scholarly journals P459 The impact of latent cytomegalovirus infection on the disease behaviour in patients with ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S408-S409
Author(s):  
P Långvall ◽  
C Shi ◽  
P Karling
Keyword(s):  
Ulcerative Colitis ◽  
Medical Therapy ◽  
Chart Review ◽  
University Hospital ◽  
Cmv Infection ◽  
Positive Serology ◽  
Faecal Calprotectin ◽  
Systemic Steroids ◽  
Medical Chart Review ◽  
The Impact

Abstract Background Cytomegalovirus (CMV) infection has been associated with steroid-refractory disease and risk for colectomy in patients with Ulcerative Colitis (UC). We aimed to study if patients with latent CMV infection more often needed systemic steroids, immunomodulators, biologics and surgery than patients negative for CMV infection. Methods From the national IBD register (SWIBREG) all patients with UC (n = 404) treated at Umeå University Hospital in Sweden, and who were tested for CMV infection were included. A latent CMV infection was defined if a patient had at least one positive serology and/or a positive PCR for CMV. A retrospectively medical chart review between the years 2006 and 2019 was performed to check for medical therapy and surgery due to UC. Results One hundred and thirty-one patients (32%) had at least on one occasion been tested for CMV infection and of these patients, 88 (67%) had evidence of a latent CMV infection. There were no differences in the use of systemic steroids, in the use of immunomodulators/biologics or in colectomy rate between patients with latent CMV infection and patients with no infection (table). There were no differences between patients with latent CMV infection vs. no infection in median faecal calprotectin (FC) levels the first five years after diagnosis (302 vs. 457 µg/g; p = 0.301) or at the last recorded FC test (62 vs. 82 µg/g; p = 0.317). Conclusion Patients with latent CMV infection do not differ from CMV negative patients in the use of medical therapy for UC nor in colectomy rate.

scholarly journals N12 An evaluation of the impact of IBDoc in clinical practice 5 years after introduction

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S662-S663
Author(s):  
K Sugrue ◽  
S Gleeson ◽  
J McCarthy ◽  
M Buckley
Keyword(s):  
Clinical Practice ◽  
Medical Therapy ◽  
Fast Track ◽  
Medication Compliance ◽  
Cost Savings ◽  
University Hospital ◽  
Faecal Calprotectin ◽  
Track System ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background Faecal Calprotectin is a well-established biomarker to measure the level of inflammation in the gut. Assessment of calprotectin is important to measure disease activity, effectiveness of treatments as well as predicting relapses in inflammatory bowel disease (IBD). IBDoc® allows reliable testing of faecal calprotectin using a smartphone at home. IBDoc® was introduced at Mercy University Hospital in 2014 and now has 733 users. It has proved hugely popular with patients, has increased medication compliance and promoted self management. The objective of this study was to evaluate the impact of IBDoc® in clinical practice. Methods IBDoc® results were monitored over a 6 month period. A total of 240 tests were performed by patients with IBD (age 18–52 years). The results were evaluated to determine suitable clinical interventions, fast track clinic appointments, urgent colonoscopies, change of medical therapy and suitability for Virtual Clinics (VC’s). Results Of the 240 tests performed 40% had a normal result, 40% were moderate and 20% were high. All of the normal results avoided clinic appointments which freed up clinic time for patients with active disease and resulted in cost savings for the hospital. 70% of these patients were deemed suitable for future Virtual Clinics which resulted in further cost savings and freed up Consultant time. The majority of patients 60% had moderate or high results. The 20% of results that were high were all booked for urgent colonoscopy. All of the moderate results were fast tracked to clinic and 20% of these had a change of medical therapy. Conclusion This study shows the benefits of using IBDoc® in clinical practice. It is central to facilitating a fast track system for patients which results in better outcomes for patients.

scholarly journals P237 Annual incidence and prevalence of ulcerative colitis and Crohn’s disease from 2010 to 2017 in four Nordic countries: Results from the TRINordic study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S261-S262
Author(s):  
M Lördal ◽  
J Burisch ◽  
E Langholz ◽  
T Knudsen ◽  
M Voutilainen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Observational Study ◽  
Nordic Countries ◽  
Annual Incidence ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Western World ◽  
The Impact

