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Simpson AN, Sutradhar R, Benchimol EI, Chan WC, Porter J, Moore S, Dossa F, Huang V, Maxwell C, Targownik L, Liu N, Baxter NN. Risk of Cesarean Delivery Among People With Inflammatory Bowel Disease According to Disease Characteristics: A Population-Based Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102463. [PMID: 38631434 DOI: 10.1016/j.jogc.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES It is unclear if use of cesarean delivery in people with inflammatory bowel disease (IBD) is guideline-concordant. We compared the odds of cesarean delivery among primiparous individuals with IBD versus without, overall, and by disease characteristics, as well as time to subsequent delivery. METHODS Retrospective matched population-based cohort study between 1 April 1994 and 31 March 2020. Primiparous individuals aged 15-55 years with IBD were matched to those without IBD on age, year, hospital, and number of newborns delivered. Primary outcome was cesarean delivery versus vaginal delivery. Multivariable conditional logistic regression analyses were performed to estimate the odds of cesarean delivery among individuals with and without IBD as a binary exposure, and a categorical exposure based on IBD-related indications for cesarean delivery. Time to subsequent delivery was evaluated using a Cox proportional hazard model. RESULTS We matched 7472 individuals with IBD to 37 360 individuals without (99.02% match rate). Individuals with IBD were categorised as having perianal (PA) disease (IBD-PA, n = 764, 10.2%), prior ileal pouch-anal anastomosis (n = 212, 2.8%), or IBD-Other (n = 6496, 86.9%). Cesarean delivery rates were 35.4% in the IBD group versus 30.4% in their controls (adjusted odds ratio 1.27; 95% CI 1.20-1.34). IBD-ileal pouch-anal anastomosis had a cesarean delivery rate of 66.5%, compared to 49.9% in IBD-PA and 32.7% in IBD-Other. There was no significant difference in the rate of subsequent delivery in those with and without IBD (adjusted hazard ratio 1.03; 95% CI 1-1.07). CONCLUSIONS The higher risk of cesarean delivery in people with IBD reflects guideline-concordant use. Individuals with and without IBD were equally likely to have a subsequent delivery with similar timing.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON.
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Eric I Benchimol
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Joan Porter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON
| | - Sarah Moore
- Department of Surgery, MacKenzie Health, Vaughan, ON
| | - Fahima Dossa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian Huang
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Laura Targownik
- Department of Gastroenterology, Sinai Health System, Toronto, ON
| | - Ning Liu
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Nancy N Baxter
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Xu M, Liu T, Ye M, Tan X, Sun Q. The Use of an Iterative Strategy of Cognitive Interview and Expert Consultation to Revise the Quality of Life Scale for Patients with Aplastic Anemia (QLS-AA). Patient Prefer Adherence 2023; 17:1741-1749. [PMID: 37489164 PMCID: PMC10363392 DOI: 10.2147/ppa.s418773] [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: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023] Open
Abstract
Background Aplastic anemia is characterized by anemia, hemorrhage and infection, and is accompanied by a variety of complications and psychological burden. Therefore, the quality of life of AA patients is not optimistic. Our team is committed to developing an assessment tool for the quality of life of AA patients, and adopting an iterative strategy of cognitive interview and expert consultation to solve the challenges encountered in item revision. Purpose We aim to use the strategy of cognitive interview and expert consultation to inform revision of the QLS-AA into a user-friendly tool with unambiguous items and improve the content validity of the scale. Methods We used an iterative strategy of cognitive interview and expert consultation. Two rounds of cognitive interview were conducted to identify problems with item comprehension, recall and other cognitive processes. As well as, a multi-disciplinary group of expert consultation was consulted to review the rationality of item revisions. Results In the first round of cognitive interview, 16 participants responded to 107 items. Among them, the most common problems were "clarification" and "item duplication". Based on the results of the first round of interview, an expert consultation was organized. A total of 16 amendments were put forward by the expert and 14 were adopted. In the second round of cognitive interviews, A total of 5 participants were included and 64 items were evaluated. Two items were suggested to be revised, and the remaining items were accurately understood and recognized by all participants. Couclusion This study highlights the key issues to consider when incorporating patient perspectives into quality measurement. The revision of QLS-AA through the strategy of cognitive interview and expert consultation may provide valuable insights into the measurement of quality of life in aplastic patients. Trial Registration Number ChiCTR2100047575.
