Prevalence of faecal incontinence in patients with inflammatory bowel disease: Severity and its relationship with quality of life.

AIMS: To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method. DESIGN: Correlational-descriptive study. METHODS: Hebrew-speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale. RESULTS: Ninety-six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty-five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self-perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self-embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group. CONCLUSION: A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse. IMPACT: There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

DIFERENCES IN THE INTERPRETATION OF "DNR" AMONG PHYSICIANS AND NURSES ON INTERNAL MEDICINE WARDS.

In 2005, in an attempt to regulate care for patients expected to live no longer than six months, Israel enacted the Dying Patient Law. The law sets forth in detail actions that should be performed to respect the patient's wishes, and also defines treatment to be given to patients who have directed that there be no heroic measures taken to prolong life. In some terminal cases, such as a patient who stops breathing or has a cardiac arrest, health care providers are instructed not to perform cardiopulmonary resuscitation (CPR). However, most healthcare providers are unsure of exactly what the definition of the Do-Not-Resuscitate order (DNR) means. The research goal was to identify opinions held by nurses and physicians as to the meaning of the DNR directive. The study was of a descriptive correlational design, based on a convenience sample of 61 physicians and nurses. The research instrument comprised a structured self administrative questionnaire. The results showed differences in the opinions of the health care staff as to which actions should be performed on patients who signed DNR directives, and which should not. While a majority of the respondents agreed that heart massage and ventilation were considered actions that should not be performed on DNR patients, other actions were found to be the subject of differences of opinion. For example, about half the respondents considered imaging tests and other tests as actions that should not be performed if a DNR order is in place. The study emphasizes the need to set multiple parameters and not only a single-dimension definition of DNR. Nurses and physicians should have regularly scheduled meetings to discuss the DNR order of specific patients.

Factors associated with corticosteroid use in Crohn's disease and ulcerative colitis patients in Israel: A multicenter cross-sectional study.

BACKGROUND: We examined corticosteroid use among Israeli patients with Inflammatory Bowel Disease (IBD), focusing on demographic, disease-related, and psychosocial factors. The objective was to contribute to the development of strategies minimizing corticosteroid dependence and improving patient outcomes, given the adverse effects associated with prolonged corticosteroid use. METHODS: A comprehensive analysis was conducted on data collected from adult IBD patients attending six gastroenterological outpatient clinics in Israel. The data collected encompassed disease characteristics, demographic information, service level characteristics, social data, and steroid use. Statistical analyses were performed to associate these variables with steroid use. RESULTS: Out of 402 patients, 26 % had been treated with corticosteroids in the previous year, with a majority of these having only one treatment course. Of patients treated with steroids, 57% (n-44) met steroid dependent/excess criteria. Steroid use was more common in patients diagnosed with ulcerative colitis (UC) compared to those with Crohn's disease. Factors such as a diagnosis of UC, male gender, elevated C-reactive protein and fecal calprotectin, and decreased albumin and hemoglobin were associated with steroid use. CONCLUSION: Corticosteroid use among Israeli IBD patients was associated with disease-related factors and some demographic characteristics. The results highlight the need for continued research to inform strategies aimed at reducing corticosteroid dependence in managing IBD, thereby improving patient outcomes.