Impact of the COVID-19 pandemic on the activity of advanced-practice nurses on a reference unit for inflammatory bowel disease.

OBJECTIVE: To report the impact of the COVID-19 pandemic on the activity of nurses working on an inflammatory bowel disease (IBD) unit and to identify reasons for telehealth care and its relationship to certain characteristics. BACKGROUND: The COVID-19 pandemic had led to an increase in demand for remote care in patients with inflammatory bowel disease who require monitoring and frequent access to health services. DESIGN - METHODS: A retrospective study of all activity (in person and by phone call or email) done on the unit during the acute phase of the pandemic at a reference hospital in Spain. Numbers of activities done by nurses, reasons for telehealth care and sociodemographic and clinical data were collected. Statistical analysis was performed using frequency, chi-squared and analysis of variance tests. RESULTS: A total of 1095 activities for 561 patients who received care were reported. Among them, 1042 (95.2%) were telemedicine activities, amounting to a 47.3% increase over the prior year. COVID-19-related activities numbered 588 (59.5%). Consultations due to disease flare-up numbered 134 (13.7%), representing a 145% increase compared to 2019. Significant differences were found between reasons for using telemedicine and diagnosis, occupational status, contact week and treatment. CONCLUSION: The acute phase of the pandemic has changed the activity managed by the nursing staff on the unit. Identifying and analysing these changes has yielded valuable information to achieve more efficient management and better care quality for patients in special situations.

ACG Clinical Guideline: ulcerative colitis in adults

Ulcerative colitis (UC) is a chronic disease affecting the large intestine, with an increasing incidence worldwide. Nearly 1 million individuals each in the United States and Europe are affected by this condition and many more globally. Over the past decade, since the publication of the last guideline from the American College of Gastroenterology (ACG) on this topic, the management of disease has grown increasingly complex with availability of additional therapeutic classes. In addition, algorithms for initiating, optimizing, and monitoring response to existing therapies have undergone considerable evolution.

Immunosuppressive/Autoimmune Disorders.

Autoimmune disorders are a category of diseases in which the immune system attacks healthy cells as a result of a dysfunction of the acquired immune system. Clinical presentation and diagnosis are disease specific and often correspond with the degree of inflammation, as well as the systems involved. Treatment varies based on the specific disease, its stage of presentation, and patient symptoms. The primary goal of treatment is to decrease inflammation, minimize symptoms, and lessen the potential for relapse. Graves disease, Hashimoto thyroiditis, rheumatoid arthritis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, and multiple sclerosis are discussed in this article.

Effects of introduction of an inflammatory bowel disease nurse position on the quality of delivered care.

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal conditions requiring long-term outpatient follow-up, ideally by a dedicated, multidisciplinary team. In this team, the IBD nurse is the key point of access for education, advice, and support. We investigated the effect of the introduction of an IBD nurse on the quality of care delivered. METHODS: In September 2014, an IBD nurse position was instituted in our tertiary referral center. All contacts and outcomes were prospectively recorded over a 12-month period using a logbook kept by the nurse. RESULTS: Between September 2014 and August 2015, 1313 patient contacts were recorded (42% men, median age: 38 years, 72% Crohn's disease, 83% on immunosuppressive therapy). The contacts increased with time: Q1 (September-November 2014): 144, Q2: 322, Q3: 477, and Q4: 370. Most of the contacts were assigned to scheduling of follow-up (316/1420), start of new therapy (173/1420), therapy follow-up (313/1420), and providing disease information (227/1420). In addition, 134 patients contacted the IBD nurse for flare management and a smaller number for administrative support, psychosocial support, and questions about side effects. During the study period, 30 emergency room and 133 unscheduled outpatient visits could be avoided through the intervention of the IBD nurse. A faster access to procedures and other departments could be provided for 136 patients. CONCLUSION: The role of IBD nurses as the first point of contact and counseling is evident from a high volume of nurse-patient interactions. Avoidance of emergency room and unscheduled clinic visits are associated with these contacts.

Inflammatory bowel disease.

