RESUMO
BACKGROUND: Patients with inflammatory bowel disease (IBD) experience difficulties in daily life and demanding self-care needs. The goal of our support for patients is to ease their difficulties and improve their belief in their capacity to self-manage their disease (self-efficacy), by increasing their ability for self-care. The nurse's contribution is vital in empowering patients and supporting them to better manage their disease. There is evidence that higher nurse staffing levels are associated with better patient outcomes in acute care settings, but little is known about the outpatient setting. The objective of this study was to explore the impact of multidisciplinary team care with abundant nurse staffing levels on patient-reported outcome measures (PROMs) among patients with IBD, encompassing Crohn's disease (CD) and ulcerative colitis (UC), in clinical remission. METHODS: Patients with IBD in clinical remission were included because disease activity influences the patient's subjective evaluation. A total of 499 valid responses from two different sources were analyzed: 318 from a specialized IBD clinic with abundant nurse staffing and a multidisciplinary care team (UC: 83, CD: 235) and 181 from an online survey panel (UC: 109, CD: 72). The IBD Self-Efficacy Scale (IBD-SES) and the difficulty of life scale (DLS) were used as disease-specific PROMs. RESULTS: In two multiple regression models adjusted by background characteristics (age, sex, diagnosis [UC/CD], employment status, use of biologics, and disease duration) using the IBD-SES or DLS as a dependent variable, the responses from clinic patients showed a more favorable score (higher self-efficacy or lower difficulty) than the online responses. CONCLUSIONS: Multidisciplinary team care with abundant nurse staffing may improve self-efficacy and ease difficulties of life among patients with IBD in clinical remission. These results could help bring attention to nurse staffing in an outpatient setting, which has previously been overlooked, and be the first to provide evidence of its importance in encouraging enhanced staffing levels.
Assuntos
Doenças Inflamatórias Intestinais , Equipe de Assistência ao Paciente , Medidas de Resultados Relatados pelo Paciente , Humanos , Feminino , Masculino , Adulto , Equipe de Assistência ao Paciente/organização & administração , Pessoa de Meia-Idade , Doenças Inflamatórias Intestinais/terapia , Doenças Inflamatórias Intestinais/psicologia , Doenças Inflamatórias Intestinais/enfermagem , Inquéritos e Questionários , Autoeficácia , Qualidade de Vida , Colite Ulcerativa/terapia , Doença de Crohn/terapia , Doença de Crohn/psicologia , Admissão e Escalonamento de PessoalRESUMO
Lesley Dibley, Reader in Nursing Research and Education, University of Greenwich (L.B.Dibley@greenwich.ac.uk), and Jennie Burch, Head of Gastrointestinal Nurse Education, St Mark's Hospital, outline the need to assess patients' emotional as well as physical needs before stoma surgery for IBD.
Assuntos
Adaptação Psicológica , Doenças Inflamatórias Intestinais/cirurgia , Estomas Cirúrgicos , Pesquisa Biomédica , Previsões , Humanos , Doenças Inflamatórias Intestinais/enfermagemRESUMO
Introduction: The purpose of this review is to highlight the role of biosimilars in early treatment in IBD and introduce ways to facilitate a patient-centric switching process through multidisciplinary approach. Areas covered: We summarize existing scientific literature related to the role of biosimilars in inflammatory bowel disease in terms of early treatment and cost-saving and implementing switching process. Expert opinion: Use of anti-TNF biosimilars in patients has the potential for large drug-acquisition cost-saving, which can be reinvested into early treatment. Managed switched programs for adalimumab can add further benefits in the future.
Assuntos
Anti-Inflamatórios/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Doença de Crohn/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Medicamentos Biossimilares/administração & dosagem , Medicamentos Biossimilares/economia , Doença de Crohn/diagnóstico , Doença de Crohn/economia , Doença de Crohn/enfermagem , Custos de Medicamentos , Monitoramento de Medicamentos/economia , Monitoramento de Medicamentos/métodos , Diagnóstico Precoce , Humanos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/enfermagem , Doenças Inflamatórias Intestinais/terapia , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/métodosRESUMO
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.
