'Food doesn't control me anymore!' psychosocial experiences during dietary management in adults with inflammatory bowel disease: A qualitative study.

AIMS: To explore the psychosocial experiences during dietary management among Chinese adults with inflammatory bowel disease. DESIGN: Qualitative phenomenological design. METHODS: Eighteen adults diagnosed with inflammatory bowel disease for more than 6 months were recruited using purposive sampling from June to December 2023. Two trained researchers used van Manen's approach to analyse the data. RESULTS: The three themes with multiple subthemes emerged: facing the unknown: at a loss and aggrieved, trying to cope: uncertain and distressed, and growing in adaptation: relieved and transcendent. The first theme included unknown relapses, overlooking diet management and the absence of dietary rules. The second theme showed different coping situations, like complex dietary information and ever-closing worlds. The third theme explores how participants adapted to disease and their eating patterns. CONCLUSION: The psychosocial experiences during dietary management are complex. The accumulation of diet-related experience, acceptance of illness and social support facilitate patients in overcoming negative emotions and adhering to dietary management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Nurses should provide tailored dietary guidance and appropriate psychological interventions to promote healthy eating in patients. IMPACT: This study may enhance healthcare professionals' understanding, particularly those in China, of the diet-related experiences among patients. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION: Participants contributed by sharing their first hand experiences.

Difficulties in eating out of home while diagnosed with inflammatory bowel disease: A qualitative interview study from China.

BACKGROUND: Meeting healthy dietary needs while eating out can be a challenging experience for adults with inflammatory bowel disease. This study examined the barriers experienced by adults with inflammatory bowel disease (IBD) when eating out. OBJECTIVE: This study aimed to explore the perceptions of people with IBD on eating out barriers. DESIGN: A qualitative study among individuals affected by IBD was conducted through semi-structured interviews. RESULTS: Sixteen adults from China were diagnosed with IBD between 6 months and 20 years prior to the study. They were recruited from four tertiary care hospitals in Nanjing, China. The participants completed a semi-structured interview between April and September 2022. Self-perceived difficulties with eating and drinking when eating out were varied. After thematic analysis of the data, five main themes emerged: limited access to healthy and hygiene food; no pleasure of food enjoyment; financial strain; not feeling loved, supported or understood; and coping strategies for not meeting demand. CONCLUSIONS: This study highlights the various barriers encountered by patients with inflammatory bowel disease when eating out. These findings will help people with IBD to encourage the formation of targeted health and well-being-related interventions. Knowledge of nutrition and diet should be provided in education and training programs administered to IBD.

Risk of avoidant/restrictive food intake disorder in patients with inflammatory bowel disease: predictive value of disease phenotype, disease activity and food literacy.

BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is a newly described eating disorder. Adequate levels of food literacy allow individuals to have adequate food choices. This study aimed to assess the prevalence of ARFID and the level of food literacy in patients with inflammatory bowel disease (IBD) and to analyse the correlation between ARFID and food literacy. METHOD: This cross-sectional study screened for ARFID and assessed food literacy levels in patients with IBD attending four tertiary hospitals in China. ARFID risk was measured using the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS). Food literacy was assessed using the Food Literacy Evaluation Questionnaire (Chinese version, FLEQ-Ch).The relationship between individual NIAS scores and food literacy variables was analysed to assess which food literacy aspect is positively or negatively associated with NIAS scores. Stepwise linear regression analysis was performed to identify the possible predictors of NIAS scores in patients with IBD. RESULT: A total of 372 IBD subjects completed the NIAS and FLEQ-Ch. The overall mean NIAS scores for the IBD cohort was 28.16 ± 8.03 (p < 0.01), and of the 372 participants, 123 (32.5%) had positive ARFID risk scores (≥ 10 NIAS-picky eating, ≥ 9 NIAS-poor appetite, and ≥ 10 NIAS-fear of negative consequences).The NIAS scores were inversely associated with food literacy levels (ß = - 0.299; p < 0.01).Disease phenotype, disease activity, and food literacy in patients with IBD provided valuable predictive insights for avoiding positive outcomes in ARFID. CONCLUSION: This study shows that the risk of ARFID in the cohort of patients with IBD is associated with their inadequate food literacy levels. Therefore, this study supports the notion that patients with IBD should be assessed for food literacy regardless of whether they are currently diagnosed with ARFID. Specifically, for early identification of those at risk for ARFID in IBD, disease phenotype, disease activity, and food literacy should be routinely considered in clinical practice.The food literacy awareness of patients must be investigated and improved to predict the risk occurrence of ARFID and encourage healthy eating behaviour.

