关键词： 肛肠疾病   PDCA   质量改进   围手术期   健康教育  

摘要： 目的探讨PDCA质量管理在提高肛肠疾病围手术期健康教育合格率中的效果。方法运用PDCA循环法对肛肠围手术期开展健康教育质量改进。选取PDCA实施前的2018年4月-6月施行肛肠手术的81例患者设为对照组,另选取实施后的2018年8月-10月收治的77例患者设为观察组。比较2组健康教育合格率和满意度。结果观察组健康教育合格率、满意度均高于对照组,差异有统计学意义(P<0.05)。结论运用PDCA质量管理能够提高肛肠疾病围手术期健康教育合格率。

关键词： 胃肠疾病   手术   早期肠内营养支持   有针对性护理  

摘要： 目的:探讨对进行手术后的胃肠疾病患者实施早期肠内营养支持及有针对性护理的效果.方法:将皖南医学院第一附属医院弋矶山医院收治的97例胃肠疾病患者分为对照组(n=48)和观察组(n=49).在对两组患者进行手术后,对观察组患者进行早期肠内营养支持及有针对性护理.对对照组患者进行常规肠内营养支持及有针对性护理.然后比较两组患者术毕至肠道蠕动恢复正常的时间、住院的时间及术后并发症的发生率.结果:观察组患者术毕至肠道蠕动恢复正常的时间及住院的时间均短于对照组患者(P<0.05),其术后并发症的发生率低于对照组患者(P<0.05).结论:对进行手术后的胃肠疾病患者实施早期肠内营养支持及有针对性护理的效果较为理想,可降低其术后并发症的发生率,促进其胃肠功能的恢复.

关键词： Crohn's disease   diet   dietary beliefs   ulcerative colitis  

摘要： Diet is regarded as one of the important environmental factors triggering inflammatory bowel disease (IBD). Many IBD patients avoid numerous types of foods in fear of disease exacerbation. The aim of the study was to investigate dietary beliefs and food avoidance among pediatric patients with IBD. This questionnaire-based study was conducted in three University-affiliated children's hospitals in Poland. Data were collected from parents of children who were diagnosed with IBD. A total of 155 parents of IBD patients participated in the survey: 104 (67.1%) had a child with Crohn's disease and 51 (32.9%) with ulcerative colitis. Parents of older children and those with longer disease duration predicted diet being considered one of the causative agents of IBD, and differences were statistically significant (P = .01 and P = .04, respectively). Also, patients with a shorter history of disease rarely shared food with other family members (P = .02). In total, 61.5% of patients avoided some kind of food in fear of disease flares. In the parent's opinion, the food the children liked but avoided included fried dishes, sweets (e.g., chocolate, cookies, cakes, candies, jellies), and fast food. Due to their dietary beliefs, parents of children with IBD commonly introduced dietary restrictions for their offspring. Frequent and unjustified food avoidance may influence not only nutritional status but also general well-being of pediatric patients. Our results underscore the urgent need for IBD patients and parents of ill children to receive reliable dietary advice based on strong scientific evidence.

关键词： Colon   Inflammation   Animal behavior   Inflammatory bowel disease   Dextran   Colitis   Pain   Body weight  

摘要： Administration of dextran sodium sulfate (DSS) to rodents at varying concentrations and exposure times is commonly used to model human inflammatory bowel disease (IBD). Currently, the criteria used to assess IBD-like pathology seldom include surrogate measures of visceral pain. Thus, we sought to standardize the model and then identify surrogate measures to assess effects on visceral pain. We used various 4% DSS protocols and evaluated effects on weight loss, colon pathology, biochemistry, RNA signature, and open field behavior. We then tested the therapeutic potential of NPY Y1 and/or Y2 receptor inhibition for the treatment of IBD pathology using this expanded panel of outcome measures. DSS caused weight loss and colon shrinkage, increased colon NPY and inflammatory cytokine expression, altered behaviors in the open field and induced a distinct gene metasignature that significantly overlapped with that of human IBD patients. Inhibition of Y1 and/or Y2 receptors failed to improve gross colon pathology. Y1 antagonism significantly attenuated colon inflammatory cytokine expression without altering pain-associated behaviors while Y2 antagonism significantly inhibited pain-associated behaviors in spite of a limited effect on inflammatory markers. A protocol using 7 days of 4% DSS most closely modeled human IBD pathology. In this model, rearing behavior potentially represents a tool for evaluating visceral pain/discomfort that may be pharmacologically dissociable from other features of pathology. The finding that two different NPY receptor antagonists exhibited different efficacy profiles highlights the benefit of including a variety of outcome measures in IBD efficacy studies to most fully evaluate the therapeutic potential of experimental treatments.

