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Straatmijer T, van den Akker-van Marle ME, Ponsioen CY, van der Horst D, Scherpenzeel MP, Duijvestein M, van der Meulen-de Jong AE. Patient preferences in treatment options of ulcerative colitis: a discrete choice experiment. Scand J Gastroenterol 2024; 59:288-295. [PMID: 38042982 DOI: 10.1080/00365521.2023.2286191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/15/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Since the number of medical treatment options for Ulcerative Colitis (UC) has expanded over the last decades, patients and physicians face challenges regarding decisions about the medication options. We aimed to identify patients' preferences about their UC treatment options in the Netherlands. Furthermore, we assessed after how many failed treatment options, patients are willing to consider surgical treatment. METHODS We conducted a web-based, multicenter, discrete choice experiment (DCE) among adult UC patients. Patients were repeatedly asked to choose between two hypothetical medicinal treatment options. The choice tasks were based on administration route, administration location, chance of symptom reduction (on short and long term) and chances on infection and other adverse events. Data were analyzed by using Hierarchical Bayes estimation. RESULTS A total of 172 UC patients participated in the DCE. More than half were anti-TNF experienced (52.9%). The chance of symptom reduction after one year (relative importance (RI) 27.7 (95% CI 26.0-29.4)) was most important in choosing between medicinal treatments, followed by the chance of infection (RI 22.3 (21.4 - 23.3)) and chance of symptom reduction after eight weeks (RI 19.5 (18.3 - 20.6)). Considering surgical treatment, nineteen patients (14.3%) would not even consider surgery after failing eight treatment options without any new available therapies left. Nine patients would consider surgery before trying any treatment options. CONCLUSION We found that symptom reduction after one year was the most important attribute in choosing between treatments in UC patients. These outcomes can help understand the trade-offs and preferences of UC patients.
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Affiliation(s)
- Tessa Straatmijer
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
| | - M Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Cyriel Y Ponsioen
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
| | | | | | - Marjolijn Duijvestein
- Radboudumc, Department of Gastroenterology and Hepatology, Nijmegen, The Netherlands
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Nass BYS, Dibbets P, Markus CR. The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6976. [PMID: 37947534 PMCID: PMC10648781 DOI: 10.3390/ijerph20216976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.
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Affiliation(s)
- Boukje Yentl Sundari Nass
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Dr. Rath Health Foundation, 6422 RG Heerlen, The Netherlands
| | - Pauline Dibbets
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - C. Rob Markus
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Matsumoto T, Imai K, Goda Y, Fujimitsu Y, Kajioka T, Kihara H, Funaki Y, Imaki S, Ueno M. Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey. CROHN'S & COLITIS 360 2023; 5:otad069. [PMID: 38028953 PMCID: PMC10676197 DOI: 10.1093/crocol/otad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background/Aims The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Methods Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Results Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Conclusions Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Keita Imai
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Goda
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Fujimitsu
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | | | - Hideaki Kihara
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuji Funaki
- Department of Integrated Marketing, EA Pharma Co., Ltd., Tokyo, Japan
| | - Shigeru Imaki
- Department of Corporate Communication, EA Pharma Co., Ltd., Tokyo, Japan
| | - Masato Ueno
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
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Graham J, Iverson A, Monteiro J, Weiner K, Southall K, Schiller K, Gupta M, Simard EP. Applying computable phenotypes within a common data model to identify heart failure patients for an implantable cardiac device registry. IJC HEART & VASCULATURE 2022; 39:100974. [PMID: 35242997 PMCID: PMC8861122 DOI: 10.1016/j.ijcha.2022.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger Clinic, Danville, PA, USA
- Corresponding author at: 100 N Academy Ave, MC 44-01, Danville, PA 17822-2402, USA.
| | - Andy Iverson
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Joao Monteiro
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Katherine Weiner
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Kara Southall
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Katherine Schiller
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
| | - Mudit Gupta
- Phenomic Analytics and Clinical Data Core, Geisinger Clinic, Danville, PA, USA
| | - Edgar P. Simard
- Global Clinical Research and Analytics Medtronic, Inc., Minneapolis, MN, USA
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Allahwala UK, Cistulli P, Ciofani JL, Dissanayake HU, Ward M, Weaver JC, Bhindi R. Influence of Obstructive Sleep Apnoea on Outcomes in Patients With ST Elevation Myocardial Infarction (STEMI): the Role of the Coronary Collateral Circulation. Heart Lung Circ 2021; 30:1883-1890. [PMID: 34366217 DOI: 10.1016/j.hlc.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) occurs frequently in patients with coronary artery disease, with associated intermittent hypoxia a possible stimulus for coronary collateral recruitment through ischaemic preconditioning. We sought to determine whether OSA affects recruitment of coronary collaterals and prognosis of patients presenting with ST elevation myocardial infarction (STEMI). METHODS Patients with a STEMI undergoing percutaneous coronary intervention (PCI) from July 2010 to December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA. Patients with robust collaterals were defined as Rentrop grade 2 or 3. RESULTS 1,863 patients were included, of which 143 (7.7%) patients had documented evidence of OSA in their health record. Patients with OSA had a higher body mass index (BMI) (30.2 kg/m2 vs 27 kg/m2, p<0.0001), greater rate of hypertension (61.1% vs 45.1%, p<0.0001), hypercholesterolaemia (47.4% vs 38.4%, p<0.05) and diabetes mellitus (22.6% vs 15.9%, p<0.05). Patients with OSA were more likely to have robust coronary collaterals (OR: 2.2 [95% CI: 1.5-3.2]) and a lower rate of left ventricular (LV) impairment (50.7% vs 63.1%, p<0.01), a higher LV ejection fraction (50.3% vs 46.7%, p<0.0001) and a lower peak troponin-I level (26,452 ng/L vs 39,469 ng/L, p<0.01). There were no differences in rates of in-hospital or longer term mortality, in patients with OSA compared to those without. CONCLUSIONS Patients with documented OSA presenting with STEMI appear to have more robust coronary collaterals observed on angiography which likely mediates lower myocardial necrosis. Broader implications of this finding on treatment require further investigation.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia.