Excessive dietary restriction is common in patients with inflammatory bowel disease (IBD) and in severe cases can lead to Avoidant/Restrictive Food Intake Disorder (ARFID).ARFID is a new eating disorder that has been proposed in recent years. Studies have shown that food literacy can influence patients' eating behaviour to some extent. Research on the risk factors associated with ARFID is necessary to better understand why people with IBD develop ARFID and to inform programmes aimed at reducing these risk factors. In our study, we found that disease phenotype, disease activity, and food literacy in patients with IBD provided valuable predictive insights for avoiding positive outcomes in ARFID. These factors can provide valuable perspectives for healthcare providers and patients at this critical juncture in the disease dietary management process. Therefore, this study supports the notion that patients with IBD should be assessed for food literacy regardless of whether they are currently diagnosed with ARFID. Specifically, for early identification of those at risk for ARFID in IBD, disease phenotype, disease activity, and food literacy should be routinely considered in clinical practice.

Mobile-based program improves healthy eating of ulcerative colitis patients: A pilot study.

Background: Dietary management plays a crucial role in the treatment of patients with ulcerative colitis (UC). While various e-services provide dietary advice, the long-term dietary management requires continuous monitoring and dynamic adjustment to accommodate the evolving nature of the disease and meet the patients' nutritional needs. Consequently, the development of a novel dietary management tool that incorporates diet tracking, personalized nutritional feedback, and evidence-based advice becomes imperative. This study aims to address this need by developing a WeChat applet called "HealthyGut" specifically designed for the dietary management of UC patients, and evaluate its feasibility, acceptability, and preliminary efficacy. Methods: A total of 134 UC patients were equally allocated into the intervention group (receiving a 12-week mobile-based dietary management via HealthyGut) and control group (receiving a paper-based food diary and routine advice). The feasibility outcomes were recruitment, retention, engagement, satisfaction, and acceptability in the intervention group. Dietary intakes were effective outcomes. Results: Both groups had satisfactory retention rates (89.6% and 77.6%, respectively). The System Usability Scale in the intervention group yielded "good usability" with a mean score of 79.63 (SD 7.39), and all participants reported good user experiences and perceived benefits after using HealthyGut. At week 12, intervention responders reported significantly higher daily energy intake than control group (Z = -3.089, p = 0.002). Conclusions and Implications: The results display that HealthyGut as a dietary management tool is feasible and accepted by UC patients, and it may help them make healthier food choices. Larger sample studies should be considered in the future.

Evaluating the Risk of Social Isolation in Older People: AHP-Fuzzy Comprehensive Evaluation.

