measure>
      <time_frame>month 12</time_frame>
      <description>Number of inpatient hospitalizations</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>disease-related surgery</measure>
      <time_frame>week 0</time_frame>
      <description>Number of disease related surgeries</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>disease-related surgery</measure>
      <time_frame>month 12</time_frame>
      <description>Number of disease related surgeries</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>ambulatory care visits</measure>
      <time_frame>week 0</time_frame>
      <description>number of ambulatory care visits</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>ambulatory care visits</measure>
      <time_frame>month 12</time_frame>
      <description>number of ambulatory care visits</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>drug therapy</measure>
      <time_frame>week 0</time_frame>
      <description>A list of current medications the patient is taking</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>drug therapy</measure>
      <time_frame>month 12</time_frame>
      <description>A list of current medications the patient is taking</description>
    </secondary_outcome>
    <other_outcome>
      <measure>HBI Index Score</measure>
      <time_frame>week 0 (baseline), week 12-14, week 30, week 50</time_frame>
      <description>IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:&#xD;
  Remission: &lt;5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: &gt;16</description>
    </other_outcome>
    <other_outcome>
      <measure>HBI Index Score</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:&#xD;
  Remission: &lt;5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: &gt;16</description>
    </other_outcome>
    <other_outcome>
      <measure>HBI Index Score</measure>
      <time_frame>week 12</time_frame>
      <description>IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:&#xD;
  Remission: &lt;5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: &gt;16</description>
    </other_outcome>
    <other_outcome>
      <measure>HBI Index Score</measure>
      <time_frame>week 30</time_frame>
      <description>IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:&#xD;
  Remission: &lt;5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: &gt;16</description>
    </other_outcome>
    <other_outcome>
      <measure>HBI Index Score</measure>
      <time_frame>week 50</time_frame>
      <description>IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are strata for final score results:&#xD;
  Remission: &lt;5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: &gt;16</description>
    </other_outcome>
    <other_outcome>
      <measure>Partial Mayo Score</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:&#xD;
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9</description>
    </other_outcome>
    <other_outcome>
      <measure>Partial Mayo Score</measure>
      <time_frame>week 12</time_frame>
      <description>IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:&#xD;
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9</description>
    </other_outcome>
    <other_outcome>
      <measure>Partial Mayo Score</measure>
      <time_frame>week 30</time_frame>
      <description>IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:&#xD;
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9</description>
    </other_outcome>
    <other_outcome>
      <measure>Partial Mayo Score</measure>
      <time_frame>week 50</time_frame>
      <description>IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:&#xD;
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9</description>
    </other_outcome>
    <other_outcome>
      <measure>Fecal calprotectin</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>Fecal calprotectin concentration, assayed by stool sample</description>
    </other_outcome>
    <other_outcome>
      <measure>Fecal calprotectin</measure>
      <time_frame>week 12</time_frame>
      <description>Fecal calprotectin concentration, assayed by stool sample</description>
    </other_outcome>
    <other_outcome>
      <measure>Fecal calprotectin</measure>
      <time_frame>week 30</time_frame>
      <description>Fecal calprotectin concentration, assayed by stool sample</description>
    </other_outcome>
    <other_outcome>
      <measure>Fecal calprotectin</measure>
      <time_frame>week 50</time_frame>
      <description>Fecal calprotectin concentration, assayed by stool sample</description>
    </other_outcome>
    <other_outcome>
      <measure>CRP concentration</measure>
      <time_frame>week 0 (baseline)</time_frame>
      <description>serum CRP concentration</description>
    </other_outcome>
    <other_outcome>
      <measure>CRP concentration</measure>
      <time_frame>week 12</time_frame>
      <description>serum CRP concentration</description>
    </other_outcome>
    <other_outcome>
      <measure>CRP concentration</measure>
      <time_frame>week 30</time_frame>
      <description>serum CRP concentration</description>
    </other_outcome>
    <other_outcome>
      <measure>CRP concentration</measure>
      <time_frame>week 50</time_frame>
      <description>serum CRP concentration</description>
    </other_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">182</enrollment>
    <condition>Inflammatory Bowel Diseases</condition>
    <condition>Ulcerative Colitis</condition>
    <condition>Crohn Disease</condition>
    <arm_group>
      <arm_group_label>Biologic Care Pathway</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Care through a biologic care pathway</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Control</arm_group_label>