Abstract Background Incidence and prevalence of inflammatory bowel diseases (IBD) have been increasing for the past decades in the western world, however with an emerging trend of incidence stabilisation in recent years. There is an indication of higher IBD incidence and prevalence in northern Europe, especially in the Nordic region, compared with southern Europe. Methods This retrospective observational study collected data from the National Patient Registries and National Prescription Registries (Sweden [SWE], Norway [NOR], Denmark [DEN]) and one university hospital database (Turku, Finland [FIN]) during 2010–2017 to investigate the annual incidence and prevalence of ulcerative colitis (UC) and Crohn’s disease (CD). Patients with ≥2 ICD-10 diagnosis codes for UC (K51) or CD (K50) from 2010 or later and no K51 or K50 codes prior to 2010 were included; patients were classified according to their last code. The look-back period for SWE was until 2000, for NOR until 2008, for DEN until 1995, and for FIN until 2004. Incidence proportions highlight results through 2016, as 2017 patients had less than 1-year follow-up. Results In total, 69,876 patients were included (SWE n = 27,902, NOR n = 20,761, FIN n = 2,118, DEN n = 19,095), of which 44 367 patients were diagnosed with UC and 25,509 with CD. In 2016, the annual incidence of UC was 28 patients per 100,000 persons in NOR, 32 patients per 100,000 persons in DEN, 25 patients per 100,000 persons in SWE, and 44 patients per 100,000 in FIN. The corresponding results for the annual incidence of CD per 100,000 persons were 22 in NOR, 16 in DEN, 16 in SWE, and 21 in FIN. The prevalence per 100,000 persons of both UC and CD was the highest in DEN, followed by SWE and NOR, and lowest in FIN. Prevalence estimates increased in all four Nordic countries during 2010–2017: for UC, from 409 to 488 patients in SWE, from 256 to 428 in NOR, from 129 to 375 in FIN, and from 577 to 798 in DEN. For CD, it increased from 261 to 313 patients in SWE, from 164 to 258 in NOR, from 54 to 164 in FIN, and from 280 to 400 in DEN. Conclusion This retrospective observational study showed that during 2016, the annual incidence of UC ranged from 25–44 patients per 100,000 persons across the evaluated Nordic countries, whereas the annual incidence of CD was 16–22 patients per 100,000 persons. Prevalence of both UC and CD increased during 2010–2017 in all four countries. Estimates of UC and CD incidence and prevalence in this analysis are greater than reported in the published literature. Additional analyses are underway to further explore the impact of methodological decisions on the estimates of UC and CD annual incidence and prevalence.

scholarly journals The impact of COVID-19 on the injury pattern for maxillofacial fracture in Daegu city, South Korea

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Dong-Woo Lee ◽  
So-Young Choi ◽  
Jin-wook Kim ◽  
Tae-Geon Kwon ◽  
Sung-Tak Lee
Keyword(s):  
South Korea ◽  
Chart Review ◽  
Daily Life ◽  
Demographic Data ◽  
Injury Pattern ◽  
University Hospital ◽  
Maxillofacial Fracture ◽  
Maxillofacial Fractures ◽  
National University ◽  
The Impact

Abstract Background This study aimed to analyze the impact of COVID-19 on oral and maxillofacial fracture in Daegu by comparing the demographic data in 2019 and 2020, retrospectively. We collected data from all patients having trauma who visited the emergency room for oral and maxillofacial fractures. Methods This retrospective study was based on chart review of patients who visited the emergency department of Kyungpook National University Hospital in Daegu, South Korea from January 1, 2019, to December 31, 2020. We conducted a comparative study for patients who presented with maxillofacial fractures with occlusal instability during pre-COVID-19 era (2019) and COVID-19 era (2000) with demographics and pattern of injuries. Results After the outbreak of COVID-19, the number of monthly oral and maxillofacial fractures, especially sports-related oral and maxillofacial fractures, decreased significantly. Also, the number of alcohol-related fractures increased significantly. In addition, as the number of monthly confirmed cases of COVID-19 increases, the incidence of fracture among these cases tends to decrease. Conclusions The COVID-19 pandemic has changed the daily life in Korea. Identifying the characteristics of patients having trauma can provide a good lead to understand this long-lasting infectious disease and prepare for future outbreaks.

scholarly journals Mixed method study focusing on cost effectiveness of utilizing Guideline Directed Medical Therapy using Secondary and Primary Data

2020 ◽  
Vol 3 ◽  
Author(s):  
Lovekirat Singh ◽  
Carly Daley ◽  
Shauna Wagner ◽  
Roy Robertson ◽  
Michael Mirro
Keyword(s):  
Heart Failure ◽  
Healthcare Cost ◽  
Medical Therapy ◽  
Healthcare Costs ◽  
Chart Review ◽  
Grey Literature ◽  
The United States ◽  
Primary Data ◽  
Reduced Ejection Fraction ◽  
The Impact

