Systematic review: the role of psychological stress in inflammatory bowel disease.

BACKGROUND: Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in inflammatory bowel disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured. AIMS: To explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD METHODS: We performed a systematic review, searching Medline, CINAHL, Embase and PsycInfo databases on 21 January 2021. We included prospective studies that recruited people with IBD who were aged 16 or over and that measured psychological stress or distress. Analyses included Critical Appraisal Skills Programme quality assessments of included studies and narrative analyses against each research question. RESULTS: We reviewed 38 studies with 4757 people with IBD, and included 23 observational and 15 interventional studies using 36 different instruments to measure stress. Perceived stress was the most frequently studied concept and preceded IBD exacerbation. Only three studies examined the relationship between stress and psychosocial factors. Cognitive behavioural interventions may reduce stress and other interventions with disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits. CONCLUSION: Psychological stress appears to precede IBD exacerbation, although what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research needs to examine the differential effects of stress on disease subtypes and IBD in flare and remission.

Evaluating the effectiveness of a nutrition assistant role in a head and neck cancer clinic.

AIM: Acute toxicities secondary to (chemo)radiation for head and neck cancer can substantially impact nutritional intake. Nutrition is usually managed by dietitians, although time constraints may limit capacity to sufficiently deal with complex nutritional issues. The aim of the present study was to determine the effectiveness of a nutrition assistant performing screening and intervention of patients in a multidisciplinary head and neck clinic. METHODS: A model of care was developed to guide nutrition assistant practice within the clinic, with training provided to nutrition assistants prior to the clinic's implementation. Outcomes, including amount of dietitian time managing high risk patients, weight change over the duration of treatment, timing of initiation of enteral feeding and patient satisfaction were compared with pre- and post-implementation of the nutrition assistant role. RESULTS: Ninety-one patients were included, 43 pre-implementation and 48 post-implementation. Overall, (n = 21, 44%) of patients met criteria for nutrition assistant screening or intervention. Mean weight change between groups was comparable both during (-5.6% vs -4.7%, P = 0.3) and post-radiotherapy (-6.6% vs -6.49%, P = 0.9). Following implementation of the role significant improvement was found for overall patient satisfaction (4.0 ± 1.1 vs 4.6 ± 0.61, P = 0.03), and the dimensions: patient-perceived benefit (3.8 ± 0.69 vs 4.4 ± 0.62, P < 0.01) and dietitian/nutrition-assistant interpersonal skills (3.91 ± 1.1 vs 4.6 ± 0.55, P = 0.02). CONCLUSIONS: The nutrition assistant role resulted in improved patient satisfaction and maintenance of nutritional outcomes demonstrating the effectiveness of this role in supporting the management of head and neck cancer patients within a multidisciplinary treatment clinic.

Challenges of collaboration to address health disparities in the rapidly growing community of Las Vegas, Nevada.

Collaboration was established between a university and the faith-based community in Clark County, Nevada to develop a coalition to address chronic disease in the African American population. The university faculty enlisted several churches and health related agencies to join the coalition. The challenges of collaborating with a community coalition to develop and implement a grant are discussed.