      <arm_group_type>No Intervention</arm_group_type>
      <description>Care as usual</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>Biologic Care Pathway</intervention_name>
      <description>Receiving care administered through a biologic care pathway.The central biologic intake nurse will touch base with the IBD program nurse navigator at preselected time points as per the pathway in order to coordinate the baseline pre- biologic work-up, clinical and biomarker assessments, and clinical assessments. Clinical management decisions will be informed by a combination of data points including clinical risk factors, TDM, fecal calprotectin concentrations, endoscopic and clinical disease activity indices as well as drug tolerance and adverse events. Within the care pathway, time- bound clinical and biomarker data will be provided to the treating clinician to help inform their clinical decisions.</description>
      <arm_group_label>Biologic Care Pathway</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Greater than or equal to age 18&#xD;
  &#xD;
            -  Starting an Anti TNF biologic therapy&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  High-grade, symptomatic fibrostenotic strictures&#xD;
  &#xD;
            -  Perforating complications&#xD;
  &#xD;
            -  Intraabdominal or perianal abscesses&#xD;
  &#xD;
            -  Active infection,&#xD;
  &#xD;
            -  Known malignancy&#xD;
  &#xD;
            -  Any contraindication to biologic therapy&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>99 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_contact>
      <last_name>Jennifer Jones, MD</last_name>
      <phone>902-473-1499</phone>
      <email>jljones@dal.ca</email>
    </overall_contact>
    <overall_contact_backup>
      <last_name>Natalie Willett, BSc</last_name>
      <phone>902-473-7074</phone>
      <email>natalie.willett@nshealth.ca</email>
    </overall_contact_backup>
    <verification_date>September 2023</verification_date>
    <study_first_submitted>July 10, 2023</study_first_submitted>
    <study_first_submitted_qc>September 2, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 11, 2023</study_first_posted>
    <last_update_submitted>September 2, 2023</last_update_submitted>
    <last_update_submitted_qc>September 2, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 11, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor-Investigator</responsible_party_type>
      <investigator_affiliation>Nova Scotia Health Authority</investigator_affiliation>
      <investigator_full_name>Jennifer Jones</investigator_full_name>
      <investigator_title>Gastroenterologist, Associate Professor, Department of Medicine, Dalhousie University</investigator_title>
    </responsible_party>
    <keyword>IBD</keyword>
    <keyword>Biologics</keyword>
    <keyword>Care Pathway</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Crohn Disease</mesh_term>
      <mesh_term>Intestinal Diseases</mesh_term>
      <mesh_term>Inflammatory Bowel Diseases</mesh_term>
    </condition_browse>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06030882
  org study id: 50757
  nct id: NCT06030882
  lead sponsor: 
  collaborator: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  Inflammatory Bowel Disease (IBD) includes a group of chronic inflammatory conditions of the
        gastrointestinal system and is composed of Crohn's disease and ulcerative colitis. As an
        immune-mediated disease, IBD treatment options include the use of biologic medicines
        including anti-tumor necrosis alpha factor (also called anti-TNFs) medication. Despite
        biologic medicines being an important part of IBD management, there is inconsistency in the
        way these medications are used. Implementation of evidence-based, standardized biologic care
        pathways (BCP) can improve treatment related outcomes. Previous research has shown that using
        a clinical care pathway, such as a BCP, is a feasible method to support clinical decision
        making and may improve disease-related outcomes for patients. The researchers propose a
        prospective study to determine how well a BCP can be incorporated into clinical practice,
        improve patient health outcomes, and reduce healthcare system redundancies. Also, the impact
        of a BCP on outcomes for patients treated with the help of a standardized BCP compared to
        those in patients treated without the use of a BCP will be studied. The results of this study
        will inform how best to incorporate evidence-based BCPs into real-world practice and support
        the wide-spread adoption of BCPs in clinical practice.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Health Services Research
  masking: None (Open Label)
  measure: EQ5D Score
  time frame: week 0 (baseline)
  description: General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of <0 represents the worst possible health status.
  measure: EQ5D Score
  time frame: week 50
  description: General Quality of life data measured using the Euroqol five dimension (EQ5D) Questionnaire. The EQ5D is a brief self-reported generic measure of current health. It is a 2 page questionnaire which has 5 descriptive questions. Each question may have 1 of 3-level answers, and a visual analog scale (VAS) on which patients can mark their current health state. The EQ-5D-3L index is calculated by subtracting the values of the descriptive EQ-5D system from the numerical value 1. This corresponds to the best possible health status, while an index value of <0 represents the worst possible health status.