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Affiliation(s)
- Min Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ting Liu
- The School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Menghua Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiaoxue Tan
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Qiuhua Sun
- The School of Nursing, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
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Khan SZ, Steinhagen E. Stoma Prolapse. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Pregnancy outcomes after stoma surgery for inflammatory bowel disease: The results of a retrospective multicentre audit. Colorectal Dis 2022; 24:838-844. [PMID: 35184349 PMCID: PMC9543912 DOI: 10.1111/codi.16098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 12/13/2022]
Abstract
AIM There is a paucity of data on pregnancies in women with stomas due to inflammatory bowel disease (IBD). The aim of this study was to assess stoma, IBD, obstetric and neonatal outcomes in pregnant patients with IBD and a stoma. METHOD Multicentre retrospective audit in 15 UK hospitals. Pregnancy, stoma and neonatal outcomes were elicited from routinely collected hospital records. RESULTS Data on 82 pregnancies from 77 patients (mean age 31.4 years, 60.9% Crohn's disease, 35.4% ulcerative colitis, 3.6% IBD-U) were included. Stoma types included ileostomy in 72 (88%) and colostomy in 10 (12%) women. There was one reported miscarriage, one still birth and 80 live births. Delivery occurred in 58 cases by caesarean section (CS), of which 44 were performed electively and 14 as emergency CS. The overall CS rate was 73%. Premature delivery before week 37 occurred in 19% and birth weight <2,500 g in 17%. Significant stoma related complications occurred during 20 (24%) pregnancies and included stoma prolapse in nine cases (2 required surgery), parastomal hernias in three cases (2 required surgery) and small bowel obstructions in seven cases (3 required surgery). CONCLUSIONS Pregnancy for women who previously had stoma formation for IBD is associated with higher rates of caesarean section and stoma complications. Future prospective studies should capture data, including patient reported outcomes, to gather a full picture on the impact of pregnancy after stoma surgery for IBD.
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Thygeson NM. Fifty Years With a Brooke Ileostomy: An Autobiographical Case Report. Cureus 2021; 13:e16980. [PMID: 34527460 PMCID: PMC8420992 DOI: 10.7759/cureus.16980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/23/2022] Open
Abstract
Permanent Brooke ileostomy continues to be a treatment option for selected patients with inflammatory bowel disease and cancer. This case report describes the author’s 50-year experience living with Crohn’s disease and a Brooke ileostomy, including the psychosocial and dietary adaptations required and the management of common complications such as peri-stomal irritant dermatitis, food blockage, and acute infectious diarrhea. Cross-sectional studies indicate that the quality of life with an ileostomy is usually good, but adaptation to an ileostomy is a life-long process.
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Selinger CP, Nelson-Piercy C, Fraser A, Hall V, Limdi J, Smith L, Smith M, Nasur R, Gunn M, King A, Mohan A, Mulgabal K, Kent A, Kok KB, Glanville T. IBD in pregnancy: recent advances, practical management. Frontline Gastroenterol 2020; 12:214-224. [PMID: 33912333 PMCID: PMC8040511 DOI: 10.1136/flgastro-2019-101371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) poses complex issues in pregnancy, but with high-quality care excellent pregnancy outcomes are achievable. In this article, we review the current evidence and recommendations for pregnant women with IBD and aim to provide guidance for clinicians involved in their care. Many women with IBD have poor knowledge about pregnancy-related issues and a substantial minority remains voluntarily childless. Active IBD is associated with an increased risk of preterm birth, low for gestation weight and fetal loss. With the exception of methotrexate and tofacitinib the risk of a flare outweighs the risk of IBD medication and maintenance of remission from IBD should be the main of care. Most women with IBD will experience a normal pregnancy and can have a vaginal delivery. Active perianal Crohn's disease is an absolute and ileal pouch surgery a relative indication for a caesarean section. Breast feeding is beneficial to the infant and the risk from most IBD medications is negligible.