Background and Hypothesis:  In the United States, heart failure (HF) affects an increasing 5.8 million people, with healthcare costs estimated at $31 billion (2012). Guideline Directed Medical Therapy (GDMT) is the primary method to standardize medical care of patients diagnosed with Heart Failure reduced Ejection Fraction (HFrEF). GDMT lowers mortality rates, decreases readmission, and decreases the cost, but the success of GDMT is limited by adherence. We hypothesize increased GDMT prescription through integration of a pharmacist will decrease readmissions and hospital costs.    Methods:  This mixed-methods study involved a literature review and retrospective chart review. Online databases (PubMed, Embase, and Ovid) were searched using keywords related to GDMT and economic outcomes. The research was refined using empirical research and grey literature focusing on healthcare costs and readmission rates.  The chart review is part of a larger study examining the impact of integrating a pharmacist into a cardiology center on GDMT prescription. Inpatient and outpatient charges data was analyzed to determine if integration of a pharmacist led to decreased healthcare costs. This project was supported by Parkview Health and received funding from ACC Accreditation Foundation Board.     Results:  The study is currently ongoing. 70 articles and abstracts were reviewed, and 10 articles fit the criteria focusing on GDMT, healthcare cost, or readmissions. Articles supported a correlation between decreased readmission and overall healthcare cost with compliance to GDMT. Literature also supports the addition of an intervention leading to decreased readmissions. Preliminary charges data analysis showed a decrease in cost by 46% in inpatients and 35% in outpatients after pharmacist intervention.     Conclusion:  We conclude GDMT is associated with decreased healthcare costs due to decreased readmissions. Although there are multiple confounding variables when evaluating the primary data, data showed a  correlation between adding intervention (i.e. pharmacist) and decreasing readmissions and overall healthcare costs. Further studies need to be conducted to show causation.  

scholarly journals Impact of a Multidisciplinary eBoard on the Management of Patients With Complex Inflammatory Bowel Disease

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Kevin P Quinn ◽  
Breanne L Prothero ◽  
Jennifer M Russell ◽  
Ryan J Hegge ◽  
Alexander G von Bormann ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Chart Review ◽  
Inflammatory Bowel ◽  
The Impact

Abstract Background We aim to assess the impact of a multidisciplinary inflammatory bowel disease (IBD) conference on the management of patients with complex IBD. Methods Data were collected during each conference from February 2017 through October 2018 with chart review performed at 6 months to determine if conference recommendations were successfully implemented. Results Eighty-five patients were discussed. The presenting diagnosis was changed by 11.8%. Recommendations for further testing, medical therapy, and surgery were successfully implemented in 77.1%, 98.1%, and 88.4%, respectively. Conclusions This study supports the role of IBD multidisciplinary conferences in the management of patients with complex IBD.

scholarly journals Feasibility of Radial Endobronchial Ultrasound-Guided Bronchoscopic Cryobiopsy without Fluoroscopy for Lung Parenchymal Lesions

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chih-Hao Chang ◽  
Chung-Shu Lee ◽  
Shih-Hong Li ◽  
Fu-Tsai Chung ◽  
Chih-Wei Wang ◽  
...  
Keyword(s):  
Chart Review ◽  
Endobronchial Ultrasound ◽  
Chang Gung Memorial Hospital ◽  
Ultrasound Guided ◽  
Lung Lesions ◽  
Specimen Diameter ◽  
Medical Chart Review ◽  
Peripheral Lung ◽  
The Mean ◽  
The Impact

Background. Cryobiopsy is used to biopsy peripheral lung lesions through flexible bronchoscopy with fluoroscopic guidance. However, fluoroscopy is not available at some institutions. This study evaluated the feasibility of radial endobronchial ultrasound-guided bronchoscopic cryobiopsy without fluoroscopy. Methods. This retrospective study was conducted at Chang Gung Memorial Hospital, Linkou branch, in Taiwan. This study enrolled patients who received bronchoscopy examinations with cryotechnology between July 2014 and June 2016. The data were collected through medical chart review. Results. During the study period, 101 patients underwent bronchoscopy examinations with cryotechnology. Ninety patients with endobronchial tumors were excluded from this study. Eleven patients who underwent radial endobronchial ultrasound-guided bronchoscopic cryobiopsy for lung parenchymal lesions were enrolled into this study. The mean age was 61.1 ± 13.8 years. Five patients were men, and the other six were women. The number of cryobiopsies ranged from 1 to 3. In the histological biopsies, the mean specimen diameter was 0.53 ± 0.23 cm, and the mean biopsy area was 0.20 ± 0.19 cm2. Nine of 11 patients had pathological diagnoses. No complications, including pneumothorax, respiratory failure, or major bleeding, were recorded after the procedure. Conclusions. Endobronchial ultrasound is used to ensure biopsy location, and endobronchial ultrasound-guided cryobiopsy is a feasible technique to biopsy peripheral lung lesions in selected cases at institutions without fluoroscopy equipment. This study provided some rationale for further studies examining the impact of fluoroscopy.