关键词： infliximab   paradoxical psoriasis   pediatric inflammatory bowel disease  

摘要： Objectives: In adult inflammatory bowel disease (IBD) treated by anti-TNF antibodies, paradoxical psoriasis has an estimated prevalence of 1.6 to 22%, especially in infliximab (IFX)-treated patients. Little is known in the pediatric IBD (PIBD) populations. Methods: All patients ages from 2 to 18 years with Crohn disease (CD) or ulcerative colitis (UC) and treated for the first time by IFX between January 2002 and March 2014, were considered for inclusion in this retrospective study performed in a tertiary PIBD centre. Paradoxical psoriasis events together with clinical and biological data were collected in all patients. Comparisons between psoriasis and control groups were performed using univariate statistical analyses. Results: One hundred and twenty-three CD patients and 24 UC patients were treated with IFX. Twenty patients (13.6%) experienced a paradoxical psoriasis. All of them were affected by CD. Perianal CD was more frequent in the psoriasis group (P = 0.033). Fourteen patients (70%) were in remission when skin lesions occurred. Paradoxical psoriasis was diagnosed 355 days (median, interquartile range [IQR] 239;532) after the initiation of IFX corresponding to the eighth injection (median, IQR: 6;15). Psoriasis lesions were controlled by local steroids in all cases and no patients discontinued IFX therapy. Conclusions: 13.6% of our IBD patients treated with IFX developed psoriasis during a median follow-up of 23.9 months (IQR: 11.6;36.5). Crohn disease patients with perianal disease were at a higher risk to develop this common side effect.

摘要： Pain is reported to affect over 70% of individuals with inflammatory bowel diseases (IBD), with abdominal and musculoskeletal (MSK) pain representing the most common complaints. MSK pain is typically considered within the narrow framework of inflammatory extraintestinal manifestations of IBD, resulting in a limited scope for the nature and underlying mechanisms participating in MSK pain experiences in this population. Symptoms related to central sensitization have recently demonstrated association with active IBD and worse MSK pain experiences, suggesting a potential roll for central mechanisms in MSK-related pain. Current literature exploring persistent pain in chronic inflammatory and MSK populations propose complex pain models comprised of dynamic nervous system relationships influenced by primary disease features and concomitant pain states, as well as affective and cognitive components. Nervous system contributions in the development and maintenance of persistent pain are postulated to include mechanisms of peripheral and central sensitization, changes in descending central modulation, as well as structural brain changes. These models go beyond current MSK pain models described in IBD literature, highlighting the need for new frameworks for considering MSK-related pain in IBD. Consequently, this paper proposes a broader theoretical model whereby central mechanisms, such as central sensitization and grey matter changes, as well as psychological and disease factors are suggested to modulate pain experiences in this population. Exploration of relationships within the proposed framework may provide not only a deeper understanding of the generation and maintenance of persistent MSK pain in IBD, but also highlight the need for new targeted management pathways in this population. This paper hypothesizes that exploration of central sensitization in IBD patients will demonstrate altered somatosensory functioning in patients with MSK pain, and that IBD activity and psych

关键词： Inflammatory bowel disease   Rosacea   Meta-analysis  

摘要： Backgrounds and aims: It has been argued that the relationship between inflammatory bowel disease (IBD) and rosacea is bi-directional, but this hypothesis has not been explicitly tested. This systematic review examines the bi-directional prospective relationships between IBD and rosacea. Methods: A comprehensive search through PubMed and EMBASE was undertaken for studies investigating the association between two mainly forms of IBD [ulcerative colitis (UC) and Crohn's disease (CD)] and rosacea published in English until Jan 2018. Reviewers assessed the eligibility of each report by exposure/outcome measurement and study design. Two sets of pooled risk estimates were calculated using fixed or random effects: the direction from IBD to rosacea and rosacea to IBD. Results: Five publications on 13 separate study results involving 5,051,356 participants were eligible for this meta-analysis. A total of 6 outcomes established the direction of association from IBD to rosacea, and 7 outcomes examined the direction of association from rosacea to IBD. Compared to a non-rosacea population, the pooled RR (95% CI) for overall IBD, UC and CD were 1.32 (1.18-1.49), 1.19 (1.02-1.38) and 1.52 (1.25-1.84), respectively (P < 0.05). Meanwhile, the summary RR (95% CI) of rosacea in overall IBD, UC and CD patients were 1.66 (1.50-1.84), 1.69 (1.48-1.93) and 2.08 (1.26-3.46), respectively (P < 0.05). Conclusion: Our meta-analysis confirmed a significant bi-directional association in occurrence of IBD and rosacea. Future studies should specifically investigate possible shared pathophysiological mechanisms between the two disorders. (C) 2018 Elsevier Masson SAS. All rights reserved.