Background: Social isolation is a serious and pervasive health issue among older people, and it is difficult to identify and assess effectively. Based on a thorough and scientific evaluation index system, AHP-Fuzzy comprehensive evaluation could be a valuable technique. Objective: It is crucial to establish interventions that focus on risk factors for the prevention of social isolation in order to give a strong scientific foundation for enhancing older people's health habits. This can be achieved by using a fuzzy comprehensive evaluation method to assess the risk of social isolation in older people. Methods: A hundred community members over 60 from Nanjing were selected as the evaluation subjects in China. After the element layer was split into three categories of "social risk, economic risk, and cultural risk" using the analytic hierarchy process approach, a total of 22 assessment indicators were picked to develop a risk evaluation index system. Results: The risk level of social isolation belonging to the "low risk, relatively low risk, medium risk, relatively high risk, high risk" of membership degree are respectively "0.3392, 0.2632, 0.2257, 0.1069, 0.0650". Fuzzy comprehensive evaluation analysis showed that social relations (0.4934), monthly income (0.4654), health status (0.5960) were significant factors of social isolation risk in older people. The results showed that factors related to social risk had the most significant impact on social isolation. Conclusion: It is scientific and feasible to construct the risk evaluation index model of social isolation risk for the elderly by using AHP-Fuzzy comprehensive evaluation method. In preventing social isolation of older people in the future, we should pay attention to the impact of social and cultural factors on them, and provide practical intervention programs and references from the government, community, family.

A bibliometric analysis of the global trends and hotspots for the ketogenic diet based on CiteSpace.

The ketogenic diet (KD) is a potential nutritional therapy that is frequently utilized in various conditions. More and more studies are being done on KD in recent years. However, as far as we know, few studies have made an effort to offer a thorough synthesis and assessment of this topic. This paper aims to do a rigorous and thorough evaluation of the knowledge structure, development trend, and research hotspot of scientific outputs connected to KD. The bibliographic records connected to KD from January 1, 2001 to April 22, 2022 were collected using the core collection database of Web of Science. The complex data input, that consisted of the amount of publications, journals, authors, institutions, countries, keywords and cited references, was generated and analyzed visually using CiteSpace. A total of 2676 literatures on the KD were published between 2001 and 2022. The most KD-related publications were found in Epilepsia and Epilepsia Research. The authors with the most KD-related papers are Kossoff EH and Rho J. The United States is the country with the most publications, and Johns Hopkins University, Johns Hopkins University Hospital, and Johns Hopkins Medical Institutions are the institutions with the most articles. The high frequency keywords are "KD," "ketone body," "children," "efficacy," "weight loss," "low carbohydrate diet," "metabolism," "epilepsy," "beta hydroxybutyrate," and "modified atkins diet." The 2018 study by Kossoff EH on epilepsia and the 2017 study by Puchalska P on ketone body metabolism earned 127 and 114 citations, respectively. The results of this bibliometric analysis provide information on the state and trends in KD and may be used by researchers to pinpoint hot issues and discover new areas of study.

Prognosis and Immunological Characteristics of PGK1 in Lung Adenocarcinoma: A Systematic Analysis.

Background: Aerobic glycolysis plays a key role in tumor metabolic reprogramming to reshape the immune microenvironment. The phosphoglycerate kinase 1 (PGK1) gene codes a glycolytic enzyme that converts 1,3-diphosphoglycerate to 3-phosphoglycerate. However, in lung adenocarcinoma (LUAD), the role of PGK1 in altering the tumor microenvironment (TME) has not yet been determined. Methods: Raw data, including bulk DNA and mRNA-seq data, methylation modification data, single-cell RNA-seq data, proteomics data, clinical case characteristics survival, immunotherapy data, and so on, were obtained from multiple independent public data sets. These data were reanalyzed to uncover the prognosis and immunological characteristics of PGK1 in LUAD. Results: We found that PGK1 mRNA and protein were considerably over-expressed in LUAD compared to normal tissue and that high PGK1 expression is associated with poorer prognostic outcomes in LUAD. The enrichment analysis of PGK1 co-expressed genes in lung adenocarcinoma revealed that PGK1 may be involved in hypoxia, metabolism, DNA synthesis, cell cycle, PI3K/AKT, and various immune and inflammatory signaling pathways. Furthermore, PGK1 is also linked to the recruitment of numerous immune cells, including aDC (dendritic cells), macrophages, and neutrophils. More importantly, PGK1 was highly expressed in immunosuppressive cells, including M2 macrophages, Tregs, and exhausted T cells, among others. Finally, higher PGK1 expression indicated significant correlations to immune checkpoints, TMB (tumor mutation burden), and high response to immunotherapy. Conclusions: The presented findings imply that PGK1, as a glycolysis core gene, may be important for the modification of the immune microenvironment by interacting with the tumor metabolism. The results of this study provide clues for a potential immunometabolic combination therapy strategy in LUAD, for which more experimental and clinical translational research is needed.

