Comparative Analysis of Body Image Dissatisfaction, Depression, and Health-Related Quality of Life in Adults with Type 1 Diabetes: A Case-Control Study.

(1) Objective: This case-control study investigated body image dissatisfaction, depression, and health-related quality of life (HRQoL) in adults with type 1 diabetes. (2) Methods: A total of 35 adults with diabetes and an equal number of age- and gender-matched controls were included. Assessment tools used were the Body Image Disturbance Questionnaire (BIDQ), the Hospital Anxiety and Depression Scale (HADS), and the RAND 36-Item Health Survey. Both quantitative and qualitative data were analyzed. (3) Results: Body image dissatisfaction did not differ significantly between the groups. However, adults with diabetes reported higher levels of depression (p = 0.002) and lower scores for physical health (p = 0.015) and general health (p < 0.001) on the HRQoL measure. Qualitative analysis identified common themes related to physical disturbance, effect on activities, and psychosocial concerns. (4) Conclusions: Despite similar body image dissatisfaction, adults with type 1 diabetes exhibited increased depression and reduced HRQoL. These findings emphasize the need to integrate psychological well-being into type 1 diabetes management. They also support further research into the impact of body image dissatisfaction in T1D and potential interventions to address it.

Pharmacist-Driven Therapeutic Infliximab Monitoring at the Point of Care Using Rapidly Assessed Drug Levels in Patients with Inflammatory Bowel Disease.

BACKGROUND: Therapeutic monitoring of infliximab is limited by the time lag between drug-level measurement and dose adjustment, along with the cost of dose escalation. Strategies for dose reduction in stable patients on maintenance infliximab at supratherapeutic levels are uncertain. This study determined the feasibility of a pharmacist-driven strategy for immediate dose adjustment using a sliding scale at the point of care in stable patients with inflammatory bowel disease on maintenance therapy. METHODS: Adult patients with stable disease undergoing maintenance therapy with infliximab infusions, 5 mg/kg every 8 weeks, were prospectively studied. Trough drug levels were assessed by a rapid assay (and later by ELISA) at all infusions for up to 12 months with immediate but quantitatively small dose adjustment according to a sliding scale targeting a therapeutic range of 3-7 mcg/mL. Disease activity was assessed both clinically and biochemically. RESULTS: The rapid assay and ELISA detected similar infliximab levels, and the strategy added approximately 30 minutes to the duration of infusion events. Only 20% of 48 patients (77% with Crohn disease) had baseline trough infliximab concentrations within the therapeutic range. This value increased 3-fold after 24 and 48 weeks of interventions. One in 2 patients had baseline supratherapeutic levels, and most were brought into the therapeutic range without a discernible impact on disease activity by 1 dose adjustment, but 2 or 3 adjustments were generally needed for 29% of patients with subtherapeutic levels. Overall, drug costs were reduced by 4%. CONCLUSIONS: Immediate dose adjustment after infliximab rapid assay performed by a pharmacist using a sliding scale is a feasible strategy. Supratherapeutic infliximab levels can be safely and quickly brought into the therapeutic range using small dose adjustments without affecting disease activity, offsetting (at least partly) costs associated with dose escalation.

Interrater reliability of the assessment of disease activity by gastrointestinal ultrasound in a prospective cohort of patients with inflammatory bowel disease.

