Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.

BACKGROUND: Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence. AIMS: We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. METHODS: We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively. RESULTS: A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy. CONCLUSIONS: There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.

Low awareness but positive attitudes toward fecal transplantation in Ontario physicians.

BACKGROUND: Despite mounting evidence supporting fecal transplantation (FT) as a treatment for recurrent Clostridium difficile infection (CDI), adoption into clinical practice has been slow. OBJECTIVE: To determine the health literacy and attitudes of academic physicians in Toronto and infectious disease physicians in Ontario toward FT as a treatment for recurrent CDI, and to determine whether these are significant barriers to adoption. METHODS: Surveys were distributed to 253 general internists, infectious diseases specialists, gastroenterologists and family physicians. RESULTS: The response rate was 15%. More than 60% of physicians described themselves as being 'not at all' or 'somewhat' familiar with FT. Of the 76% of physicians who had never referred a patient for FT, the most common reason (50%) was lack of awareness of where to access the treatment. The 'ick factor' accounted for only 13% of reasons for not referring. No respondent believed that the procedure was too risky to consider. CONCLUSION: Despite general poor health literacy on FT, most physicians sampled share similar positive attitudes toward the treatment.

HISTORIQUE: Malgré les données croissantes en appui à la transplantation fécale (TF) pour traiter l'infection à Clostridium difficile (ICD) récurrente, son adoption est lente en pratique clinique. OBJECTIF: Déterminer les connaissances et les attitudes des médecins universitaires de Toronto et des infectiologues de l'Ontario envers la TF pour traiter l'ICD récurrente et déterminer si elles constituent d'importants obstacles à leur adoption. MÉTHODOLOGIE: Des sondages ont été distribués à 253 internistes généraux, infectiologues, gastroentérologues et médecins de famille. RÉSULTATS: Le taux de réponse s'élevait à 15 %. Plus de 60 % des médecins se décrivaient comme « pas du tout ¼ ou « quelque peu ¼ familiers avec la TF. Des 76 % de médecins qui n'avaient jamais orienté un patient vers une TF, 50 % affirmaient manquer de connaissance quant à l'accès au traitement. Le facteur« peu ragoûtant ¼ ne constituait que 13 % des raisons de ne pas aiguiller les patients. Aucun répondant ne trouvait l'intervention trop risquée pour être envisagée. CONCLUSION: Malgré le peu de connaissances générales sur la TF, la plupart des médecins interrogés avaient les mêmes attitudes positives envers le traitement.

How psoriasis patients perceive, obtain, and use biologic agents: Survey from an academic medical center.

The availability of new biologic agents for the treatment of psoriasis provides hope for improved quality of life outcomes. However, the way patients come to use biologics, the potential barriers they encounter, and their attitudes towards using these medications are still not well studied. Here, we conducted a survey of 106 psoriasis patients at an academic medical center to discern patient attitudes towards biologics. We found that most patients learn of biologics through their physician and perform follow-up research using the Internet. Most patients did not find it difficult to make the decision to start a biologic. Difficulty in obtaining biologics was associated with age less than 55 (p = 0.01), lower income level (p = 0.007), and lack of insurance (p = 0.04). Patients were found to have high satisfaction and compliance rates on biologics. Of patients who missed a dose of their biologic, this was mainly due to logistical reasons such as not having the medication or forgetting to take it, rather than being depressed or overwhelmed. Patients with lower income levels had increased cut backs in personal expenses due to co-payments (p = 0.001). Among respondents, the mean annual out-of-pocket expense for a biologic was $557.12 per year, with a range of $0-7000.

Goeckerman therapy for the treatment of eczema: a practical guide and review of efficacy.

The Goeckerman regimen, consisting of the application of crude coal tar combined with exposure to ultraviolet radiation, was formulated in 1925 for the treatment of psoriasis. While some centers have adapted the Goeckerman regimen for the treatment of eczema, there are no published reports of its efficacy in this condition. Here, we explain how the Goeckerman regimen has been modified for use in an eczema population at the University of California San Francisco (UCSF). We reviewed the treatment records of eczema patients treated with the modified Goeckerman regimen over a 6-year period at UCSF. We found that the Goeckerman regimen was effective in treating patients with severe baseline disease, inducing a mean remission period of 7.2 months. The treatment was tolerated well with mild folliculitis and occasional ultraviolet B phototoxicity noted as the only adverse reactions. Since the use of Goeckerman as a treatment for severe eczema is both effective and safe, it should be considered an excellent alternative or adjunct to the systemic therapies currently being used.

Assessment of biocompatibility and initial evaluation of genipin cross-linked elastin-like polypeptides in the treatment of an osteochondral knee defect in rabbits.

Polypeptides based on the alternating hydrophobic and cross-linking domain structure of human elastin are capable of undergoing self-assembly to produce polymeric matrices with unique biological and mechanical properties. Here, we test the initial feasibility of using a genipin cross-linked elastin-based material as an acellular plug in the treatment of an osteochondral defect in the rabbit knee. Full-thickness defects in the weight-bearing surface of the medial femoral condyle in 18 New Zealand White rabbits were surgically produced and press fitted with cylindrical pads composed of genipin cross-linked elastin-like polypeptides, with identical wounds in the opposite knee left untreated as controls. The biocompatibility of the material, overall wound healing and regeneration of subchondral tissue was assessed at 2, 4 and 6weeks by histological evaluation, synovial fluid analysis and microcomputerized tomography scanning. Histological analysis revealed the regeneration of subchondral bone at the periphery of the material, with evidence of hyaline-like overgrowth across the apical surface in 11/16 cases. Pads developed tight contacts with host tissue and appeared completely biocompatible, with no evidence of localized immune response or increased inflammation compared to controls. The material was stable to 6weeks, with an aggregate elastic modulus calculated at approximately 470kPa when tested under confined compression. Further studies are required to assess material degradation over time and long-term replacement with repair tissue.