THE INCIDENCE of inflammatory bowel disease (IBD) is in- creasing worldwide. The underlying causes of IBD, which encom- passes Crohn's disease and ulcerative coLitis, are unknown but are thought to be a com- bination of genetics, environmental factors, abnormal immune re- sponses and disruption to the microbiota in the gut. IBD can be a devas- tating disease, affect- ing quality of Life and increasing risks for bowel cancer. Effec- tive management has been an elusive goal, but with better under- standing of the inflam- matory and immune pathways involved in IBD, more successful therapies are entering clinical practice. To deliver quality care and help people with IBD manage this dis- ease, nurses must be familiar with the cur- rent understanding of its causes.

Identification of Research Priorities for Inflammatory Bowel Disease Nursing in Europe: a Nurses-European Crohn's and Colitis Organisation Delphi Survey.

BACKGROUND: Robust research evidence should inform clinical practice of inflammatory bowel disease [IBD] specialist nurses, but such research is currently very limited. With no current agreement on research priorities for IBD nursing, this survey aimed to establish topics to guide future IBD nursing research across Europe. METHODS: An online modified Delphi survey with nurse and allied health professional members of the Nurses European Crohn's and Colitis Organisation [n = 303] was conducted. In Round One, participants proposed topics for research. In Round Two, research topics were rated on a 1-9 scale and subsequently synthesised to create composite research questions. In Round Three, participants selected their top five research questions, rating these on a 1-5 scale. RESULTS: Representing 13 European countries, 88, 90 and 58 non-medical professionals, predominantly nurses, responded to Rounds One, Two and Three, respectively. In Round One, 173 potential research topics were suggested. In Rounds Two And Three, responders voted for and prioritised 125 and 44 questions, respectively. Round Three votes were weighted [rank of 1 = score of 5], reflecting rank order. The top five research priorities were: interventions to improve self-management of IBD; interventions for symptoms of frequency, urgency and incontinence; the role of the IBD nurse in improving patient outcomes and quality of life; interventions to improve IBD fatigue; and care pathways to optimise clinical outcomes and patient satisfaction. CONCLUSIONS: The prioritised list of topics gives clear direction for future IBD nursing research. Conducting this research has potential to improve clinical practice and patient-reported outcomes.

Managing Ulcerative Colitis in the Adolescent: Highlighting the Developmental and Self-management Needs.

Ulcerative colitis (UC) is a lifelong disease that peaks in diagnosis between the ages of 15 to 25 years, making UC a significant chronic disease among adolescents that could affect the adolescents throughout their life. This article provides an overview of the role of nurse practitioners as health care providers in managing adolescent patients with UC with a holistic approach that encompasses the physical aspects of the disease, as well as developmental and psychosocial needs. By describing the influence that developmental stage and psychological stress have on patients with UC, the nurse practitioners can facilitate evidence-based and holistic care for adolescents and promote self-management.

The lived experience of adults with ulcerative colitis.

AIMS AND OBJECTIVES: The purpose of this study was to explore the experiences of adults living with ulcerative colitis. BACKGROUND: Research to date has focused on the impact of inflammatory bowel disease, by analysing the responses of persons with ulcerative colitis and Crohn's disease collectively. This article addresses the dearth in literature by exploring the experiences of adults living with ulcerative colitis. DESIGN: An exploratory qualitative phenomenological design was used. METHOD: Semi-structured interviews were conducted with a purposive sample of 10 adults with ulcerative colitis. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis. RESULTS: Three super-ordinate themes emerged from the analysis: 'living with physical discomfort', 'emotional turmoil in living the experience' and 'social interactions'. CONCLUSION: The participants described a fundamental change in their lifestyle, as a result of physical discomfort and emotional turmoil. Misconceptions held regarding the causes of their disease, further compounded their negative emotional experience. RELEVANCE TO CLINICAL PRACTICE: It is of importance that health care professionals understand and explore the unique perspectives of individuals with ulcerative colitis. These perspectives relate to both physical and psychosocial issues. The needs and concerns of persons with ulcerative colitis can then guide the formulation and development of an individualised care plan.

Nódulos pulmonares migratorios en paciente con colitis ulcerosa / Migratory Pulmonary Nodules in a Patient With Ulcerative Colitis

No disponible

N-ECCO survey results of nursing practice in caring for patients with Crohn's disease or ulcerative colitis in Europe.