OBJECTIVE: Gastrointestinal ultrasound is a radiological investigation for monitoring patients with inflammatory bowel disease. However, the reliability of the findings depends on the reproducibility of results between different operators. Thus, the study aim was to assess the interrater reliability of gastrointestinal ultrasound in individuals with inflammatory bowel disease between gastroenterologists with varying GIUS experience. . METHODS: Patients were prospectively recruited at the commencement of a new medical therapy for a baseline assessment, with a second assessment at the end of treatment induction (3 months). Consecutive, blinded ultrasounds were performed by two operators for every test. Gastrointestinal ultrasound examination included assessment of bowel wall thickness, vascularity, wall stratification assessment, mesenteric hyperechogenicity and lymphadenopathy. RESULTS: Forty-nine patients were recruited (Crohn's n = 27, ulcerative colitis n = 22) with 35 returning for a repeat assessment at 3 months. At baseline, the intraclass coefficient for bowel wall thickness was near perfect (0.882). By bowel segment, the closest correlation was in the terminal ileum and differences in bowel wall thickness were similar by disease subtype. All other ultrasound indices of disease activity demonstrated substantial to near-perfect agreement with Gwet's agreement coefficient: vascularity (0.681), wall stratification (0.685), mesenteric hyperechogenicity (0.841) and lymphadenopathy (0.633). Similar findings were seen at 3 months. CONCLUSION: There is substantial agreement between operators of varying experience in gastrointestinal ultrasound findings in patients with Crohn's disease or ulcerative colitis and this is repeatedly demonstrated over time. Thus, a well-trained operator should be sufficient to assess disease activity in patients with inflammatory bowel disease.

Rising Incidence of Inflammatory Bowel Disease in Canterbury, New Zealand.

BACKGROUND: A population-based study of inflammatory bowel disease (IBD) in the Canterbury province of New Zealand demonstrated an incidence of Crohn's disease (CD) of 16.5 per 100,000 population in 2004, along with a high rate of IBD overall. At the time, this was one of the highest rates of CD in the world. The current study aimed to ascertain the incidence of IBD in the same area 10 years later. METHODS: All patients diagnosed with IBD in 2014 within the Canterbury region were identified and characterized. Diagnosis and disease classification were ascertained using standard accepted criteria. Projected population data for age and gender were used to calculate incidence rates for IBD overall and for CD, ulcerative colitis (UC), and inflammatory bowel disease-unclassified (IBDU). RESULTS: During the 2014 years, 205 patients were diagnosed with IBD in Canterbury. This group comprised 134 patients with CD, 69 with UC, and 2 with IBDU. The age-standardized incidence of IBD, CD, UC, and IBDU was 39.5, 26.4, 12.6, and 0.17 per 100,000, respectively. Disease location of CD patients was evenly distributed (ileal 29%, colonic 35%, and ileocolonic 32%). Similarly, patients with UC had even distribution of proctitis, left-sided, and extensive disease. CONCLUSIONS: This study demonstrates a substantial increase in the incidence of IBD in this geographically well-defined area. Overall, incidence rates were 1.6-fold greater than when assessed 10 years earlier. The reasons contributing to these continued increases remain unclear. However, further increases in rates of IBD indicate growing health system demands in the future.

Waiting times for gynaecological cancer surgery.

AIM: This study sought to identify the perceived acceptable waiting times for gynaecological cancer surgery and to audit actual waiting times for gynaecological cancer patients in a tertiary referral service. METHODS: Women attending Gynaecological Outpatients and staff at Christchurch Women's Hospital were surveyed to determine their opinion regarding the acceptable waiting times from referral to diagnosis, diagnosis to treatment plan, and treatment plan to surgery for women with gynaecological cancer. The actual waiting times for patients who had surgery for gynaecological cancer over two 6-month periods at Christchurch Women's Hospital were audited. The waiting times obtained from the audit and the survey were then compared. RESULTS: Eighty-one patients were approached, and 71 surveys were completed (88%), while 97 surveys were sent to staff with a response rate of 63% (61 returns). There were similar perceptions of maximum acceptable waiting times between patients and staff. The audit reviewed notes of 82 patients. The median waiting time for referral from primary care to diagnosis was longer than the perceived maximum acceptable. However, the median waiting time from diagnosis to treatment plan and from treatment plan to surgery was less than the perceived acceptable maximum. CONCLUSIONS: This study documents perceived acceptable waiting times and actual waiting times for surgery of women with gynaecological cancer within a regional service. This study offers preliminary information towards the development of benchmarks for this service.