Secreted phosphoprotein 1 promotes angiogenesis of glioblastoma through upregulating PSMA expression via transcription factor HIF1α.

Glioblastoma multiforme (GBM) is a highly vascularized malignant brain tumor. Our previous study showed that prostate-specific membrane antigen (PSMA) promotes angiogenesis of GBM. However, the specific mechanism underlying GBM-induced PSMA upregulation remains unclear. In this study, we demonstrate that the GBM-secreted cytokine phosphoprotein 1 (SPP1) can regulate the expression of PSMA in human umbilical vein endothelial cells (HUVECs). Our mechanistic study further reveals that SPP1 regulates the expression of PSMA through the transcription factor HIF1α. Moreover, SPP1 promotes HUVEC migration and tube formation. In addition, HIF1α knockdown reduces the expression of PSMA in HUVECs and blocks the ability of SPP1 to promote HUVEC migration and tube formation. We further confirm that SPP1 is abundantly expressed in GBM, is associated with poor prognosis, and has high clinical diagnostic value with considerable sensitivity and specificity. Collectively, our findings identify that the GBM-secreted cytokine SPP1 upregulates PSMA expression in endothelial cells via the transcription factor HIF1α, providing insight into the angiogenic process and promising candidates for targeted GBM therapy.

An integrated pan-cancer analysis of PSAT1: A potential biomarker for survival and immunotherapy.

Phosphoserine aminotransferase 1 (PSAT1) may be an oncogene that plays an important role in various cancer types. However, there are still many gaps in the expression of PSAT1 gene and its biological impact in different types of tumors. Here, we performed an integrated pan-cancer analysis to explore the potential molecular mechanisms of PSAT1 in cancers. We found that most human tumors express higher levels of PSAT1 than normal tissues, and that higher PSAT1 expression is associated with worse prognosis in Lung adenocarcinoma (LUAD), Pan-kidney cohort (KIPAN) and breast invasive carcinoma (BRCA), etc. In BRCA cases, the prognosis of patients with altered PSAT1 was worse than that of patients without alteration. In addition, PSAT1 hypermethylation is associated with T cell dysfunction and shortened survival time in BRCA. The Gene Set Enrichment Analysis (GSEA) analysis showed that PSAT1 can be enriched into the classic signaling pathways of cancer such as mTORC1 signaling, MYC targets and JAK STAT3. Further analysis demonstrated that PSAT1 was enriched in immune related signaling pathways in LUAD and BRCA. The results of immunoassay showed that PSAT1 was associated with immune cell infiltration in multiple cancer species. Furthermore, expression of PSAT1 was correlated with both tumor mutational burden (TMB) and microsatellite instability (MSI) in BRCA. Additionally, a remarkable correlation was found between PSAT1 expression and TMB in LUAD, and the expression of PSAT1 was negatively correlated with the Tumor Immune Dysfunction and Exclusion (TIDE) value, suggesting a good effect of immunotherapy. Together, these data suggest that PSAT1 expression is associated with the clinical prognosis, DNA methylation, gene mutations, and immune cell infiltration, contributing to clarify the role of PSAT1 in tumorigenesis from a variety of perspectives. What's more, PSAT1 may be a new biomarker for survival and predicting the efficacy of immunotherapy for LUAD and BRCA.

Construction of path analysis model on related factors of social isolation in older people.