BACKGROUND AND AIMS: The difference in nursing roles when caring for patients with inflammatory bowel disease varies across Europe with different levels of responsibility. This might vary widely from country to country and even hospital to hospital depending on the local requirements of the patients and the gastroenterology team. This survey was developed to assess the current nursing practice across Europe. METHODS: A total of 220 nursing delegates who attended the N-ECCO Meeting and School in 2012 were invited to complete a survey. The survey consisted of 11 questions about the role and responsibility of nurses in the care of patients with inflammatory bowel disease. RESULTS: Of the 220 European nurses, 192 responded (87%). A majority (61%) came from 5 European countries, most were between 30 and 50 years old, 73% worked in public hospitals and 68% were involved in adult care. The level of education varied equally between certificate level, degree level, diploma level and masters' level. The nurses' level of experience, above that of the level of education, was the main factor in determining whether to offer advice or not to the patient, independent of a doctor (p<0.01). CONCLUSION: This survey has provided an understanding of the nursing role in the care of patients with IBD across Europe as well as Australia, Canada and Israel. It demonstrates that the role of nurses in IBD exists in various settings within hospital care, providing complex management and autonomous nursing care in a range of services to a significant number of patients with IBD.

Consulta telemática realizada por Enfermería en pacientes con enfermedad inflamatoria intestinal: valoración de su capacidad resolutiva y costes / Telematic consultations by nursing staff for patients with inflammatory bowel disease: Evaluation of its capacity for resolving problems and its costs

INTRODUCCIÓN: El manejo de los pacientes con enfermedad inflamatoria intestinal (EII) se asocia a un importante consumo de recursos sanitarios. En el año 2009 se creó en el CHUVI una consulta de enfermería en patología digestiva, con disponibilidad de atención telemática. El notable incremento en esta área nos estimula a cuantificar el ahorro de lo que esta atención puede suponer para el sistema de salud. OBJETIVOS: 1) Valorar los resultados de la puesta en marcha de una consulta telemática. 2) Valorar la capacidad de resolución telemática por parte de enfermería. 3) Estimar el posible ahorro de la consulta telemática de EII. MATERIAL Y MÉTODO: Recogida de la actividad telemática de 2009 a 2011. Análisis estimado del ahorro sanitario, mediante la aplicación de las tarifas por servicios sanitarios del SERGAS, para demandas originadas por aparición de nueva clínica/brote de actividad de EII. Análisis de datos con SPSS 15.0. RESULTADOS: Existe un aumento lineal significativo de la resolución telefónica de demandas por parte de enfermería (p = 0,03) y una reducción de las que precisan acudir a consulta médica (p < 0,0001). De las demandas por brote (n = 452), solo han requerido atención en el servicio de urgencias 65 (14,38%), precisando su ingreso 33 (7,3%). El cálculo del ahorro medio estimado en 2009-2011 ascendería de media a 73.603 €. CONCLUSIONES: Se objetiva un aumento de la capacidad de resolución de la atención telemática por parte de enfermería. En cuanto al ahorro estimado, podemos concluir que la atención telemática consigue un ahorro significativo de los costes sanitarios, que justifica la implementación de una consulta de enfermería en patología digestiva

INTRODUCTION: The management of patients with inflammatory bowel disease (IBD) is associated with a significant use of healthcare resources. In 2009, a digestive diseases nursing consultation, with availability of health telematic media was created in our hospital (CHUVI). The important activity performed in this area encouraged us to quantify the cost savings for the care health system. AIMS: 1) To evaluate the results of the implementation of a telematic IBD consultation. 2) To assess the capacity for resolving problems by nurses. 3) To estimate the potential cost savings of telematic nursing consultation in IBD. MATERIAL AND METHOD: We collected data on telematic activity from 2009 to 2011. The estimated cost saving was calculated by applying the fees for health services published by our National Health Service (SERGAS) for care in new outbreaks of IBD activity. Data were analyzed with SPSS 15.0. RESULTS: There was a significant linear increase on the resolution of telephone demands by nurses (P = .03) and an important decrease of demands needing medical advice (P < .0001). Focusing on IBD outbreak claims (n = 452), only 65 patients (14.38%) required medical attention in emergency services, and 33 (7.3%) were hospitalized. Altogether we calculated an average cost saving since 2009 to 2011 of 73,603 €. CONCLUSIONS: We found a gradual increase in resolving telematic care demands by nurses. Telematic consultation can lead to significant cost savings, which justify the implementation of a digestive diseases nurse consultation

Quality of life following ileoanal pouch failure.