  measure: Emergency room visits
  time frame: week 0 (baseline)
  description: Number of emergency room visits
  measure: Emergency room visits
  time frame: month 12
  description: Number of emergency room visits
  measure: inpatient hospitalization,
  time frame: week 0
  description: Number of inpatient hospitalizations
  measure: inpatient hospitalization,
  time frame: month 12
  description: Number of inpatient hospitalizations
  measure: disease-related surgery
  time frame: week 0
  description: Number of disease related surgeries
  measure: disease-related surgery
  time frame: month 12
  description: Number of disease related surgeries
  measure: ambulatory care visits
  time frame: week 0
  description: number of ambulatory care visits
  measure: ambulatory care visits
  time frame: month 12
  description: number of ambulatory care visits
  measure: drug therapy
  time frame: week 0
  description: A list of current medications the patient is taking
  measure: drug therapy
  time frame: month 12
  description: A list of current medications the patient is taking
  measure: HBI Index Score
  time frame: week 0 (baseline), week 12-14, week 30, week 50
  description: IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:
  Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16
  measure: HBI Index Score
  time frame: week 0 (baseline)
  description: IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:
  Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16
  measure: HBI Index Score
  time frame: week 12
  description: IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:
  Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16
  measure: HBI Index Score
  time frame: week 30
  description: IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are potential final score results:
  Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16
  measure: HBI Index Score
  time frame: week 50
  description: IBD disease activity measured by the Harvey Bradshaw Index (HBI index). The HBI involves patients answering five questions which are summed to produce a final score. The following are strata for final score results:
  Remission: <5 Mild Disease: 5-7 Moderate Disease: 8-16 Severe Disease: >16
  measure: Partial Mayo Score
  time frame: week 0 (baseline)
  description: IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9
  measure: Partial Mayo Score
  time frame: week 12
  description: IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9
  measure: Partial Mayo Score
  time frame: week 30
  description: IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9
  measure: Partial Mayo Score
  time frame: week 50
  description: IBD disease activity (as measured by the Partial Mayo Score). Partial Mayo Score measures disease activity of Ulcerative colitis. The following are strata for final score results:
  Total Partial Mayo Index Score Remission: 0-1 Mild Disease: 2-4 Moderate Disease: 5-6 Severe Disease: 7-9
  measure: Fecal calprotectin
  time frame: week 0 (baseline)
  description: Fecal calprotectin concentration, assayed by stool sample
  measure: Fecal calprotectin
  time frame: week 12
  description: Fecal calprotectin concentration, assayed by stool sample
  measure: Fecal calprotectin
  time frame: week 30
  description: Fecal calprotectin concentration, assayed by stool sample
  measure: Fecal calprotectin
  time frame: week 50
  description: Fecal calprotectin concentration, assayed by stool sample
  measure: CRP concentration
  time frame: week 0 (baseline)
  description: serum CRP concentration
  measure: CRP concentration
  time frame: week 12
  description: serum CRP concentration
  measure: CRP concentration
  time frame: week 30
  description: serum CRP concentration
  measure: CRP concentration
  time frame: week 50
  description: serum CRP concentration
  arm group label: Biologic Care Pathway
  arm group type: Experimental
  description: Care through a biologic care pathway
  arm group label: Control
  arm group type: No Intervention
  description: Care as usual
  intervention type: Other
  intervention name: Biologic Care Pathway
  description: Receiving care administered through a biologic care pathway.The central biologic intake nurse will touch base with the IBD program nurse navigator at preselected time points as per the pathway in order to coordinate the baseline pre- biologic work-up, clinical and biomarker assessments, and clinical assessments. Clinical management decisions will be informed by a combination of data points including clinical risk factors, TDM, fecal calprotectin concentrations, endoscopic and clinical disease activity indices as well as drug tolerance and adverse events. Within the care pathway, time- bound clinical and biomarker data will be provided to the treating clinician to help inform their clinical decisions.
  arm group label: Biologic Care Pathway
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 99 Years
  healthy volunteers: No
  last name: Jennifer Jones, MD
  phone: 902-473-1499
  email: jljones@dal.ca
  last name: Natalie Willett, BSc
  phone: 902-473-7074
  email: natalie.willett@nshealth.ca
  responsible party type: Sponsor-Investigator
  investigator affiliation: Nova Scotia Health Authority
  investigator full name: Jennifer Jones
  investigator title: Gastroenterologist, Associate Professor, Department of Medicine, Dalhousie University
  mesh term: Crohn Disease
  mesh term: Intestinal Diseases
  mesh term: Inflammatory Bowel Diseases