scholarly journals P136 Management of patients with Inflammatory Bowel Disease and their outcome during the first wave of Covid-19 pandemics

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S223-S224
Author(s):  
A Viola ◽  
F Giambò ◽  
M F Chiappetta ◽  
G Costantino ◽  
S Pallio ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Secondary Outcome ◽  
Reference Period ◽  
Disease Flare ◽  
Face To Face ◽  
Risk Of Disease ◽  
Inflammatory Bowel ◽  
Group 2 ◽  
The Impact

Abstract Background The restrictions adopted in Italy during the phase I COVID-19 pandemics with a nationwide lockdown period, represented a challenge in the management of Patients with Inflammatory Bowel Disease (IBD) patients. The aim of the present study was to assess if, and how, a limited course of telemedicine did influence the clinical outcome in patients with Crohn’s disease (CD) and Ulcerative Colitis (UC). Methods IBD patients followed before March 8th, 2020 were included and divided into 3 groups (Fig.1): group 1, patients on endovenous biologics (EV); group 2, patients on biologics administered subcutaneously (SC); and group 3, patients on conventional treatments (CT) at the start of lockdown. The primary outcome was to assess the occurrence of disease flare in the three groups since only the EV group received face-to-face visits during lockdown. As secondary outcome we assessed the number of control endoscopies performed and the start of new biologic therapies, compared with a reference period in 2019. Results A total of 689 patients (CD: 369, UC 320) were included in the study (247 IV, 217 SC and 225 CT, respectively). Telemedicine was more frequently adopted in SC and CS, (p<0.001) both. Treatment delays or transitory stops were more frequent in EV (p<0.001), whereas there was a significantly greater need to change therapy (p= 0.038) and need for steroids (p = 0.008) in the SC group compared with EV (Tab.1). Concerning endoscopies, compared with the reference period in 2019 only 25% of scheduled endoscopies were performed. The only risk factor for disease flare during or shortly after lockdown was belonging to the patient groups subjected to telemedicine (SC and CT groups) (p < 0.001). Conclusion Patients followed with a face-to-face approach instead of telemedicine, had a lower risk of disease flare during lockdown period. The impact of the important reduction of endoscopic assessments still needs to be assessed.

Review of a paediatric inflammatory bowel disease service during the pandemic and the impact of the CNS role

2021 ◽  
Vol 30 (14) ◽  
pp. 840-844
Author(s):  
Gemma Lee ◽  
Jochen Kammermeier ◽  
Rakesh Vora ◽  
Mohamed Mutalib
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Recovery Phase ◽  
Clinical Nurse ◽  
Face To Face ◽  
Clinical Notes ◽  
Clinical Nurse Specialists ◽  
The World ◽  
Inflammatory Bowel ◽  
The Impact

Background: Inflammatory bowel disease (IBD) is a chronic relapsing and remitting condition. The COVID-19 pandemic has severely disrupted provision of medical care across the world. IBD clinical nurse specialists (CNSs) played a pivotal role in the care of children with IBD during the pandemic national lockdown and in the recovery phase. This article aims to look at the impact of COVID-19 on the paediatric IBD service in one children's hospital and the effect on the IBD CNSs' workload. Method: A retrospective review of clinical notes and the service's IBD database from January 2019 to September 2020. Results: There was a significant increase in the number of email and telephone contacts to the IBD CNS team during lockdown. There was an increase in virtual clinics, and an increase in new IBD patients coming to the service, but a reduction in the number of face-to-face consultant clinics. Conclusion: COVID-19 has disrupted medical services to children with IBD and led to a reduction in face-to-face activities but has also led to a significant increase in virtual activities. CNSs have taken up a wider role to cover patient care during a time of both medical and nursing redeployment.

scholarly journals The Impact of Private Insurance Access on Nonurgent Inflammatory Bowel Disease-Related Emergency Department Use