scholarly journals Emergence of Glutaraldehyde-Resistant Pseudomonas aeruginosa

2011 ◽  
Vol 32 (12) ◽  
pp. 1173-1178 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Reno Frei ◽  
Günter Kampf ◽  
Michael Tamm ◽  
Eric Pflimlin ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Incidence Rates ◽  
Medical Chart ◽  
University Hospital ◽  
Clinical Samples ◽  
Medical Chart Review

Objective.In November 2009, routine sampling of endoscopes performed to monitor the effectiveness of the endoscope-cleaning procedure at our hospital detected Pseudomonas aeruginosa. Herein we report the results of the subsequent investigation.Design and Methods.The investigation included environmental cultures for source investigation, molecular analysis by pulsed-field gel electrophoresis (PFGE) to reveal the identity of the strains, and determination of the bactericidal activity of the glutaraldehyde-based disinfectant used for automated endoscope reprocessing. In addition, patient outcome was analyzed by medical chart review, and incidence rates of clinical samples with P. aeruginosa were compared.Setting.The University Hospital of Basel is an 855-bed tertiary care center in Basel, Switzerland. Approximately 1,700 flexible bronchoscopic, 2,500 gastroscopic, 1,400 colonoscopic, 140 endoscopic retrograde cholangiopancreatographic, and 140 endosonographic procedures are performed annually.Results.P. aeruginosa was detected in samples obtained from endoscopes in November 2009 for the first time since the initiation of surveillance in 2006. It was found in the rinsing water and in the drain of 1 of the 2 automated endoscope reprocessors. PFGE revealed 2 distinct P. aeruginosa strains, one in each reprocessor. The glutaraldehyde-based disinfectant showed no activity against the 2 pseudo-outbreak strains when used in the recommended concentration under standard conditions. After medical chart review, 6 patients with lower respiratory tract and bloodstream infections were identified as having a possible epidemiological link to the pseudo-outbreak strain.Conclusions.This is the first description of a pseudo-outbreak caused by P. aeruginosa with reduced susceptibility to an aldehyde-based disinfectant routinely used in the automated processing of endoscopes.

scholarly journals Optimising Early Management of Acute Severe Ulcerative Colitis in the Biologics Era: Admission Model for Intensification of Therapy in Acute Severe Colitis (ADMIT-ASC)

2021 ◽  
Author(s):  
Alex Adams ◽  
Vipin Gupta ◽  
Waled Mohsen ◽  
Thomas P Chapman ◽  
Deloshaan Subhaharan ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Medical Therapy ◽  
Rescue Therapy ◽  
University Hospital ◽  
New Delhi ◽  
Early Management ◽  
Improved Outcomes ◽  
Hospitalised Patients ◽  
Acute Severe Colitis ◽  
Severe Colitis

Background & aims: We aimed to determine whether changes in ulcerative colitis management have translated to improved outcomes, in order to develop a simple model to predict steroid non-response on admission. Methods: Outcomes of 131 adult ASC admissions (117 patients) in Oxford, UK between 2015-19 were compared with prospectively collected data from 1992-3. All patients received standard treatment with intravenous corticosteroids and endoscopic disease activity scoring (UCEIS). Steroid non-response was defined as receiving rescue medical therapy or surgery. A predictive model created in the Oxford cohort was validated in Australia and India (110 hospitalised patients Gold Coast University Hospital 2015-20; 62 hospitalised patients AIIMS, New Delhi 2018-20). Results: In the 2015-19 Oxford cohort, 71 (54%) patients received medical rescue therapy (27% ciclosporin, 27% anti-TNF), compared to 27% ciclosporin in 1992-3, p=0.0015. Only 15% required colectomy during admission vs 29% in 1992-3 (p=0.033). Admission CRP, albumin, and UCEIS scores predicted steroid non-response (FDR p=0.00066, 0.0066 and 0.015). A four-point model was developed involving CRP ≥ 100mg/L (1 point), albumin ≤ 25g/L (1 point), UCEIS ≥ 4 (1 point) or ≥ 7 (2 points). Scoring 0 or 4 was 100% predictive of steroid response and non-response, respectively, in all three cohorts. Patients scoring 3-4 had 83% risk of steroid non-response in Oxford and 84% (0.70-0.98) in the validation cohorts -- OR 11.9 (10.8-13). Conclusion: Colectomy rates for ASC have halved in 25 years, while use of rescue medical therapy has doubled. Patients who are highly unlikely to respond to parenteral steroid treatment alone may be readily identified on admission, to be prioritised for early intensification of therapy.