关键词： Inflammatory bowel disease   Irritable bowel syndrome   Diet   Quality of life   Outcomes research  

摘要： Background Food-related quality of life (FRQoL) evaluates the impact of diet, eating behaviors, and food-related anxiety on a person's quality of life. This is the first study to evaluate FRQoL in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), two illnesses where food and diet are of importance. Methods One hundred seventy-five participants (80 IBS, 95 IBD) participated in the study by completing measures evaluating FRQoL, psychological distress, and health-related quality of life. Primary analyses evaluated differences in FRQoL between IBD and IBS patients. Secondary analyses compared differences based on remission status, dietary use, and dietary consultation, as well as evaluated potential predictors of FRQoL. Results IBD patients in remission report the highest FRQoL (IBD-remission: 91.2 (26.5) vs. IBD-active: 67.7 (19.6) and IBS-active: 67.6 (18.3), p < .001). Using more dietary treatments is associated with decreased FRQoL for IBS (r = -0.23, p < .05) and IBD patients (r = -0.31, p < .01). IBS patients are more likely to use dietary treatments than IBD (IBS = 81% vs. IBD = 64%, p < .01), with self-directed diets being the most commonly used approach. Symptom severity is the strongest predictor of FRQoL in both groups (IBD: R-2 = .27, p < .01;IBS: R-2 = .23, p < .001). Conclusion FRQoL is a unique construct for IBD and IBS patients that can be influenced by several clinical and dietary factors, including number of diets and type of diet used, depending on the diagnosis. Thus, FRQoL should be considered when working with both IBD and IBS patients.

关键词： Surgeons   Inflammatory Bowel Diseases   Intestinal Diseases  

摘要： Could be involved earlier

关键词： adverse events   allopurinol   hepatotoxicity   inflammatory bowel disease   myelotoxicity   thiopurine  

摘要： Background Low-dose thiopurine-allopurinol (LDTA) combination therapy is a commonly applied optimisation strategy in IBD patients with a skewed thiopurine metabolism. Aim To assess continued LDTA maintenance treatment at annual intervals and explore risk factors for treatment cessation Methods Adult IBD patients treated with LDTA between 2009 and 2016 were retrospectively included. Data on the incidence of clinical and laboratory adverse events (AEs), including hepatotoxicity and myelotoxicity resulting in imposing LDTA therapy cessation and associated risk factors were collected. Results In total, 221 IBD patients (46% male, median age 42 years) were included. Maintenance LDTA treatment was continued in 78% of patients at 1 year (n = 145), 66% at 2 years (n = 83), 57% at 3 years (n = 52) and 52% at 4 years (n = 33). Treatment in patients receiving LDTA therapy for AEs during thiopurine monotherapy was more often continued than in patients initiating LDTA for other indications (eg, ineffectiveness of thiopurine monotherapy, routinely discovered skewed metabolism) (P = 0.016). Myelotoxicity during thiopurine monotherapy resolved in 87% and hepatotoxicity in 86% after median of 1.2 and 1.4 months after LDTA initiation. Cumulative incidence of AEs during LDTA resulting in therapy cessation within total follow-up of 449 treatment-years was 7% for clinical AEs, 4% for myelotoxicity and 1% for hepatotoxicity. Conclusion LDTA therapy is a safe and beneficial optimisation strategy in IBD patients. Continued maintenance LDTA treatment is 52% after 4 years of treatment and most commonly affected by ineffectiveness of LDTA rather than LDTA-attributed toxicity. LDTA optimisation strategy is most advantageous in patients failing thiopurine monotherapy due to AEs.