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Affiliation(s)
| | | | - Aileen Fraser
- Gastroenterology, United Hospitals Bristol, Bristol, Avon, UK
| | - Veronica Hall
- Gastroenterology, Royal Bolton Foundation NHS Trust, Bolton, UK
| | - Jimmy Limdi
- Section of iBD- Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK,Gastroenterology, Manchester Academic Health Science Centre, Manchester, UK
| | - Lyn Smith
- Gastroenterology, NHS Greater Glasgow and Clyde North Glasgow University Hospitals Division, Glasgow, UK
| | - Marie Smith
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Reem Nasur
- Obstetrics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Melanie Gunn
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Andrew King
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Aarthi Mohan
- Obstetrics, United Hospitals Bristol, Bristol, Avon, UK
| | | | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
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Mahadevan U, Robinson C, Bernasko N, Boland B, Chambers C, Dubinsky M, Friedman S, Kane S, Manthey J, Sauberan J, Stone J, Jain R. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology 2019; 156:1508-1524. [PMID: 30658060 DOI: 10.1053/j.gastro.2018.12.022] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Uma Mahadevan
- University of California, San Francisco, San Francisco, California
| | - Christopher Robinson
- Bon Secours St Francis and Summerville Medical Center, Charleston, South Carolina
| | - Nana Bernasko
- Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Marla Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Jacob Manthey
- American Gastroenterological Association, Bethesda, Maryland
| | - Jason Sauberan
- Sharp Neonatal Research Institute, San Diego, California
| | - Joanne Stone
- Icahn School of Medicine at Mount Sinai, New York, New York
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Mahadevan U, Robinson C, Bernasko N, Boland B, Chambers C, Dubinsky M, Friedman S, Kane S, Manthey J, Sauberan J, Stone J, Jain R. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Am J Obstet Gynecol 2019; 220:308-323. [PMID: 30948039 DOI: 10.1016/j.ajog.2019.02.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Uma Mahadevan
- University of California, San Francisco, San Francisco, California
| | - Christopher Robinson
- Bon Secours St Francis and Summerville Medical Center, Charleston, South Carolina
| | - Nana Bernasko
- Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Marla Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Jacob Manthey
- American Gastroenterological Association, Bethesda, Maryland
| | - Jason Sauberan
- Sharp Neonatal Research Institute, San Diego, California
| | - Joanne Stone
- Icahn School of Medicine at Mount Sinai, New York, New York
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Mahadevan U, Robinson C, Bernasko N, Boland B, Chambers C, Dubinsky M, Friedman S, Kane S, Manthey J, Sauberan J, Stone J, Jain R. Inflammatory Bowel Disease in Pregnancy Clinical Care Pathway: A Report From the American Gastroenterological Association IBD Parenthood Project Working Group. Inflamm Bowel Dis 2019; 25:627-641. [PMID: 30821832 DOI: 10.1093/ibd/izz037] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Uma Mahadevan
- University of California, San Francisco, San Francisco, California
| | - Christopher Robinson
- Bon Secours St Francis and Summerville Medical Center, Charleston, South Carolina
| | - Nana Bernasko
- Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Marla Dubinsky
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Jacob Manthey
- American Gastroenterological Association, Bethesda, Maryland
| | - Jason Sauberan
- Sharp Neonatal Research Institute, San Diego, California
| | - Joanne Stone
- Icahn School of Medicine at Mount Sinai, New York, New York
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