Assuntos
Doenças Autoimunes/diagnóstico , Doenças Autoimunes/enfermagem , Doenças Autoimunes/terapia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/enfermagem , Colite Ulcerativa/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/enfermagem , Doença de Crohn/terapia , Doença de Graves/diagnóstico , Doença de Graves/enfermagem , Doença de Graves/terapia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/enfermagem , Doença de Hashimoto/terapia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/enfermagem , Doenças Inflamatórias Intestinais/terapia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/enfermagem , Lúpus Eritematoso Sistêmico/terapia , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/enfermagem , Esclerose Múltipla/terapiaRESUMO
Symptoms (pain, fatigue, sleep disturbance, depression, and anxiety) in inflammatory bowel disease (IBD) are associated with reduced quality of life. Understanding how IBD symptoms cluster and the clinical and demographic factors associated with symptom clusters will enable focused development of symptom management interventions. The study purposes were to (i) identify symptom cluster membership among adults with IBD and (ii) examine associations between demographic (age, gender, race/ethnicity, and education) and clinical factors (smoking status, time since diagnosis, medication type, IBD type, disease activity), and membership in specific symptom cluster groups. We conducted a retrospective study of data from the Crohn's and Colitis Foundation of America's (CCFA) Partners Cohort and used Patient Reported Outcome Measurement Information System (PROMIS) measures to measure pain interference, fatigue, sleep disturbance, anxiety, and depression. The sample included 5,296 participants with IBD (mean age 44, 72% female). In latent class analysis (LCA), four groups of participants were identified based on symptoms: "low symptom burden" (26% of sample), "high symptom burden" (38%), "physical symptoms" (22%), and "psychological symptoms" (14%). In multinomial regression, female gender, smoking, corticosteroids, Crohn's disease, and active disease state were associated with membership in the high symptom burden group. Additional research is needed to test interventions that may be effective at reducing symptom burden for individuals with IBD.
Assuntos
Doenças Inflamatórias Intestinais/enfermagem , Doenças Inflamatórias Intestinais/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Síndrome , Estados UnidosRESUMO
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.
Assuntos
Colite Ulcerativa/enfermagem , Doença de Crohn/enfermagem , Colite Ulcerativa/genética , Colite Ulcerativa/imunologia , Colite Ulcerativa/microbiologia , Doença de Crohn/genética , Doença de Crohn/imunologia , Doença de Crohn/microbiologia , Microbioma Gastrointestinal , Humanos , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/microbiologia , Doenças Inflamatórias Intestinais/enfermagem , Qualidade de VidaRESUMO
Inflammatory bowel disease (IBD) is a chronic, idiopathic disease characterized by inflammation of the gastrointestinal tract. It affects more than 5 million people worldwide and in Chile studies suggest that IBD incidence has increased in recent years. It is manifested by periods of remission and activity, requiring permanent pharmacological treatment. Both, the occurrence of a crisis episode and the need for lifetime medical treatment could affect the quality of life of IBD patients. Studies suggest that patients with IBD require education to develop self-management of their disease and adhere to treatment, thus reducing the risk of crisis episodes. The importance of this strategy or action is significant if we consider that studies have shown that the level of knowledge of IBD patients regarding their pathology is low. The purpose of this article is to review the effect of education on the management of IBD patients and the implications of a multidisciplinary team with an IBD specialist nurse.
La enfermedad inflamatoria Intestinal (EII) es una enfermedad crónica, idiopática, caracterizada por la inflamación del tracto gastrointestinal. Afecta a más de 5 millones de personas en el mundo y en Chile estudios sugieren que ha ido en aumento en los últimos años. Se manifiesta por períodos de remisión y actividad, siendo necesario un tratamiento farmacológico permanente. Tanto la presencia de crisis como la necesidad de un tratamiento médico de por vida, podrían afectar la calidad de vida de estos pacientes. Estudios sugieren que los pacientes con EII requieren de educación para poder desarrollar un buen autocuidado de su enfermedad, adherirse al tratamiento y disminuir así el riesgo de crisis. Esta estrategia o acción no deja de ser importante si consideramos que estudios han mostrado que el nivel de conocimiento de los pacientes con EII respecto a su patología es bajo. El propósito de este artículo es revisar el efecto de la educación en el manejo de los pacientes con EII, y las implicancias de un equipo multidisciplinario con una enfermera especialista en EII que realice el seguimiento de estos pacientes.
Assuntos
Humanos , Equipe de Assistência ao Paciente , Doenças Inflamatórias Intestinais/terapia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Doenças Inflamatórias Intestinais/enfermagem , Colite Ulcerativa/terapia , Doença de Crohn/terapia , Conhecimentos, Atitudes e Prática em Saúde , Cooperação do Paciente , Cooperação e Adesão ao TratamentoRESUMO
Improving the daily life of patients suffering from inflammatory bowel disease is one of the objectives of the gastroenterological team of Nice general hospital. Therapeutic patient education has been developed in the hospital, through the Edu MICI programme. The practice of this multi-disciplinary team gives nurses the opportunity to fully express their unique role.