BACKGROUND: With the gradual acceleration of population ageing, social isolation in older people has increasingly become a hot topic of social concern. The reduction of valid social participation will cause older people to weaken their sense of belonging to the community and social acquisition, negatively impacting on older people's quality of life. This study is aimed to explore the main related factors affecting the social isolation of older people, so as to provide a solid scientific basis for improving the health behaviour of older people in China. METHOD: A cross-sectional study was conducted among 2267 community residents over 60 years old from four cites in Jiangsu Province, China. Perceived social support scale, Geriatric Depression Scale, Connor-Davidson Resilience Scale, Comprehensive Ability of Older People Assessment Scale and other influencing factors scales were used to investigate the current situation. Social isolation was measured with the Lubben Social Network Scale. Demographic data were evaluated using descriptive statistical analyses and relationships among study variables were determined to use a path analysis. All data were analyzed using SPSS version 22 and AMOS version 26 using T-test, analysis of variance, logistic regression analyses, and path analysis method. The test level was set at alpha = 0.05, and the difference was statistically significant at P-value <0.05. RESULTS: The results of the model test analysis indicated that the hypothesised paths were supported by data from our samples and demonstrated significance on the path coefficients (P < 0.05). Related factors in the three dimensions of social risk, economic risk and cultural risk have an impact on the social isolation of older people in the community through direct and indirect pathways, and also indirectly through the partially mediated role of depression. Overall, our hypothesised model was retained, indicating empirical support and adequate model fit indices for the theoretical model. CONCLUSION: The findings demonstrated the predictive role of related factors of social isolation in older people. In the future, we should focus on developing interventions by uniting many forces such as society, family and older people themselves to reduce social isolation among this vulnerable population and improve the quality of life of older people and promote healthy ageing.

Preoperative neutrophil-to-lymphocyte ratio (preNLR) for the assessment of tumor characteristics in lung adenocarcinoma patients with brain metastasis.

OBJECTIVES: Brain metastases from lung adenocarcinoma cause significant patient mortality. This study aims to evaluate the role of preoperative Neutrophil-to-Lymphocyte ratio (preNLR) in predicting the survival and prognosis of Lung adenocarcinoma (LUAD) patients with brain metastasis (BM) and provide more references for predicting peritumoral edema. METHODS: We retrospectively reviewed 125 LUAD-BM patients who had undergone surgical resection from December 2015 to December 2020. The clinical characteristic, demographic, MRI data, and preNLR within 24-48 h before craniotomy were collected. Patients were divided into two groups based on preNLR (high NLR and low NLR), with cutoff values determined by receiver operating characteristic (ROC) analysis. Association between preoperative NLR and clinical features was determined by using Pearson chi-squared tests. Uni- and multivariate analyzes were performed to compare the overall survival (OS) of clinical features. RESULTS: The patients were divided into NLR-low (64 patients) and NLR-high (61 patients) groups based on receiver operating characteristic analysis of NLR area. According to correlation analysis, a high preNLR (NLR≥2.8) is associated with the both supra- and infratentorial location involved (P = 0.017) and a greater incidence of severe peritumoral edema (P = 0.038). By multivariable analysis, age ≥ 65 years (P = 0.011), KPS < 70 (P = 0.043), elevated preNLR (P = 0.013), extracerebral metastases (P = 0.003), EGFR/ALK+ (P = 0.037), postoperative radiotherapy (P = 0.017) and targeted therapy (P = 0.007) were independent prognostic factors. OS nomogram was constructed based on cox model and model performance was examined (AUC = 0.935). CONCLUSIONS: PreNLR may serve as a prognosis indicator in LUAD patients with brain metastasis, and high preNLR tends to be positively associate with multiple locations and severe peritumoral edema.

Visual Analysis of Research Hotspots in Geriatric Nursing Education in China and Abroad.