| | - Peter Cistulli
- Centre for Sleep Health and Research, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jonathan L Ciofani
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia. https://twitter.com/JonathanCiofani
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
| | - James C Weaver
- The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia. https://twitter.com/Ravinay
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El-Matary W. Are Patient Self-reported Healthcare Utilization Data Reliable in Persons With IBD? CROHN'S & COLITIS 360 2021; 3:otab033. [PMID: 36776651 PMCID: PMC9802399 DOI: 10.1093/crocol/otab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wael El-Matary
- Section of Pediatric Gastroenterology, Department of Pediatrics, Max Rady College of Medicine, Rady Faculty of Health Sciences and Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada,Address correspondence to: Wael El-Matary, MBBCh, MD, MSc, FRCPCH, FRCPC, Section of Pediatric Gastroenterology, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 408 Children’s Hospital, Health Sciences Centre, 840 Sherbrook St., Winnipeg, MB R3A 1S1, Canada ()
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van Deen WK, Freundlich N, Kwon MH, Patel DB, Crate DJ, Oberai R, Shah SA, Hwang C, Weaver SA, Siegel CA, Melmed GY. The Reliability of Patient Self-reported Utilization in an Inflammatory Bowel Diseases Learning Health System. CROHN'S & COLITIS 360 2021; 3:otab031. [PMID: 36776667 PMCID: PMC9802108 DOI: 10.1093/crocol/otab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) care is beset with substantial practice variation. Learning health systems (LHSs) aim to learn from this variation and improve quality of care by sharing feedback and improvement strategies within the LHS. Obtaining accurate information on outcomes and quality of care is a priority for LHS, which often includes patients' self-reported data. While prior work has shown that patients can accurately report their diagnosis and surgical history, little is known about their ability to self-report recent healthcare utilization, medication use, and vaccination status. Methods We compared patient self-reported data within the IBD Qorus LHS regarding recent IBD-related emergency department (ED) visits, hospitalizations, computerized tomography (CT) scans, corticosteroid use, opioid use, influenza vaccinations, and pneumococcal vaccinations with electronic health record (EHR) data. Results We compared 328 patient self-reports to data extracted from the EHR. Sensitivity was moderate-to-high for ED visits, hospitalizations, and CT scans (76%, 87%, and 87%, respectively), sensitivity was lower for medication use with 71% sensitivity for corticosteroid use and only 50% sensitivity for self-reported use of opioids. Vaccinations were reported with high sensitivity, but overall agreement was low as many patients reported vaccinations that were not registered in the EHR. Conclusions Self-reported IBD-related ED visits, hospitalizations, and CT scans are reported with high sensitivity and accuracy. Medication use, and in particular opioid use, is less reliably reported. Vaccination self-report is likely more accurate than EHR data as many vaccinations are not accurately registered.
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Affiliation(s)
- Welmoed K van Deen
- Cedars-Sinai Medical Center, Center for Outcomes Research and Education (CS-CORE), Division of Health Services Research, Department of Medicine, Los Angeles, CA, USA,Erasmus School of Health Policy and Management, Division of Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands,University of Southern California, Gehr Family Center for Health Systems Science, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine, Los Angeles, CA, USA,Address correspondence to: Welmoed K. van Deen, MD, PhD, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Bayle (J) Building, Room J8-55, 3062 PA Rotterdam, The Netherlands ()
| | - Noah Freundlich
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Lebanon, NH, USA
| | - Michelle H Kwon
- Gastroenterology Associates Inc, Providence, RI, USA,Brown University, Division of Gastroenterology, Department of Medicine, Alpert Medical School, Providence, RI, USA
| | - Devin B Patel
- Cedars-Sinai Medical Center, Inflammatory Bowel Disease Center, Division of Gastroenterology, Los Angeles, CA, USA
| | - Damara J Crate
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Lebanon, NH, USA
| | | | - Samir A Shah
- Gastroenterology Associates Inc, Providence, RI, USA,Brown University, Division of Gastroenterology, Department of Medicine, Alpert Medical School, Providence, RI, USA
| | - Caroline Hwang
- University of Southern California, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Corey A Siegel
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Lebanon, NH, USA
| | - Gil Y Melmed
- Cedars-Sinai Medical Center, Inflammatory Bowel Disease Center, Division of Gastroenterology, Los Angeles, CA, USA
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Allahwala UK, Cistulli PA, Ekmejian A, Mughal N, Dissanayake HU, Ward M, Weaver JC, Bhindi R. Relation of Obstructive Sleep Apnea in Patients With a Coronary Chronic Total Occlusion to Coronary Collaterals and Mortality. Am J Cardiol 2021; 148:30-35. [PMID: 33675771 DOI: 10.1016/j.amjcard.2021.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
A chronic total occlusion (CTO) is frequently identified in patients undergoing coronary angiography. The prognostic implications of intermittent hypoxia from obstructive sleep apnea (OSA) on patients with a CTO, and effects on collateral recruitment are unknown. The aim of this study was to determine the prevalence, vascular effects, and prognostic implications of the presence of OSA in patients with a CTO. Patients with a CTO between July 2010 and December 2019 were reviewed. Electronic medical records were accessed to determine documented patient history of OSA, demographics, and clinical course. Patients with robust collateral recruitment were defined as Rentrop grade 2 or 3. A total of 948 patients were included in the study, of which 127 (13.4%) had a documented history of OSA. These patients were younger (67.0 years vs 70.6 years, p < 0.01), had a higher body mass index (29.6 kg/m2 vs 26.7 kg/m2, p < 0.0001), higher rates of hypertension (91.3% vs 83.2%, p < 0.05), higher rates of smokers (63.3% vs 49.0%, p < 0.01) and more use of β-blockers (79% vs 68.5%, p < 0.05) and statins (92.7% vs 82.1%, p < 0.01). A documented history of OSA was independently associated with robust collaterals (OR 3.0 95%CI 1.5 to 5.8, p < 0.01) and lower mortality (HR 0.3 95% CI 0.1 to 0.7, p < 0.01) with a mean survival of 10.8 years, as compared to 8.1 years (log rank p < 0.0001). In conclusion, in patients with a CTO, documented OSA is independently associated with more robust coronary collaterals and lower mortality. The possible cardioprotective implications of intermittent hypoxia in OSA, as well as treatment effect requires further investigation.
