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112 Background: Cancer Care Ontario, the government's cancer management agency, mandated routine collection of smoking data province wide (catchment of > 13 million individuals), but did not mandate specifics of a smoking cessation program for cancer patients, despite known benefits. Referral rates to smoking cessation clinics for cancer patients are low. In 2014, Princess Margaret Cancer Centre developed an electronic, patient-driven e-referral tool shown to improve referral rates, known as the smoking Cessation E-referrAl SystEm (CEASE). The objective of this study is to assess the feasibility for expanding this program through adoption and implementation of the CEASE tool to 5 additional clinics across 3 different Cancer Centres. Methods: The Canadian Institute of Health Research’s Knowledge-to- Action (CHIR KTA) framework guided the assessment. Feasibility was addressed through situational assessments, pilot implementation, and clinic/patient feedback in at least two cycles, with procedural changes made at the conclusion of each cycle. Clinics were selected to cover a wide range of hospital, clinic styles, and disease sites. Results: Pilot implementation occurred over 21 clinic days (Jun 2017- Aug 2017); 123 patients were enrolled in the pilot studies in breast, gastrointestinal, head and neck, and thoracic sites. Feasibility assessment in each clinic identified similarities and differences in resource availability, access to authority figures, and patient flow patterns. After the feasibility assessment, a pilot implementation identified English as a second language and the lack of patient's tablet/technological experience as the main barriers for implementation in 4 of 5 clinics. The use of volunteers assisting patients with the survey helped address these barriers. Strong internet connection, short survey length and staff engagement were seen as universal common facilitators to implementation in all 5 clinics. Conclusions: Despite different outpatient environments, common barriers and potential solutions were identified, which will help with scalable future widespread implementation of CEASE across the province of Ontario.

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Background Cirrhosis is the leading cause of liver-related death globally. Hepatic encephalopathy (HE) leads to significant morbidity and mortality. Lactulose is the current gold standard treatment for HE; it eliminates nitrogenous waste from the gut. Polyethylene glycol 3350–electrolyte solution (PEG) is a safe, common and effective purgative with recent studies suggesting its efficacy resulting in faster resolution of HE and shorter hospital length of stay. Aims To assess the efficacy and safety of PEG 3350 compared to lactulose in adult cirrhotic patients 18 years of age and older with overt hepatic encephalopathy on patient important outcomes including: improvement of hepatic encephalopathy, hospital length of stay and mortality. Methods We reviewed databases MEDLINE, EMBASE, OVID, CINAHL, Cochrane Database, PubMed, Trip database, the grey literature, and clinicaltrials.gov from inception to December 2020: PROSPERO CRD42021257641. Search strategy was developed in conjunction with medical librarian. Randomized controlled trials (RCTs), either published or non-published, were included in the review. Continuous data was analyzed using mean difference with random-effects model. Dichotomous data was analyzed using the Mantel-Haenszel method using random-effects model. Statistical effect-size heterogeneity was assessed using Chi2 test and quantifying the relative proportion of variation using I2 statistic. The overall certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations system (GRADE). Results From the 68 studies, 16 were assessed for full text review from which 5 studies were included in the meta-analysis representing a total of 351 patients. The primary outcome of mean change in Hepatic Encephalopathy Scoring Algorithm (HESA) at 24-hours from baseline demonstrated an improvement in the PEG group compared to lactulose group [Mean difference (MD)= 0.60, 95% CI (0.20, 1.01)]. In comparison to lactulose, PEG also demonstrated a shorter hospital length of stay [MD = -1.00, 95% CI (-1.99, -0.01)], shorter time to HE resolution [MD= -1.49, 95% CI (-1.81, -1.16)] and showed a mortality benefit [RR=0.35, 95% CI (0.13 to 0.92)]. There was no significant difference between change in ammonia levels at 24 hours [MD= -25.80, 95% CI (-95.39, 43.78)]. Conclusions PEG leads to a faster improvement and resolution of HE when compared to the current standard of care, lactulose. Funding Agencies None