RESUMO
Objective: Endoscopic resection (ER) often involves referral to tertiary centres with high volume practices. Lesions can be subject to prior manipulation and mischaracterisation of features required for accurate planning, leading to prolonged or cancelled procedures. As potential solutions, repeating diagnostic procedures is burdensome for services and patients, while even enriched written reports and still images provide insufficient information to plan ER. This project sought to determine the frequency and implications of polyp mischaracterisation and whether the use of telestration might prevent it. Design/method: A retrospective data analysis of ER referrals to four tertiary centres was conducted for the period July-December 2019. Prospective telestration with a novel digital platform was then performed between centres to achieve consensus on polyp features and ER planning. Results: 163 lesions (163 patients; mean age 67.9±12.2 y; F=62) referred from regional hospitals, were included. Lesion site was mismatched in 11 (6.7%). Size was not mentioned in the referral in 27/163 (16.6%) and incorrect in 81/136 (51.5%), more commonly underestimated by the referring centre (<0.0001), by a mean factor of 1.85±0.79. Incurred procedure time (in units of 20 min) was significantly greater than that allocated (p=0.0085). For 10 cases discussed prospectively, rapid consensus on lesion features was achieved, with agreement between experts on time required for ER. Conclusions: Polyp mischaracterisation is a frequent feature of ER referrals, but could be corrected by the use of telestration between centres. Our study involved expert-to-expert consensus, so extending to 'real-world' referring centres would offer additional learning for a digital pathway.
RESUMO
Objectives: With increasing treatment choices for inflammatory bowel disease (IBD), patients' preferences should be considered to limit non-adherence. We explored patients' preferences for route, form and frequency of medication administration, and factors influencing these choices.Methods: Patients rated acceptability of different forms of medication on 10-point Likert scales and preferences for highest acceptable frequency.Results: Of 298 patients significantly more found tablets (91%) to be highly acceptable compared to granules (64%), infusions (33%) and subcutaneous injections (34%; p < 0.0001). The acceptable frequency for tablets was considered as daily by 63.5% and several times daily by 32.3%. Participants preferred nurse delivered over self-administered injections (median score 8 vs 5, p < 0.0001) and hospital-based infusions over infusions at home (median score 7 vs 5, p = 0.001). Patients with previous or current anti-TNF exposure were more accepting of self-administered injections (50.5% vs 23.3% anti-TNF naive; p < 0.001), more accepting of home based infusions (43.7% vs 28.0%; p = 0.001) and more accepting of hospital-based infusions (57.2% vs 37.8%; p = 0.02).Conclusion: Most patients with IBD prefer tablets. Those patients who already experienced biological agents, had a high level of acceptance for subcutaneous and intravenous forms of medication.