Inflammatory bowel disease patient-reported quality assessment should drive service improvement: a national survey of UK IBD units and patients.

BACKGROUND: Healthcare service provision in inflammatory bowel disease (IBD) is often designed to meet targets set by healthcare providers rather than those of patients. It is unclear whether this meets the needs of patients, as assessed by patients themselves. AIMS: To assess patients' experience of IBD and the healthcare they received, aiming to identify factors in IBD healthcare provision associated with perceived high-quality care. METHODS: Using the 2019 IBD standards as a framework, a national benchmarking tool for quality assessment in IBD was developed by IBD UK, comprising a patient survey and service self-assessment. RESULTS: 134 IBD services and 9757 patients responded. Perceived quality of care was lowest in young adults and increased with age, was higher in males and those >2 years since diagnosis. No hospital services met all the national IBD standards for recommended workforce numbers. Key metrics associated with patient-reported high- quality care were: identification as a tertiary centre, patient information availability, shared decision- making, rapid response to contact for advice, access to urgent review, joint medical/surgical clinics, and access to research (all p < 0.001). Higher numbers of IBD nurse specialists in a service was strongly associated with patients receiving regular reviews and having confidence in self-management and reporting high- quality care. CONCLUSIONS: This extensive patient and healthcare provider survey emphasises the importance of aspects of care less often measured by clinicians, such as communication, shared decision- making and provision of information. It demonstrates that IBD nurse specialists are crucial to meeting the needs of people living with IBD.

Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK.

OBJECTIVE: Symptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models. DESIGN: Led by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi. RESULTS: Consensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework. CONCLUSIONS: The Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.

A surface-enhanced Raman study of N-methylquinolinium tricyanoquinodimethanide adsorbed on Ag nanospheres: Determination of molecular orientation and order.

Quinolinium tricyanoquinodimethanides are among the most promising molecules for electronic applications. Disorder can be detrimental to the desired electronic properties of a monolayer, and as such, a reliable method to characterize a monolayer without destroying or creating defects is paramount to determining potential applications. Here, the normal and surface-enhanced Raman scattering spectra of N-methylquinolinium tricyanoquinodimethanide (CH3Q-3CNQ) on silver coated nanosurfaces have been obtained and analyzed. Theoretical treatment of CH3Q-3CNQ was performed. Optimization and frequency search was conducted using the B3LYP functional with the 6-31G(d) basis set. A complete list of frequencies and assignments for the molecules are presented. The spectroscopic evidence points to the fact that a monolayer of CH3Q-3CNQ can be formed through the self-assembly process, and the SERS data indicate that the monolayer attaches to the silver surface through the nitrile groups.

Determination of molecular orientation and order of N-(6-mercaptoacetylhexyl)quinolinium tricyanoquinodimethanide adsorbed on Ag nanoparticles.

The surface-enhanced and tip-enhanced Raman scattering spectra of N-(6-Mercaptoacetylhexyl)quinolinium tricyanoquinodimethanides on silver coated nanosurfaces have been obtained, analyzed using Density Functional Theory Calculations, and a complete list of frequencies and assignments for the molecules are presented. The spectroscopic evidence points to the fact that monolayers of the molecule can be formed through the self-assembly process and the SERS data indicate that the monolayer attach to the silver surface through the nitrile groups. SERS spectroscopy was useful in determining the orientation of the monolayer as well as estimating its order. Deprotection the thiol group thereby terminating the tail of the molecule with a sulfur atom allowed for a selectively oriented monolayer to be formed which permanently bound the molecules to the surface preventing rearrangements. This orientation of AcSC6H12Q-3CNQ on silver a surface allowed the electron pairs of the nitrogen to be available for interaction with a second contact. Based on trigonometric tangent function calculations the tilt angle was calculated to be 38° for the protected molecule and 70° for the deprotected alkane thiol monolayer.

Surface-enhanced Raman scattering of a Ag/oligo(phenyleneethynylene)/Ag sandwich.

α,ω-Dithiols are a useful class of compounds in molecular electronics because of their ability to easily adsorb to two metal surfaces, producing a molecular junction. We have prepared Ag nanosphere/oligo(phenyleneethynylene)/Ag sol (AgNS/OPE/Ag sol) and Ag nanowire/oligo(phenyleneethynylene)/Ag sol (AgNW/OPE/Ag sol) sandwiches to simulate the architecture of a molecular electronic device. This was achieved by self-assembly of OPE on the silver nanosurface, deprotection of the terminal sulfur, and deposition of Ag sol atop the monolayer. These sandwiches were then characterized by surface-enhanced Raman scattering (SERS) spectroscopy. The resulting spectra were compared to the bulk spectrum of the dimer and to the Ag nanosurface/OPE SERS spectra. The intensities of the SERS spectra in both systems exhibit a strong dependence on Ag deposition time and the results are also suggestive of intense interparticle coupling of the electromagnetic fields in both the AgNW/OPE/Ag and the AgNS/OPE/Ag systems. Three previously unobserved bands (1219, 1234, 2037 cm(-1)) arose in the SER spectra of the sandwiches and their presence is attributed to the strong enhancement of the electromagnetic field which is predicted from the COSMOL computational package. The 544 cm(-1) disulfide bond which is observed in the spectrum of solid OPE but is absent in the AgNS/OPE/Ag and AgNW/OPE/Ag spectra is indicative of chemisorption of OPE to the nanoparticles through oxidative dissociation of the disulfide bond.

Detection of benzopyrene-deoxyguanosine adducts by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

A method for the detection of BPDE-d guanosine adducts using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) is described and illustrated. The results indicate that MALDI is capable of detecting two other DNA benzopyrene adducts, which are trace products formed during the synthesis of BPDE-d guanosine. This MALDI-TOFMS method offers the potential for the detection of DNA adducts in human tissue using very limited sample purification and preparation.

Over-the-counter decorative contact lenses: Cosmetic or Medical Devices? A Case Series.

PURPOSE: To illustrate the implications of the unauthorized sale and unmonitored wearing of decorative cosmetic contact lenses resulting in ocular complications and to determine the prevalence of the use of cosmetic contact lenses obtained from unlicensed providers by adolescents. METHODS: Observational case report, structured interview, and survey in a retrospective, observational, clinical practice setting. Reported sources of contact lenses were categorized as provider and nonprovider, and associations within the data were reviewed by using a Pearson correlation and chi-square test. RESULTS: Twelve patients (eight female and four male) were seen urgently for acute eye pain and redness after wearing plano decorative contact lenses. None of the patients had previously worn a contact lens. None of the lenses were dispensed by eye care professionals. Four patients developed blinding infections requiring hospital admission. Causative organisms included staphylococci, Pseudomonas, and acanthamoeba. One patient required a penetrating keratoplasty. One hundred fifty-nine patients were surveyed. Thirty-seven (23%) used decorative contact lenses. Lenses were obtained from an unlicensed provider 51% of the time. Education about lens care and handling was significantly associated with acquiring lenses from licensed providers (R = 0.74, P < 0.0001). CONCLUSIONS: Colored noncorrective contact lenses are being dispensed without a prescription or fitting from unlicensed vendors. Patients who acquire lenses from unauthorized providers are significantly less likely to be instructed on appropriate lens use and care. Consequently, uninformed lens wearers are experiencing acute vision-threatening infections and inflammation.