Assuntos
Doenças Inflamatórias Intestinais/enfermagem , Doenças Inflamatórias Intestinais/terapia , Equipe de Enfermagem/normas , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Adulto , Doença de Crohn/enfermagem , Doença de Crohn/psicologia , Doença de Crohn/terapia , Feminino , Humanos , Doenças Inflamatórias Intestinais/psicologia , Masculino , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Autonomia Pessoal , Desenvolvimento de Programas , Autoeficácia , Adulto JovemRESUMO
BACKGROUND: Chronic gastrointestinal symptoms after pelvic radiotherapy are common, multifactorial in cause, and affect patients' quality of life. We assessed whether such patients could be helped if a practitioner followed an investigative and management algorithm, and whether outcomes differed by whether a nurse or a gastroenterologist led this algorithm-based care. METHODS: For this three-arm randomised controlled trial we recruited patients (aged ≥18 years) from clinics in London, UK, with new-onset gastrointestinal symptoms persisting 6 months after pelvic radiotherapy. Using a computer-generated randomisation sequence, we randomly allocated patients to one of three groups (1:1:1; stratified by tumour site [urological, gynaecological, or gastrointestinal], and degree of bowel dysfunction [IBDQ-B score <60 vs 60-70]): usual care (a detailed self-help booklet), gastroenterologist-led algorithm-based treatment, or nurse-led algorithm-based treatment. The primary endpoint was change in Inflammatory Bowel Disease Questionnaire-Bowel subset score (IBDQ-B) at 6 months, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00737230. FINDINGS: Between Nov 26, 2007, and Dec 12, 2011, we enrolled and randomly allocated 218 patients to treatment: 80 to the nurse group, 70 to the gastroenterologist group, and 68 to the booklet group (figure). Most had a baseline IBDQ-B score indicating moderate-to-severe symptoms. We recorded the following pair-wise mean difference in change in IBDQ-B score between groups: nurse versus booklet 4·12 (95% CI 0·04-8·19; p=0·04), gastroenterologist versus booklet 5·47 (1·14-9·81; p=0·01). Outcomes in the nurse group were not inferior to outcomes in the gastroenterologist group (mean difference 1·36, one sided 95% CI -1·48). INTERPRETATION: Patients given targeted intervention following a detailed clinical algorithm had better improvements in radiotherapy-induced gastrointestinal symptoms than did patients given usual care. Our findings suggest that, for most patients, this algorithm-based care can be given by a trained nurse. FUNDING: The National Institute for Health Research.
Assuntos
Gastroenterologia , Trato Gastrointestinal/efeitos da radiação , Doenças Inflamatórias Intestinais/enfermagem , Neoplasias Pélvicas/radioterapia , Lesões por Radiação/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Doenças Inflamatórias Intestinais/etiologia , Masculino , Pessoa de Meia-Idade , Folhetos , Qualidade de Vida , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Resultado do TratamentoAssuntos
Terapia Biológica , Unidades Hospitalares/organização & administração , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/terapia , Seleção de Pacientes , Anticorpos Antivirais/sangue , Autoanticorpos/sangue , Terapia Biológica/efeitos adversos , Terapia Biológica/enfermagem , Análise Química do Sangue , Protocolos Clínicos , Testes Diagnósticos de Rotina , Hospitais Universitários/organização & administração , Humanos , Imunossupressores/efeitos adversos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/enfermagem , Testes de Função Hepática , Guias de Prática Clínica como Assunto , Sociedades Médicas , Espanha , Teste Tuberculínico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , VacinaçãoRESUMO
A stoma constitutes a surgical solution for diseases, most commonly cancerous, of the digestive or urinary systems or for inflammatory bowel diseases. In order to gain a better understanding of how people choose and use their stoma appliances, the French federation of stoma patients (FSF) carried out a survey of its members in 2004.
Assuntos
Neoplasias do Sistema Digestório/enfermagem , Doenças Inflamatórias Intestinais/enfermagem , Estomas Cirúrgicos , Neoplasias Urológicas/enfermagem , Adulto , Idoso , Desenho de Equipamento , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estomas Cirúrgicos/efeitos adversos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life. OBJECTIVES: To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD). SEARCH STRATEGY: A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008). SELECTION CRITERIA: Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion. DATA COLLECTION AND ANALYSIS: Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus. MAIN RESULTS: One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences. AUTHORS' CONCLUSIONS: Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.
Assuntos
Doenças Inflamatórias Intestinais/enfermagem , Padrões de Prática em Enfermagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Inflammatory bowel disease is highly associated with an option of potential surgical treatment. Variety of surgical methods require detailed and appropriate patient preparation for the operation. In our study we tried to present some problems in dealing with patients with inflammatory bowel disease in aspect of perioperative period. We discussed methods of solving these problems and expected effects of nursing procedures.