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Affiliation(s)
- Usaid K Allahwala
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia.
| | - Peter A Cistulli
- Centre for Sleep Health and Research, Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, Sydney, Australia; Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Avedis Ekmejian
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Nadeem Mughal
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre, School of Medicine, University of Sydney, Sydney, Australia
| | - Michael Ward
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - James C Weaver
- The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
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Falling C, Stebbings S, Baxter GD, Gearry RB, Mani R. Criterion validity and discriminatory ability of the central sensitization inventory short form in individuals with inflammatory bowel diseases. Scand J Pain 2021; 21:577-585. [PMID: 34015864 DOI: 10.1515/sjpain-2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Increased symptoms related to central sensitization have previously been reported in inflammatory bowel disease (IBD) patients, identified by the original central sensitization inventory (CSI-25). However, the recently developed CSI short form (CSI-9) may be more clinically useful. The aim of the present study was to evaluate the performance of CSI-9 compared to the original CSI-25 in individuals with IBD. Study objectives were to investigate the criterion validity of the CSI-9 to the CSI-25, assess individual association of the CSI measures with clinical features of IBD and pain presentations, and to establish disease-specific CSI-9 and CSI-25 cut-off scores for discriminating the presence of self-reported pain in individuals with IBD. METHODS Cross-sectional online survey was performed on adults with IBD exploring self-reported demographics, comorbidity, and clinical IBD and pain features. Criterion validity of the CSI-9 was investigated using intraclass correlation coefficient (ICC)3,1. Area under the receiver operating characteristic curve (AUC-ROC) analysis was conducted to investigate the discriminative ability of both versions of CSI. RESULTS Of the 320 participants, 260 reported the presence of abdominal and/or musculoskeletal pain. CSI-9 and CSI-25 demonstrated substantial agreement (ICC3,1=0.64, 95% CI [0.58, 0.69]). AUC (95% CI) indicated that CSI-9 (0.788 (0.725, 0.851), p<0.001) and CSI-25 (0.808 (0.750, 0.867), p<0.001) were able to adequately discriminate the presence of pain using cut-offs scores of ≥17 (CSI-9) and ≥40 (CSI-25). Abdominal pain severity was the only feature to differ in significant association to CSI-25 (p=0.002) compared to CSI-9 (p=0.236). All other features demonstrated significant associations to both CSI versions, except age (p=0.291 and 0.643) and IBD subtype (p=0.115 and 0.675). CONCLUSIONS This is the first study to explore and validate the use of CSI-9 in IBD patients. Results demonstrated concurrent validity of the CSI-9 to CSI-25, with similar significant association to multiple patient features, and a suggested cut-off value of 17 on CSI-9 to screen for individuals with pain experiences. Study findings suggest that CSI-9 is suitable to use as a brief tool in IBD patients.
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Affiliation(s)
- Carrie Falling
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Simon Stebbings
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Liu Y, Xu F, Wheaton AG, Greenlund KJ, Thomas CW. The association between inflammatory bowel disease and migraine or severe headache among US adults: Findings from the National Health Interview Survey, 2015-2016. Headache 2021; 61:612-619. [PMID: 33756009 DOI: 10.1111/head.14087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the prevalence of migraine or severe headache among US adults by inflammatory bowel disease (IBD) status. BACKGROUND Emerging evidence in clinical settings suggests a higher prevalence of migraine among patients with IBD than those without IBD. METHODS Data from 60,436 US adults aged ≥18 years participating in the 2015 and 2016 National Health Interview Survey (NHIS) were analyzed. The relationship between IBD status and migraine or severe headache was assessed overall and stratified by levels of selected characteristics including sex, age, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status. RESULTS Overall, the age-adjusted prevalence of migraine or severe headache was 15.4% (n = 9062) and of IBD was 1.2% (n = 862). A higher age-adjusted migraine or severe headache prevalence was reported among participants with IBD than those without IBD (28.1% vs. 15.2%, p < 0.0001). The association of migraine or severe headache with IBD remained significant overall [adjusted prevalence ratio (95% CI) = 1.59 (1.35-1.86)] and within the levels of most other selected characteristics after controlling for all other covariates. CONCLUSIONS Our results confirmed a higher prevalence of migraine or severe headache among US adults with IBD than those without. Healthcare providers might assess migraine or severe headache among patients with IBD to improve management and quality of life.
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Affiliation(s)
- Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Craig W Thomas
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Thomas PWA, West RL, Russel MGVM, Jansen JM, Kosse LJ, Jessurun NT, Römkens TEH, Hoentjen F. Inflammatory bowel disease patients provide reliable self-reported medical information: A multicentre prospective pharmacovigilance monitoring system. Pharmacoepidemiol Drug Saf 2020; 30:520-524. [PMID: 33219593 PMCID: PMC7983909 DOI: 10.1002/pds.5175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022]
Abstract
Purpose To assess the agreement between patient‐reported and health care provider‐reported medical information in inflammatory bowel disease (IBD). Methods This multicentre, prospective, event monitoring study enrolled adult Crohn's disease (CD) and ulcerative colitis (UC) patients treated with a biological in four medical centers in the Netherlands. At two‐monthly intervals, patients completed questionnaires on biological use, combination therapy and indication. The patient‐reported information was compared with their electronic health records (EHRs) and analysed for percentage agreement and Cohen's kappa. A reference population from a prospective IBD registry was used to assess the representativeness of the study population. Results In total, 182 patients (female 50.5%, mean age 42.2 years, CD 76.9%) were included in the analysis. At baseline, 51.0% of the patients were prescribed an immunomodulator (43.9% thiopurines, 7.1% methotrexate), and patients were prescribed biologicals as follows: 59.3% infliximab, 30.2% adalimumab, 9.3% vedolizumab, and 1.1% ustekinumab. Agreement on patient‐reported indication and biological use was almost perfect (κ = 0.878 and κ = 1.000, respectively); substantial for combination therapy (κ = 0.672). Gender, age, type of IBD, biological use and combination therapy were comparable with the reference population. Conclusion Systematic patient‐reporting by questionnaires was reliable in retrieving indication and treatment specific information from IBD patients. These results indicate that the use of patient‐reporting outcomes in daily IBD practice can ensure reliable information collection.