Background: This study aimed to conduct a literature search to determine research hotspots in the field of gerontological care education in China and abroad. A knowledge of the focus of research conducted abroad may assist Chinese educators in determining the shape of gerontological care education in the future. Methods: The "Web of Science Core Collection" and "CNKI" databases were searched for literature on gerontological care education published from 2010 to 2020. CiteSpace software was used to display the knowledge map of co-occurrence of keywords, and an evolution trend map of research hotspots in recent 10 years was constructed. Results: From 2010 to 2020, the focus of foreign gerontological nursing education research was on the training of gerontological nursing personnel; the development of elderly care services; and education and training in dealing with patients with senile delirium and dementia. The focus of gerontological nursing education research in China was primary care education, training of senior elderly nursing personnel, talent training mode reform, training of nursing staff, and career development paths for geriatric nursing staff. Conclusions: Foreign geriatric nursing education research focuses on cultivating talents, mental health services for the elderly, innovating the mode of pension, and the care of patients with disorders such as dementia and delirium, while in China, the emphasis remains on gerontological nursing personnel training. Attention to research developments in other countries may assist Chinese educators to promote the development of geriatric nursing education in our country.

Anti-epileptic effect of 16-O-acetyldigitoxigenin via suppressing mTOR signaling pathway.

Epilepsy is a common chronic disease of the central nervous system that can last for years or even decades, causing serious adverse effects on the body, mind, and psychology of patients. Traditional antiepileptic drugs can effectively control seizures, but because of large individual differences, serious adverse reactions, narrow therapeutic window and other shortcomings, more effective, new treatment drugs are looked for. Streptocaulon griffithii is a plant of Asclepiadaceae. 16-O-acetyldigitoxigenin (ACE) is a strong cardiac glycoside isolated from methanol extract of Streptocaulon griffithii. The aim of this study was to investigate the antiepileptic effect of ACE on Pilocarpine (Pilo) induced epilepsy in mice, and to explore the effect of mTOR signaling pathway on its antiepileptic effect. The results showed that ACE had antiepileptic and neuroprotective effects on Pilo induced epilepsy mice. ACE attenuates Pilo induced seizures by inhibiting the activation of p-mTOR/p-70S6K pathway, and inhibits Pilocarpine induced brain damage by inhibiting mTOR signaling pathway. These results suggest that ACE has a promising future in the treatment of epilepsy and other nervous system diseases.

Histone deacetylase inhibitor treated cell sheet from mouse tendon stem/progenitor cells promotes tendon repair.

Tendon stem/progenitor cells (TSPCs) have been identified as a rare population in tendons. In vitro propagation is indispensable to obtain sufficient quantities of TSPCs for therapies. However, culture-expanded TSPCs are prone to lose their phenotype, resulting in an inferior repaired capability. And little is known about the underlying mechanism. Here, we found that altered gene expression was associated with increased histone deacetylase (HDAC) activity and expression of HDAC subtypes. Therefore, we exposed ScxGFP mice-derived TSPCs to HDAC inhibitor (HDACi) trichostatin A (TSA) or valproic acid (VPA), and observed significant expansion of ScxGFP+ cells without altering phenotypic properties. TSA upregulated Scx expression by inhibiting HDAC1 and -3, and increasing the H3K27Ac level of Tgfb1 and -2 genome region. Additionally, cell sheets formed from TSA-pretreated mTSPCs retained the ability to accelerate tendon repair in vivo. Thus, our results uncovered an unrecognized role of HDACi in phenotypic and functional mTSPCs expansion to enhance their therapeutic potential.

An epigenetic bioactive composite scaffold with well-aligned nanofibers for functional tendon tissue engineering.

