Assessment of patients' understanding of inflammatory bowel diseases: Development and validation of a questionnaire.

BACKGROUND: Educating patients regarding thier inflammatory bowel disease (IBD) is important for their empowerment and disease management. We aimed to develop a questionnaire to evaluate patient understanding and knowledge of IBD. METHODS: We have developed the Understanding IBD Questionnaires (U-IBDQ), consisting of multiple-choice questions in two versions [for Crohn's disease (CD) and ulcerative colitis (UC)]. The questionnaires were tested for content and face validity, readability, responsiveness and reliability. Convergent validity was assessed by correlating the U-IBDQ score with physician's subjective assessment scores. Discriminant validity was assessed by comparison to healthy controls (HC), patients with chronic gastrointestinal (GI) conditions other than IBD, and to GI nurses. Multivariate analysis was performed to determine factors associated with a high level of disease understanding. RESULTS: The study population consisted of IBD patients (n = 106), HC (n = 35), chronic GI disease patients (n = 38) and GI nurses (n = 19). Mean U-IBDQ score among IBD patients was 56.5 ± 21.9, similar for CD and UC patients (P = 0.941), but significantly higher than that of HC and chronic GI disease patients and lower than that of GI nurses (P < 0.001), supporting its discriminant validity. The U-IBDQ score correlated with physician's subjective score (r = 0.747, P < 0.001) and was found to be reliable (intra-class correlation coefficient = 0.867 P < 0.001). Independent factors associated with high U-IBDQ scores included academic education (OR = 1.21, 95% CI 1.10-1.33, P < 0.001), biologic therapy experience (OR = 1.24, 95% CI 1.01-1.53, P = 0.046), and IBD diagnosis at <21 years of age (OR = 2.97, 95% CI 1.05-8.87, P = 0.050). CONCLUSIONS: The U-IBDQ is a validated, reliable and short, self-reported questionnaire that can be used for assessing understanding of disease pathophysiology and treatment by IBD patients.

Preemptive enteral nutrition enriched with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in severe multiple trauma: a prospective, randomized, double-blind study.

BACKGROUND: Severe injury triggers a complex systemic immune response which may result in significant respiratory compromise, including the development of acute respiratory distress syndrome (ARDS). No randomized clinical trial has assessed the role of nutritional interventions to limit respiratory complications. METHODS: This was a single-center, prospective, randomized, comparative, double-blind, controlled study of patients with severe trauma requiring mechanical ventilation. Patients were randomly assigned to receive either a control formula (n = 58) or a formula enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA) and antioxidants (n = 62) at time of admission to the intensive care unit (ICU). Primary outcome measures included the level of oxygenation (PaO2/FiO2 ratio, PF ratio) on days 4 and 8, incidence of acute lung injury (ALI) and/or ARDS and length of ventilation. The development of infectious complications and fatty acid red blood cell membrane composition were also assessed. RESULTS: In this intention-to-treat population, no significant differences between the control and study groups were found for the PF ratio at day 4 (213.7 ± 85.6 vs. 227.2 ± 67.7, respectively; P = 0.24) and day 8 (187.8 ± 65.2 vs. 188.9 ± 56.0, respectively; P = 0.82), the incidence of ARDS/ALI (24.1 vs. 29.0 %, respectively; P = 0.68), length of ventilation time (13.6 ± 10.7 vs. 17.0 ± 15.1 days, respectively; P = 0.15), duration of ICU stay (16.4 ± 11.3 vs. 19.5 ± 15.3 days, respectively; P = 0.21) and 28-day mortality (8.6 vs. 12.9 %, respectively P = 0.56). While the study group showed a significant increase in EPA and GLA concentrations at day 4 (P = 0.05) and day 8 (P < 0.001), the Omega-3 Index (O-3I) failed to reach those suggested as being optimal to obtain clinical efficacy. The significantly higher incidence of bacteremia noted in the study group (P = 0.03) was associated with a higher number of patients with multiple trauma and a higher red blood cell transfusion requirement (P = 0.008). CONCLUSION: This study failed to show a significant benefit for the preemptive use of the study formula in patients with severe trauma. Additional studies need to be performed in which the amount of supplementation is targeted to a potentially measurable endpoint, e.g. the O-3I.

Impact of a nutritional formula enriched in fish oil and micronutrients on pressure ulcers in critical care patients.

BACKGROUND: Pressure ulcers are an important source of morbidity and suffering for patients and a formidable burden on caregivers. OBJECTIVES: To assess the impact of a feeding formula enriched with fish oil on healing of preexisting pressure ulcers and serum levels of C-reactive protein in critical care patients. METHODS: Adult patients with pressure ulcers grade II or higher were randomly allocated to receive either a formula enriched with fish oil or an isocaloric control formula. Wound healing was assessed by using the Pressure Ulcer Scale for Healing tool on days 7, 14, and 28. Blood levels of C-reactive protein were measured on days 0, 7, and 14. RESULTS: Baseline demographics did not differ between the study (n = 20) and the control (n = 20) groups. The mean score on the ulcer healing tool increased significantly (P = .02) from day 0 to day 28 in the control group (from 9.25 [SD, 2.12] to 10.75 [SD, 3.41]) compared with the study group (from 9.10 [SD, 2.84] to 9.40 [SD, 3.72]). Mean levels of C-reactive protein decreased significantly (P= .02) from day 0 to day 14 in the study group (from 191 [SD, 104.4] mg/L to 111.7 [SD, 97.8] mg/L) compared with the control group (from 145 [SD, 90] mg/L to 139 [SD, 62] mg/L). CONCLUSION: Administration of a feeding formula enriched with fish oil was associated with decreased progression of pressure ulcers and a decrease in blood concentrations of C-reactive protein.