Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial

There is little evidence on the reliability of the video-based telehealth physical examinations. Our objective was to evaluate the feasibility of a physician-directed abdominal examination using telehealth. This was a prospective, blinded observational study of patients >19 years of age presenting with abdominal pain to a large, academic emergency department. In addition to their usual care, patients had a video-based telehealth examination by an emergency physician early in the visit. We compared the in-person and telehealth providers’ decisions on imaging. Thirty patients were enrolled and providers’ recommendations for imaging were YES (telehealth: 18 (60%); in-person: 22 (73%)), UNSURE (telehealth: 9 (30%); in-person: 2 (7%)) and NO (telehealth: 6 (20%); in-person: 3 (10%)). There were 20 patients for whom both telehealth and in-person providers were not unsure; of these, 16 (80%, 95% confidence interval 56.3–94.3%) patients had a provider agreement on the need for imaging. While the use of video-based telehealth may be feasible for patients seeking emergency department care for abdominal pain, further study is needed to determine how it may be safely deployed. Currently, caution should be exercised when evaluating the need for abdominal imaging remotely.

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Physical activity for treatment of irritable bowel syndrome: Cochrane systematic review

British Journal of General Practice ◽

10.3399/bjgp19x703205 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703205

Author(s):

David Nunan ◽

José M Ordóñez-Mena ◽

Nia Roberts ◽

Elizabeth Thomas ◽

Kamal Mahtani

Keyword(s):

Physical Activity ◽

Irritable Bowel Syndrome ◽

Abdominal Pain ◽

Adverse Effects ◽

Usual Care ◽

Physical Activity Intervention ◽

Small Body ◽

Effect Estimate ◽

Irritable Bowel

BackgroundCurrent recommendations for patients with irritable bowel syndrome to partake in physical activity do not incorporate evidence from all available randomised control trials (RCTs), with little information regarding potential adverse effects.AimTo assess the benefits and harms of physical activity interventions in adults diagnosed with irritable bowel syndrome.MethodTen electronic databases including CENTRAL, MEDLINE and EMBASE were searched until 24 November 2017 for RCTs comparing a physical activity intervention with no intervention, usual care, or another intervention; assessing a validated measure of symptoms, quality of life (QoL), and bowel movement in any setting.ResultsNine RCTs with data for 326 participants were included. Interventions included yoga (n = 5), advice and support (n = 2), treadmill exercise (n = 1), and Qigong (n = 1) compared with usual care (n = 4), walking (n = 2), diet (n = 1), or medication only (n = 2). A meta-analysis of three studies demonstrated a large and statistically significant improvement in reported IBS symptoms (standardised mean difference −1.06, 95% confidence interval = −2.08 to −0.04; N = 84). However, evidence was rated as very low quality, providing very little confidence in the effect estimate. In additional meta-analyses, physical activity did not conclusively demonstrate improvements in QoL or abdominal pain. The quality of evidence was judged very low and low respectively, providing little confidence in the effect estimates. There was insufficient evidence to assess adverse effects due to poor trial reporting.ConclusionA small body of low to very-low quality evidence suggests physical activity may improve symptoms but not QoL or abdominal pain in people with irritable bowel syndrome but findings are uncertain.

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