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Natasha Bollegala ◽  
Geoffrey C Nguyen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Emergency Department ◽  
Bowel Disease ◽  
Private Insurance ◽  
Urban Setting ◽  
Secondary Outcome ◽  
Linear Regression Models ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD)-related Emergency Department (ED) visits are a costly component to current healthcare expenditures. Patients who are discharged directly from the ED for nonurgent issues (aka “treat and release” ED visits) present an opportunity for quality improvement. Purpose To determine the impact of private insurance on IBD-related treat and release ED visits. The secondary outcome was cost per IBD-related ED visit. Methodology A retrospective cohort study was performed on the 2006 Nationwide Emergency Department Sample (NEDS). Comparisons were made between patients with access to private insurance vs those without. Multivariable survey-weighted logistic and linear regression models with clustering by hospital were created for the primary and secondary outcomes, respectively. Results In total, 19,324 patient encounters were included in the stratified analytic sample. Of these, 9272 (47.98%) patients reported private insurance as their primary payment method. An additional 10,052 (52.02%) patients reported an alternative payment form. The private insurance group was statistically younger, less likely to reside in an urban setting and had more representation within the highest income quartile. The OR of a treat and release ED visit was 1.47 (95% confidence interval 1.34–1.62) for no private insurance compared to private insurance. On average, the cost per ED visit of patients without private insurance was $214.80 ± 48.48, P < 0.001 less than those with private insurance. Conclusions Lack of private insurance is an important predictor of IBD-related treat and release ED visits.

scholarly journals Outcomes of inflammatory bowel disease in patients with eosinophil-predominant colonic inflammation

2020 ◽  
Vol 7 (1) ◽  
pp. e000373
Author(s):  
Tarik Alhmoud ◽  
Anas Gremida ◽  
Diego Colom Steele ◽  
Imaneh Fallahi ◽  
Wael Tuqan ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Mucosal Inflammation ◽  
High Power Field ◽  
Disease Flare ◽  
Kaplan Meier ◽  
Treatment Naïve ◽  
Risk Of Disease ◽  
Inflammatory Bowel

BackgroundInflammatory bowel disease (IBD) is characterised by acute intestinal mucosal inflammation with chronic inflammatory features. Various degrees of mucosal eosinophilia are present along with the typical acute (neutrophil-predominant) inflammation. The effect of intestinal eosinophils on IBD outcomes remains unclear.MethodsThis is a retrospective study. Archived intestinal mucosal biopsy specimens of treatment-naïve IBD patients were examined by two pathologists. The number of eosinophils per high-power field was counted, and the mucosal inflammation was classified according to the eosinophilic inflammatory patterns. Clinical outcomes during the follow-up period were recorded.Results142 treatment-naïve IBD patients were included. Mean age was 39 years. 83% of patients had ulcerative colitis, and median follow-up was 3 years. 41% of patients had disease flare(s) and 24% required hospitalisation. Eosinophil count was not associated with risk of disease flare or hospitalisation. Patients with neutrophil-predominant inflammation (>70% neutrophils) had greater risk of disease flare(s): 27(55%) versus 24(36%) and 7(28%) in patients with mixed and eosinophil-predominant inflammation, respectively (p=0.04). Overall, patients with neutrophil-predominant inflammation were more likely to have a disease flare; HR: 2.49, 95% CI (1.0 to 5.6). Hospitalisation rate was higher in patients with neutrophil-predominant inflammation: 17(35%) compared to 17(19%) in patients with eosinophil-rich inflammation (p=0.04). Kaplan–Meier analysis showed higher flare-free survival in patients with eosinophil-predominant inflammation compared to mixed and neutrophil-predominant inflammation.ConclusionIBD patients with eosinophil-predominant inflammation phenotype might have reduced risk of disease flares and hospitalisation. Larger prospective studies to assess IBD outcomes in this subpopulation are warranted.

scholarly journals Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study

2020 ◽  
Vol 105 (12) ◽  
pp. 1186-1191 ◽  
Author(s):  
James John Ashton ◽  
Jochen Kammermeier ◽  
Christine Spray ◽  
Richard K Russell ◽  
Richard Hansen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Provision ◽  
Exclusive Enteral Nutrition ◽  
Face To Face ◽  
Inflammatory Bowel ◽  
Histological Confirmation ◽  
The Uk ◽  
The Impact

BackgroundCOVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic.MethodsFor the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD.ResultsAll centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres.ConclusionsDiagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.

scholarly journals Insight from patients and healthcare professionals on the implementation of virtual clinics in patients with inflammatory bowel disease

2021 ◽  
pp. flgastro-2020-101714
Author(s):  
Aditi Kumar ◽  
Mohammed Nabil Quraishi ◽  
Shanika de Silva ◽  
Nigel John Trudgill ◽  
Helen Steed ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Telephone Consultation ◽  
Face To Face ◽  
Short Answer ◽  
Inflammatory Bowel ◽  
The Uk ◽  
Short Answer Questions ◽  
The Impact