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Affiliation(s)
- Pepijn W A Thomas
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Maurice G V M Russel
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Leanne J Kosse
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Naomi T Jessurun
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Snyder ME, Adeoye-Olatunde OA, Gernant SA, DiIulio J, Jaynes HA, Doucette WR, Russ-Jara AL. A user-centered evaluation of medication therapy management alerts for community pharmacists: Recommendations to improve usability and usefulness. Res Social Adm Pharm 2020; 17:1433-1443. [PMID: 33250363 DOI: 10.1016/j.sapharm.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/14/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Community pharmacists provide comprehensive medication reviews (CMRs) through pharmacy contracts with medication therapy management (MTM) vendors. These CMRs are documented in the vendors' web-based MTM software platforms, which often integrate alerts to assist pharmacists in the detection of medication therapy problems. Understanding pharmacists' experiences with MTM alerts is critical to optimizing alert design for patient care. OBJECTIVES The objectives of this study were to 1) assess the usability and usefulness of MTM alerts for MTM vendor-contracted community pharmacists and 2) generate recommendations for improving MTM alerts for use by community pharmacists. METHODS This was a convergent, parallel mixed-methods evaluation of data collected from 3 sources, with individual pharmacists contributing data to one or more sources: 1) community pharmacists' submissions of observational data about MTM alerts encountered during routine MTM provision, 2) videos of naturalistic usability testing of MTM alerts, and 3) semi-structured interviews to elicit pharmacists' perspectives on MTM alert usefulness and usability. MTM alert data submitted by pharmacists were summarized with descriptive statistics. Usability testing videos were analyzed to determine pharmacists' time spent on MTM alerts and to identify negative usability incidents. Interview transcripts were analyzed using a hybrid approach of deductive and inductive codes to identify emergent themes. Triangulation of data (i.e., determination of convergence/divergence in findings across all data sources) occurred through investigator discussion and identified overarching findings pertaining to key MTM alert challenges. These resulted in actionable recommendations to improve MTM alerts for use by community pharmacists. RESULTS Collectively, two and four overarching key challenges pertaining to MTM alert usability and usefulness, respectively, were identified, resulting in 15 actionable recommendations for improving the design of MTM alerts from a user-centered perspective. CONCLUSIONS Recommendations are expected to inform enhanced MTM alert designs that can improve pharmacist efficiency, patient and prescriber satisfaction with MTM, and patient outcomes.
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Affiliation(s)
- Margie E Snyder
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Omolola A Adeoye-Olatunde
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Stephanie A Gernant
- University of Connecticut School of Pharmacy, 69 North Eagleville Rd, U-3095, Storrs, CT, 06269, USA.
| | - Julie DiIulio
- Applied Decision Science, 1776 Mentor Ave. #424, Cincinnati, OH, 45212, USA.
| | - Heather A Jaynes
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - William R Doucette
- University of Iowa College of Pharmacy, 339 CPB 180 S. Grand Avenue, Iowa City, IA, 52242, USA.
| | - Alissa L Russ-Jara
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
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13
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Pritchett JW. Hip Replacement or Hip Resurfacing with a Highly Cross-Linked Polyethylene Acetabular Bearing: A Qualitative and Quantitative Preference Study. JB JS Open Access 2020; 5:JBJSOA-D-20-00004. [PMID: 32832826 PMCID: PMC7418920 DOI: 10.2106/jbjs.oa.20.00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Most surgeons strongly prefer total hip arthroplasty (THA) over hip resurfacing arthroplasty (HRA). However, it is unknown whether patients prefer the results of 1 procedure over the other. The purpose of this study was to answer 3 questions: (1) Do patients with an HRA on 1 side and a THA on the other notice a difference? (2) Do patients have a preference? (3) What are the reasons for their preference? Methods Between 1998 and 2012, 332 patients underwent staged bilateral hip arthroplasties with cementless THA on 1 side and HRA on the other, with a highly cross-linked polyethylene acetabular component used for both. Patient preferences, Harris hip scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded by blinded examiners. Patients provided reasons for their preference in semi-structured interviews using both quantitative and qualitative measures. Results The mean follow-up was 11 years (range, 7 to 21 years). Of 324 patients with complete data, 279 (86%) preferred the HRA, 19 (6%) preferred the THA, and 26 (8%) had no preference. The most common reasons for preference for the HRA were better balance (n = 143), felt more normal (n = 141), better activity participation/more reliable hip during sports (n = 139), and stronger on stairs (n = 129). A fair or poor outcome was reported by the patient after 4 HRAs and 7 THAs. The remainder of the patients reported improved function and satisfactory pain relief and range of motion for both hips. Conclusions In conclusion, most patients in this study preferred the side on which the HRA had been done. Since essentially all current hip prostheses perform well, a paired bilateral study may be the optimal way to determine patient preferences and values of HRA compared with THA. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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14
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Scott AJ, Flowers O, Rowse G. Do specific types of sleep disturbances represent risk factors for poorer health-related quality of life in inflammatory bowel disease? A longitudinal cohort study. Br J Health Psychol 2020; 26:90-108. [PMID: 32634291 DOI: 10.1111/bjhp.12457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/12/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Poor global sleep quality is commonly reported in people with inflammatory bowel disease (IBD) and is linked to poorer health-related quality of life (HRQoL). However, understanding is currently limited by a lack of: (1) longitudinal research and (2) research investigating the impact of specific types of problems sleeping on IBD-related outcomes, particularly on HRQoL. DESIGN Observational longitudinal cohort study. METHODS N = 276 participants with IBD completed measures at baseline (T1) and 4 weeks later at T2. Four specific sleep disturbances associated with IBD including sleep apnoea, insomnia, restless legs, and nightmares were measured alongside depression, anxiety and stress, and HRQoL. RESULTS After controlling for participant demographics and clinical characteristics, T1 depression, anxiety, stress, and T1 HRQoL, more severe symptom severity of sleep apnoea (B = -0.30, p < .05) and insomnia symptoms (B = -0.23, p < .05) at T1 significantly predicted poorer HRQoL at T2. However, the experience of restless legs (B = -0.03, p > .87) and nightmares (B = -0.14, p > .11) at T1 did not predict HRQoL. CONCLUSION Symptoms synonymous with sleep apnoea and insomnia might represent modifiable risk factors that provide independent contributions to HRQoL over time in those with IBD. These findings suggest that interventions designed to improve sleep apnoea and insomnia could confer benefits to HRQoL in those with IBD. However, more longitudinal research is needed to understand the contribution of sleep disturbances over the longer term, as well as more randomized controlled trials testing the effect of improving sleep on IBD-related outcomes.