Poor tendon repair is often a clinical challenge due to the lack of ideal biomaterials. Electrospun aligned fibers, resembling the ultrastructure of tendon, have been previously reported to promote tenogenesis. However, the underlying mechanism is unclear and the aligned fibers alone are not capable enough to commit teno-differentiation of stem cells. Here, based on our observation of reduced expression of histone deacetylases (HDACs) in tendon stem/progenitor cells (TSPCs) cultured on aligned fibers, we proposed a strategy to enhance the tenogenesis effect of aligned fibers by using a small molecule Trichostatin A (TSA), an HDAC inhibitor. Such a TSA-laden poly (l-lactic acid) (PLLA) aligned fiber (A-TSA) scaffold was successfully fabricated by a stable jet electrospinning method, and demonstrated its sustained capability in releasing TSA. We found that TSA incorporated aligned fibers of PLLA had an additive effect in directing tenogenic differentiation. Moreover, the in situ implantation study in rat model further confirmed that A-TSA scaffold promoted the structural and mechanical properties of the regenerated Achilles tendon. This study demonstrated that HDAC was involved in the teno-differentiation with aligned fiber topography, and the combination of HDAC with aligned topography might be a more efficient strategy to promote tenogenesis of stem cells. STATEMENT OF SIGNIFICANCE: Electrospun aligned fibers, resembling the ultrastructure of tendon, have been previously reported to promote tenogenesis. However, the underlying mechanism is unclear and the aligned fibers alone are not capable enough to commit teno-differentiation of stem cells. The uniqueness of our studies are as follows, based on our observation of reduced expression of histone deacetylases (HDACs) in tendon stem/progenitor cells (TSPCs) cultured on aligned fibers, we proposed a strategy to enhance the tenogenesis effect of aligned fibers by using a small molecule Trichostatin A (TSA), a HDAC inhibitor. Such a TSA-laden poly (l-lactic acid) (PLLA) aligned fiber (A-TSA) scaffold was successfully fabricated by a stable jet electrospinning method, and demonstrated its sustained capability in releasing TSA. The incorporation and subsequent release of bioactive small molecule TSA into electrospun aligned fibers allows a controllable manner for both biochemical and physical regulation of tenogenesis of stem cells both in vitro and in vivo. Collectively, the present study provides a model of "translating the biological knowledge learned from cell-material interaction into optimizing biomaterials (from Biomat-to-Biomat)".

Structure and content components of self-management interventions that improve health-related quality of life in people with inflammatory bowel disease: a systematic review, meta-analysis and meta-regression.

AIMS AND OBJECTIVES: The purpose of this review was to identify and categorise the components of the content and structure of effective self-management interventions for patients with inflammatory bowel disease. BACKGROUND: Inflammatory bowel diseases are chronic gastrointestinal disorders impacting health-related quality of life. Although the efficacy of self-management interventions has been demonstrated in previous studies, the most effective components of the content and structure of these interventions remain unknown. DESIGN: A systematic review, meta-analysis and meta-regression of randomised controlled trials was used. METHODS: A systematic search of six electronic databases, including Pubmed, Embase, Cochrane central register of controlled trials, Web of Science, Cumulative Index of Nursing and Allied Health Literature and Chinese Biomedical Literature Database, was conducted. Content analysis was used to categorise the components of the content and structure of effective self-management interventions for inflammatory bowel disease. Clinically important and statistically significant beneficial effects on health-related quality of life were explored, by comparing the association between effect sizes and various components of self-management interventions such as the presence or absence of specific content and different delivery methods. RESULTS: Fifteen randomised controlled trials were included in this review. Distance or remote self-management interventions demonstrated a larger effect size. However, there is no evidence for a positive effect associated with specific content component of self-management interventions in adult patients with inflammatory bowel disease in general. CONCLUSIONS: The results showed that self-management interventions have positive effects on health-related quality of life in patients with inflammatory bowel disease, and distance or remote self-management programmes had better outcomes than other types of interventions. RELEVANCE TO CLINICAL PRACTICE: This review provides useful information to clinician and researchers when determining components of effective self-management programmes for patients with inflammatory bowel disease. More high-quality randomised controlled trials are needed to test the results.