scholarly journals Disease monitoring of biologic treatment in IBD: early impact and future implications of COVID-19 pandemic

2020 ◽  
pp. flgastro-2020-101563
Author(s):  
Stephanie Shields ◽  
Allan Dunlop ◽  
John Paul Seenan ◽  
Jonathan Macdonald
Keyword(s):  
Clinical Care ◽  
Chronic Illnesses ◽  
Therapeutic Drug ◽  
Disease Monitoring ◽  
Biologic Treatment ◽  
Faecal Calprotectin ◽  
Routine Clinical Care ◽  
Risk Of Disease ◽  
Inflammatory Bowel ◽  
The Impact

COVID-19 has dominated life in 2020 with, at the time of writing, over 4.9M global cases and >320 000 deaths. The impact has been most intensely felt in acute and critical care environments. However, with most UK elective work postponed, laboratory testing of faecal calprotectin halted due to potential risk of viral transmission and non-emergency endoscopies and surgeries cancelled, the secondary impact on chronic illnesses such as inflammatory bowel disease (IBD) is becoming apparent. Data from the Scottish Biologic Therapeutic Drug Monitoring (TDM) service shows a dramatic drop in TDM testing since the pandemic onset. April 2020 saw a 75.6% reduction in adalimumab testing and a 36.2% reduction in infliximab testing when compared with February 2020 data, a reduction coinciding with the widespread cancellation of outpatient and elective activity. It is feared that disruption to normal patterns of care and disease monitoring of biologic patients could increase the risk of disease flare and adverse clinical outcomes. Urgent changes in clinical practice have been instigated to mitigate the effects of the pandemic on routine clinical care. Further transformations are needed to maintain safe, effective, patient-centred IBD care in the future.

scholarly journals Outcomes of COVID-19 Hospitalized Patients Previously Treated with Renin-Angiotensin System Inhibitors

2020 ◽  
Vol 9 (11) ◽  
pp. 3472 ◽  
Author(s):  
Elena-Mihaela Cordeanu ◽  
Lucas Jambert ◽  
Francois Severac ◽  
Hélène Lambach ◽  
Jonathan Tousch ◽  
...  
Keyword(s):  
Renin Angiotensin System ◽  
Severe Pneumonia ◽  
University Hospital ◽  
Angiotensin System ◽  
Angiotensin Converting Enzyme 2 ◽  
Renin Angiotensin ◽  
Previously Treated ◽  
The Impact ◽  
Harmful Effects ◽  
Observation Period

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates respiratory epithelium through angiotensin-converting enzyme-2 binding, raising concerns about the potentially harmful effects of renin–angiotensin system inhibitors (RASi) on Human Coronavirus Disease 2019 (COVID-19) evolution. This study aimed to provide insight into the impact of RASi on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 943 COVID-19 patients were admitted to our institution, of whom 772 were included in this analysis. Among them, 431 (55.8%) had previously known hypertension. The median age was 68 (56–79) years. Overall, 220 (28.5%) patients were placed under mechanical ventilation and 173 (22.4%) died. According to previous exposure to RASi, we defined two groups, namely, “RASi” (n = 282) and “RASi-free” (n = 490). Severe pneumonia (defined as leading to death and/or requiring intubation, high-flow nasal oxygen, noninvasive ventilation, and/or oxygen flow at a rate of ≥5 L/min) and death occurred more frequently in RASi-treated patients (64% versus 53% and 29% versus 19%, respectively). However, in a propensity score-matched cohort derived from the overall population, neither death (hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.57–1.50), p = 0.76) nor severe pneumonia (HR 1.03 (95%CI 0.73–1.44), p = 0.85) were associated with RASi therapy. (4) Conclusion: Our study showed no correlation between previous RASi treatment and death or severe COVID-19 pneumonia after adjustment for confounders.

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