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Affiliation(s)
- Alexander J Scott
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Olivia Flowers
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
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15
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Yanai S, Toya Y, Nakamura S, Matsumoto T. Patients' Preference of Topical Therapy for Ulcerative Colitis in Japan: A Web-based 3T Survey. CROHN'S & COLITIS 360 2020; 2:otaa030. [PMID: 36798649 PMCID: PMC9927820 DOI: 10.1093/crocol/otaa030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background The therapeutic drugs available for ulcerative colitis (UC) have recently increased. However, use of topical therapy for UC in Japan has not been determined. This study aimed to investigate real-world use of topical therapy for UC in Japan using a web-based survey designed for UC patients. Methods A web-based questionnaire on UC management was administered to 773 patients over a 2-day period in September 2019. The responses regarding topical therapy use were analyzed. Results Questionnaire responses were obtained from 323 UC patients. Of these, the mean disease duration was 12.2 years, and 220 patients (68.1%) had used topical therapy, of whom 68 (21.1%) were currently using this treatment. The frequency of using the prescribed topical therapy was appropriate in 36.8% of patients, only when needed in 38.6%, and rarely in 24.5%. Among all topical therapy users, 64.4% reported that budesonide foam was easy to use, which was significantly higher than the rates for mesalazine suppositories (43.6%), mesalazine enemas (12.9%), and glucocorticoid enemas (13.9%; P < 0.05). Regarding treatment effects, 68.9% of patients were satisfied with the budesonide foam, which was a significantly higher rate of satisfaction than those for mesalazine suppositories (44.6%), mesalazine enemas (30.2%), glucocorticoid enemas (36.1%), and glucocorticoid suppositories (41.9%; P < 0.05). Conclusions Although topical therapy use was common in this Japanese UC population, patient adherence was not very high. Of all the topical therapy types, budesonide foam, which has recently become available, was rated highly by these patients.
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Affiliation(s)
- Shunichi Yanai
- Address correspondence to: Shunichi Yanai, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, Iwate 028-3694, Japan ()
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
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16
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Kato I, Sun J, Larson J, Hastert T, Abrams J. History of Inflammatory Bowel Disease and Self-Reported Oral Health: Women's Health Initiative Observational Study. J Womens Health (Larchmt) 2020; 29:1032-1040. [PMID: 32302514 DOI: 10.1089/jwh.2019.8162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and Objective: Both periodontal disease and inflammatory bowel disease (IBD), are chronic inflammatory conditions, which are mediated by a complex interplay among a dysbiotic microbiota, dysregulated host immune-inflammatory responses, and lifestyle factors. Despite substantial differences in physical and chemical environments, rather strong correlations have been detected between microbial compositions of the oral cavity and stool. In this study, we tested the hypothesis that oral health conditions are affected by the presence of IBD. Materials and Methods: We analyzed the data from 73,621 women who were enrolled in the Women's Health Initiative observational cohort study and completed a follow-up questionnaire that surveyed oral health status specifically at year 5. Among these, 880 reported IBD at the baseline, including 47% who were symptomatic cases and 27% who were on immunosuppressive treatment. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association of IBD and medication status for self-reported oral health outcomes, using logistic regression models, adjusted for selected covariates. Results: IBD was not associated with periodontal disease history itself in a multivariable model; however, poorer self-rated oral health was modestly associated with the presence of IBD (OR = 1.15, 95% CI: 1.01-1.30). Likewise, more frequent eating limitations due to teeth were associated with the presence of IBD history (OR = 1.22, 95% CI: 1.07-1.39). When IBD cases were limited to those who were symptomatic, the associations with these two self-rated oral health outcomes were more pronounced with ORs of 1.28 (95% CI: 1.07-1.54) and 1.36 (95% CI: 1.07-1.54), respectively. Immunosuppressive treatment had little effect on these risk estimates. Conclusions: Among this nation-wide cohort of women 50-79 years of age, history of IBD was associated with poorer perceived oral health status.