This article describes a novel qualitative study exploring the lived experience of participants having undergone ileoanal pouch failure, on a background of ulcerative colitis (UC). It focuses on the impact of living with indefinite diversion of the pouch and a permanent end ileostomy. Six participants were interviewed with an aim to establish their experience of pouch failure and the support they required. Five pertinent themes emerged that suggested participants did not expect pouch failure and were unprepared for the regression towards UC. Some participants recommenced drug therapy, wore pads to manage leakage from the diverted pouch, avoided certain social settings or manipulated diet and lifestyle in order to gain an acceptable quality of life with a permanent ileostomy. Pouch failure potentially presents adverse effects on patients' quality of life, but currently there is a deficit in support and resources available in order to provide acceptable outcomes for patients experiencing pouch failure.

Specialist support.

People with ulcerative colitis of Crohn's disease often develop the conditions in their teens or early twenties. Specialist nurses help people cope and get on with their lives. Access is improving, but one in five young patients still miss out on specialist nursing care.

[Inflammatory bowel diseases: experiencing illness, therapy and care]. / Chronisch entzündliche Darmerkrankungen: Erleben von Krankheit, Therapie und Betreuung.

People affected by Crohn's disease or ulcerative colitis experience a high level of suffering. A new generation of anti-tumour necrosis factor-α agents can alleviate the burden of symptoms considerably. In order to develop a need-centred care programme for this patient group, we conducted problem-centred interviews with nine patients about their experience of the disease, the therapy and the quality of nursing care. The evaluation was based on qualitative content analysis. Patients' statements revealed three general categories: (1) "the never ending story" of a life with IBD, (2) "the sudden change" due to successful therapy and (3) "the narrow path" of a new stage of life: the disease no longer dominated daily life. The results emphasise the necessity of specific care for this patient group in order to perceptibly enhance their self-management and quality of life. The study illuminates a developing field of ambulant nursing care, based on the knowledge of patients' needs in the context of a chronic disease characterised by an unpredictable and irregular course.

Is patient reported outcome (PRO) affected by different follow-up regimens in inflammatory bowel disease (IBD)? A one year prospective, longitudinal comparison of nurse-led versus conventional follow-up.

OBJECTIVE: Specialist nurses have become increasingly involved in the management of Inflammatory Bowel Disease (IBD). The objectives of this study were to investigate the impact of nurse-led versus conventional follow-up on patient outcomes, such as quality of life, worries and time from relapse to start of treatment. METHODS: Patients completed the Short Form 36 (SF-36), Inflammatory Bowel Disease Questionnaire (N-IBDQ) and the Rating Form of IBD Patient Concerns (RFIPC) at baseline and after 1 year. Socio-demographic and clinical variables were obtained at V1 and V2. In addition the amount of e.g., relapses, hospitalisations, time from relapse to start of treatment, sick-leave, unscheduled visits or telephone calls was recorded during the follow-up period. RESULTS: A total of 140 patients were included; ulcerative colitis (UC) n=92, Crohn's disease (CD) n=48, mean age 46.9 and 40.0 years old, respectively. One hundred and thirty three patients attended the follow-up after 1 year. After 1 year there were no differences between the groups in relation to quality of life, worries, amount of relapse, sick-leave, hospitalisations or surgery. Participants in nurse-led follow-up had a significantly (p<0.05) shorter interval from the start of a relapse to the start of treatment. CONCLUSIONS: Nurse-led follow-up of IBD patients produces PRO results comparable to that of gastroenterologists and may shorten the interval from the beginning of a relapse to the start of treatment.

Colitis ulcerosa en 2011: mucho que mejorar / No disponible

No disponible