IntroductionDuring COVID-19, the management of outpatient inflammatory bowel disease (IBD) changed from face-to-face (F2F) to telephone and video consultations across the UK. We surveyed patients with IBD and IBD healthcare professionals (HCPs) to evaluate the impact of this abrupt transition on patient and HCP satisfaction outcomes, including the barriers and enablers of this service.MethodsPatient satisfaction surveys were sent to patients who had a telephone consultation from May to July 2020. A second survey was sent to IBD HCPs across the UK. Questions from both surveys consisted of a mixture of multiple-choice options, ranking answers as well as short-answer questions.Results210 patients and 114 HCPs completed the survey. During COVID-19, there was a significantly greater use of telephone, video or a mixture of consultation. F2F consultations were consistently preferred by patients, with 50% of patients indicating they did not want the option of for video consultations. Patients were more likely to prefer a telephone consultation if they were stable and needed routine review. Significantly fewer HCPs (5.3%) intend to use F2F consultations alone, preferring the use of telephone (20.2%) or combinations of telephone/F2F (22.8%), telephone/video (4.4%) or combination of all three consultation types (34.2%). 63% indicated they intend to incorporate video consultations in the future.ConclusionTelephone and video consultations need to be balanced proportionately with F2F clinics to achieve both patient and HCP satisfaction. Further research needs to be done to explore the use of video medicine in patients with IBD.

scholarly journals Exploitation of Marine-Derived Robust Biological Molecules to Manage Inflammatory Bowel Disease

Marine Drugs ◽  
2021 ◽  
Vol 19 (4) ◽  
pp. 196
Author(s):  
Muhammad Bilal ◽  
Leonardo Vieira Nunes ◽  
Marco Thúlio Saviatto Duarte ◽  
Luiz Fernando Romanholo Ferreira ◽  
Renato Nery Soriano ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bioactive Compounds ◽  
Bowel Disease ◽  
Clinical Translation ◽  
Biologically Active ◽  
Naturally Occurring ◽  
Inflammatory Bowel ◽  
Functional Features ◽  
Biological Entities ◽  
The Impact

Naturally occurring biological entities with extractable and tunable structural and functional characteristics, along with therapeutic attributes, are of supreme interest for strengthening the twenty-first-century biomedical settings. Irrespective of ongoing technological and clinical advancement, traditional medicinal practices to address and manage inflammatory bowel disease (IBD) are inefficient and the effect of the administered therapeutic cues is limited. The reasonable immune response or invasion should also be circumvented for successful clinical translation of engineered cues as highly efficient and robust bioactive entities. In this context, research is underway worldwide, and researchers have redirected or regained their interests in valorizing the naturally occurring biological entities/resources, for example, algal biome so-called “treasure of untouched or underexploited sources”. Algal biome from the marine environment is an immense source of excellence that has also been demonstrated as a source of bioactive compounds with unique chemical, structural, and functional features. Moreover, the molecular modeling and synthesis of new drugs based on marine-derived therapeutic and biological cues can show greater efficacy and specificity for the therapeutics. Herein, an effort has been made to cover the existing literature gap on the exploitation of naturally occurring biological entities/resources to address and efficiently manage IBD. Following a brief background study, a focus was given to design characteristics, performance evaluation of engineered cues, and point-of-care IBD therapeutics of diverse bioactive compounds from the algal biome. Noteworthy potentialities of marine-derived biologically active compounds have also been spotlighted to underlying the impact role of bio-active elements with the related pathways. The current review is also focused on the applied standpoint and clinical translation of marine-derived bioactive compounds. Furthermore, a detailed overview of clinical applications and future perspectives are also given in this review.

scholarly journals Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice

2020 ◽  
Vol 4 (1) ◽  
pp. e000786
Author(s):  
Abbie Maclean ◽  
James J Ashton ◽  
Vikki Garrick ◽  
R Mark Beattie ◽  
Richard Hansen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
High Standard ◽  
Current Evidence ◽  
Faecal Calprotectin ◽  
Paediatric Patients ◽  
Inflammatory Bowel ◽  
Working Practices ◽  
The Impact

The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services.Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges.Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted.These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices.In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.

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