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Affiliation(s)
- Ikuko Kato
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jun Sun
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joseph Larson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Judith Abrams
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
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17
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Scott AJ, Flowers O, Rowse G. A comparative study of the nature and magnitude of problems sleeping in inflammatory bowel disease (IBD) compared to healthy controls. PSYCHOL HEALTH MED 2020; 25:958-968. [DOI: 10.1080/13548506.2019.1707240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Alexander J. Scott
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Olivia Flowers
- The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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18
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Abstract
Patients with inflammatory bowel disease have adopted medical jargon terms of "flare" and "remission," but what they mean by these terms is ill-defined and may have implications for nurse-patient communication and treatment expectancy. The aim of this study was to elicit patients' understanding of "flare" and "remission." Individuals with self-reported inflammatory bowel disease were recruited through social media. A web-based survey, with closed and open-ended questions, was administered. Conventional content analysis was used to evaluate respondents' perceptions of jargon terms. A word cloud was generated to augment analysis by visualization of word use frequency. A majority of the 34 respondents had a symptom-focused understanding and described these terms as alternating states. Various symptoms were understood to signify "flare," which was largely attributed to lifestyle factors. Corroborated by the word cloud, there was rare mention of inflammation or tissue damage. This study demonstrates that an understanding of "flare" and "remission" by patients with inflammatory bowel disease is largely symptom-based. The role of inflammation, medication failure, and targets of inflammatory bowel disease treatment beyond symptom control are not currently well known to patients with inflammatory bowel disease. To create a shared understanding of symptoms and treatment goals between the patient and the nurse, patient education on emerging expectations of inflammatory bowel disease care should be prioritized.
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Grundmann O, Yoon SL, Mason S, Smith K. Gastrointestinal symptom improvement from fiber, STW 5, peppermint oil, and probiotics use-Results from an online survey. Complement Ther Med 2018; 41:225-230. [PMID: 30477844 DOI: 10.1016/j.ctim.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Several common supplements are used by a significant number of patients affected by gastrointestinal (GI) disorders to improve symptoms and quality of life. We investigated the impact of GI symptom improvement with the use of fiber, STW 5, probiotics, and peppermint oil in relation to overall GI pain and quality of life via an online survey. DESIGN We used a cross-sectional, descriptive, correlation design. A Qualtrics online survey was utilized to collect data from January to June 2013 through various websites. Areas evaluated included participant demographics, use of supplements, and gastrointestinal symptom severity. RESULTS The rate of supplement use among patients with GI disorders was high (90% in past year) and consultation with healthcare providers was reported by 80%. Participants who completed the survey (n = 68) reported a strong correlation between GI symptom severity and overall quality of life (r2 = 0.8682, p < 0.001). The use of fiber improved GI symptom severity while both STW 5 and probiotics were linked to specific improvements. CONCLUSIONS Persons with chronic GI disorders often choose the complementary use of common supplements to mitigate GI symptoms and consult with their healthcare providers frequently. The use of STW 5 and probiotics specifically is linked to overall reduction in GI symptoms and improvement of quality of life.
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Affiliation(s)
- Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, USA; College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA.
| | - Saunjoo L Yoon
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
| | - Sydney Mason
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
| | - Keore Smith
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
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20
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Abstract
BACKGROUND Daily aspirin use has been recommended for secondary prevention of cardiovascular disease, but its use for primary prevention remains controversial. METHODS We followed 440,277 men and women from the NIH-AARP Diet and Health Study (ages 50-71) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (ages 55-74) for mortality for 13 years on average. Frequency of aspirin use was ascertained through self-report, and cause of death by death certificates. We calculated multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality using Cox proportional hazards models for each cohort and combined by meta-analysis. RESULTS We found a consistent U-shaped relationship between aspirin use and mortality in both studies, with differential risk patterns for cardiovascular mortality by disease history. Among individuals with a history of cardiovascular disease, daily aspirin use was associated with reduced cardiovascular mortality [HR = 0.78 (95% CI, 0.74, 0.82)]. However, among those without a previous history, we observed no protection for daily aspirin users [HR = 1.06 (1.02, 1.11)], and elevated risk of cardiovascular mortality for those taking aspirin twice daily or more [HR = 1.29 (1.19, 1.39)]. Elevated risk persisted even among participants who lived beyond 5 years of follow-up and used aspirin without other nonsteroidal antiinflammatory drugs [HR = 1.31 (1.17, 1.47)]. CONCLUSIONS Results from these 2 large population-based US cohorts confirm the utility of daily aspirin use for secondary prevention of cardiovascular mortality; however, our data suggest that caution should be exercised in more frequent use, particularly among individuals without a history of cardiovascular disease.
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21
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Schiff ER, Frampton M, Semplici F, Bloom SL, McCartney SA, Vega R, Lovat LB, Wood E, Hart AL, Crespi D, Furman MA, Mann S, Murray CD, Segal AW, Levine AP. A New Look at Familial Risk of Inflammatory Bowel Disease in the Ashkenazi Jewish Population. Dig Dis Sci 2018; 63:3049-3057. [PMID: 30178286 PMCID: PMC6182437 DOI: 10.1007/s10620-018-5219-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS The inflammatory bowel diseases (IBD) are particularly common among the Ashkenazi Jewish (AJ) population. Population-specific estimates of familial risk are important for counseling; however, relatively small cohorts of AJ IBD patients have been analyzed for familial risk to date. This study aimed to recruit a new cohort of AJ IBD patients, mainly from the UK, to determine the familial occurrence of disease. METHODS A total of 864 AJ IBD patients were recruited through advertisements, hospital clinics, and primary care. Participants were interviewed about their Jewish ancestry, disease phenotype, age of diagnosis, and family history of disease. Case notes were reviewed. RESULTS The 864 probands comprised 506 sporadic and 358 familial cases, the latter with a total of 625 affected relatives. Of the UK cases, 40% had a positive family history with 25% having at least one affected first-degree relative. These percentages were lower among those recruited through hospital clinics and primary care (33% for all relatives and 22% among first-degree relatives). Examining all probands, the relative risk of IBD for offspring, siblings, and parents was 10.5, 7.4, and 4, respectively. Age of diagnosis was significantly lower in familial versus sporadic patients with Crohn's disease. CONCLUSIONS This study reports familial risk estimates for a significant proportion of the AJ IBD population in the UK. The high rate of a positive family history in this cohort may reflect the greater genetic burden for IBD among AJs. These data are of value in predicting the likelihood of future recurrence of IBD in AJ families.
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Affiliation(s)
- Elena R. Schiff
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Matthew Frampton
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Francesca Semplici
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Stuart L. Bloom
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Sara A. McCartney
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Laurence B. Lovat
- Department of Gastroenterology, University College London Hospital, London, UK ,Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - Eleanor Wood
- Gastroenterology Department, Homerton University Hospital, London, UK
| | - Ailsa L. Hart
- Gastroenterology Department, St Mark’s Hospital, London, UK
| | - Daniel Crespi
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - Mark A. Furman
- Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK
| | - Steven Mann
- Gastroenterology Department, Barnet General Hospital, London, UK
| | | | - Anthony W. Segal
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
| | - Adam P. Levine
- Centre for Molecular Medicine, Division of Medicine, University College London, London, UK
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22
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Solberg LI, Asche SE, Butler J, Carrell D, Norton CK, Jarvik JG, Smith-Bindman R, Tillema JO, Whitebird RR, Werner AM, Ziegenfuss JY. Patient-Centered Outcomes Measurement: Does It Require Information From Patients? J Patient Cent Res Rev 2017; 4:221-229. [PMID: 31413986 DOI: 10.17294/2330-0698.1456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims. Methods We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants' EHR progress notes over the time period between the imaging test and survey completion. We also compared survey data with algorithmically extracted data from claims files for outcomes for which data might be available from that source. Results Of the 16 outcomes for which patients' survey responses were considered to be the best information source, only 2 outcomes for back pain and 3 for abdominal pain had kappa scores above a very modest level of ≥ 0.2 for chart audit of EHR data and none for algorithmically obtained EHR/claims data. Of the other 5 outcomes for which claims data were considered to be the best information source, only 2 outcomes from patient surveys and 3 outcomes from chart audits had kappa scores ≥ 0.2. Conclusions For the types of outcomes studied here, medical record or claims data do not provide an adequate source of information except for a few outcomes where patient reports may be less accurate.
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Affiliation(s)
- Leif I Solberg
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - Stephen E Asche
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | - John Butler
- HealthPartners Medical Group, Minneapolis, MN
| | | | | | | | | | - Juliana O Tillema
- HealthPartners Institute for Education and Research, Minneapolis, MN
| | | | - Ann M Werner
- HealthPartners Institute for Education and Research, Minneapolis, MN
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Brand PLP, van Dulmen S. Can we trust what parents tell us? A systematic review. Paediatr Respir Rev 2017; 24:65-71. [PMID: 28283301 DOI: 10.1016/j.prrv.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/11/2022]
Abstract
Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.
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Affiliation(s)
- Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Jackson BD, Gray K, Knowles SR, De Cruz P. EHealth Technologies in Inflammatory Bowel Disease: A Systematic Review. J Crohns Colitis 2016; 10:1103-21. [PMID: 26928960 DOI: 10.1093/ecco-jcc/jjw059] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/18/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care. METHODS Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters. RESULTS Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [(n = 1) 18 days vs 77 days, p < 0.001]; disease activity (n = 2); short-term medication adherence (n = 3); quality of life (n = 4); IBD knowledge (n = 2); healthcare costs (n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms (n = 1), and; facilitating the remote management of up to 20% of an IBD cohort (n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost-benefit analyses. CONCLUSIONS EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.
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Affiliation(s)
- Belinda D Jackson
- Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre (HABIC), University of Melbourne, Melbourne, Australia
| | - Simon R Knowles
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia Department of Mental Health, St Vincent's Hospital, Melbourne, Australia Department of Psychiatry, The University of Melbourne, Melbourne, Australia Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne Australia Department of Medicine, University of Melbourne, Austin Academic Centre, Melbourne, Australia
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Kochar B, Aldridge M, Cook SF, Bright R, Mallette M, Moniz H, Shah SA, LeLeiko NS, Shapiro J, Sands BE, Chen W, Jaeger E, Galanko J, Long MD, Martin CF, Sandler RS, Kappelman MD. Achieving Synergy: Linking an Internet-Based Inflammatory Bowel Disease Cohort to a Community-Based Inception Cohort and Multicentered Cohort in Inflammatory Bowel Disease. J Med Internet Res 2016; 18:e124. [PMID: 27261008 PMCID: PMC4912687 DOI: 10.2196/jmir.5655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 01/29/2023] Open
Abstract
Background Traditional cohort studies are important contributors to our understanding of inflammatory bowel diseases, but they are labor intensive and often do not focus on patient-reported outcomes. Internet-based studies provide new opportunities to study patient-reported outcomes and can be efficiently implemented and scaled. If a traditional cohort study was linked to an Internet-based study, both studies could benefit from added synergy. Existing cohort studies provide an opportunity to develop and test processes for cohort linkage. The Crohn’s and Colitis Foundation of America’s (CCFA) Partners study is an Internet-based cohort of more than 14,000 participants. The Ocean State Crohn’s and Colitis Area Registry (OSCCAR) is an inception cohort. The Sinai-Helmsley Alliance for Research Excellence (SHARE) is a multicentered cohort of inflammatory bowel disease patients. Both the later cohorts include medical record abstraction, patient surveys, and biospecimen collection. Objective Given the complementary nature of these existing cohorts, we sought to corecruit and link data. Methods Eligible OSCCAR and SHARE participants were invited to join the CCFA Partners study and provide consent for data sharing between the 2 cohorts. After informed consent, participants were directed to the CCFA Partners website to complete enrollment and a baseline Web-based survey. Participants were linked across the 2 cohorts by the matching of an email address. We compared demographic and clinical characteristics between OSCCAR and SHARE participants who did and did not enroll in CCFA Partners and the data linkage. Results Of 408 participants in the OSCCAR cohort, 320 were eligible for participation in the CCFA Partners cohort. Of these participants, 243 consented to participation; however, only 44 enrolled in CCFA Partners and completed the linkage. OSCCAR participants who enrolled in CCFA Partners were better educated (17% with doctoral degrees) than those who did not (3% with doctoral degrees, P=.01). In the SHARE cohort, 436 participants enrolled and linked to the Partners cohort. More women (60% vs 50%) linked and those who linked were predominantly white (96%; P<.01). Crohn’s disease patients who linked had lower mean scores on the Harvey-Bradshaw Index (3.6 vs 4.4, P<.01). Ulcerative colitis patients who linked had less extensive disease than those who did not link (45% vs 60%, P<.01). Conclusions Linkage of CCFA Partners with cohorts such as OSCCAR and SHARE may be a cost-effective way to expand the infrastructure for clinical outcomes and translational research. Although linkage is feasible from a technical, legal, and regulatory perspective, participant willingness appears to be a limiting factor. Overcoming this barrier will be needed to generate meaningful sample sizes to conduct studies of biomarkers, natural history, and clinical effectiveness using linked data.
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Affiliation(s)
- Bharati Kochar
- University of North Carolina, Center for Gastrointestinal Biology and Disease, Chapel Hill, NC, United States.
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Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study. Inflamm Bowel Dis 2015. [PMID: 26218145 DOI: 10.1097/mib.0000000000000518] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD. METHODS Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis. RESULTS Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder. CONCLUSIONS Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.
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Matsumoto T, Yanai S, Toya Y, Ueno M, Nakamura S. Internet-orientated Assessment of QOL and Actual Treatment Status in Japanese Patients with Inflammatory Bowel Disease: The 3I survey. J Crohns Colitis 2015; 9:477-82. [PMID: 25814388 DOI: 10.1093/ecco-jcc/jjv052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS This survey aimed to compare actual lifestyle factors and QOL between Japanese IBD patients and healthy Japanese controls, by questionnaire using an internet-web system. METHODS Through the internet-web system, we asked 464 patients with Crohn's disease [CD], 360 patients with ulcerative colitis [UC], and 4100 healthy controls to answer a questionnaire including an eight-item short-form health survey [SF-8]. The survey was conducted until data had been accumulated from the predetermined numbers of patients [120 patients each with CD and UC] and healthy controls [240 subjects]. RESULTS QOL assessment by SF-8 revealed scores for six of the eight subscale items and the summary score for the mental component to be significantly lower in the CD and UC groups than in controls. There was a significant negative correlation between each SF-8 score and the degree of CD and UC symptoms. The marriage rate in adult patients was significantly lower in the CD than in the UC group or the controls. The mean annual income and the employment rate were significantly lower in the CD than in the UC group or the controls. CD patients receiving biologicals were more frequently satisfied with the efficacy of treatment than UC patients were with their treatment regimens [56% vs 29%]. CONCLUSIONS Actual lifestyle factors and QOL appear to be impaired in Japanese patients with IBD, especially those with CD. The subjective efficacy of biologicals might be greater in CD than in UC.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, School of Medicine, Iwate Medial University, Iwate, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, School of Medicine, Iwate Medial University, Iwate, Japan
| | - Yosuke Toya
- Division of Gastroenterology, School of Medicine, Iwate Medial University, Iwate, Japan
| | - Masato Ueno
- Integrated Marketing Department, Eisai Co., Tokyo, Japan
| | - Shotaro Nakamura
- Division of Gastroenterology, School of Medicine, Iwate Medial University, Iwate, Japan
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Coyne KS, LoCasale RJ, Datto CJ, Sexton CC, Yeomans K, Tack J. Opioid-induced constipation in patients with chronic noncancer pain in the USA, Canada, Germany, and the UK: descriptive analysis of baseline patient-reported outcomes and retrospective chart review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:269-81. [PMID: 24904217 PMCID: PMC4041290 DOI: 10.2147/ceor.s61602] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The characteristics of patients who suffer from noncancer pain and opioid-induced constipation are not well understood. METHODS Cross-sectional patient survey and chart review data from the baseline assessment of an ongoing longitudinal study in the USA, Canada, Germany, and the UK were evaluated via descriptive statistics. Participants had confirmation of daily opioid therapy ≥30 mg for ≥4 weeks and self-reported opioid-induced constipation. Response to laxatives was defined by classifying participants into categories of laxative use and evaluating the prevalence of inadequate response to one laxative agent and two or more agents from at least two different laxative classes. Outcomes included the Patient Assessment of Constipation-Symptoms, Work Productivity and Activity Impairment Questionnaire-Specific Health Problem, EuroQOL 5 Dimensions, and Global Assessment of Treatment Benefit, Satisfaction, and Willingness to Continue. RESULTS Patients reported a mean of 1.4 bowel movements not preceded by laxatives and 3.7 bowel movements with laxative use per week; 83% wanted at least one bowel movement per day. Most commonly reported on Patient Assessment of Constipation-Symptoms were straining/squeezing to pass bowel movements (83%), bowel movements too hard (75%), flatulence (69%), and bloating (69%). Eighty-four percent were taking natural or behavioral therapies; 60% were taking at least one over-the-counter laxative; and 19% were taking at least one prescription laxative. Prevalence of inadequate response to one laxative agent was 94%; inadequate response to two or more agents from at least two different laxative classes was 27%. Mean Work Productivity and Activity Impairment Questionnaire-Specific Health Problem values for percent work time missed, percent impairment while working, and percent activity impairment were 9%, 32% (equivalent of 14 hours of lost productivity per week), and 38%. Mean EuroQOL 5 Dimensions index and visual analog scale scores were 0.49 and 50.6, respectively. Forty-four percent reported being satisfied with their treatment for constipation. CONCLUSION Patients treated with opioids for noncancer pain commonly endure constipation symptoms that limit their work productivity and overall health-related quality of life while adhering to treatments that provide little relief. Further research is needed to identify more efficacious constipation therapies for this patient population.
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Affiliation(s)
| | | | | | | | - Karen Yeomans
- UBC: an Express Scripts Company, Montreal, QC, Canada
| | - Jan Tack
- University Hospital Gasthuisberg, Leuven, Belgium
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