"I would not go to him": Focus groups exploring community responses to a public health campaign aimed at reducing unnecessary diagnostic imaging of low back pain.

BACKGROUND: Community awareness of the harms of overdiagnosis remains low. OBJECTIVE: To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain. METHODS: We conducted two focus groups of 19 community members with or without low back pain in Sydney, Australia. This study formed the fourth and final stage of the development process of a public health campaign: (a) initial design, (b) expert review and revision, (c) online experiment and (d) community views & revision. We evaluated reactions to components of the campaign that included digital posters and an information leaflet using strong imagery and messaging about the risk of overdiagnosis. We conducted a qualitative thematic analysis to identify main themes. RESULTS: Community members reacted with surprise, initial mistrust, and occasionally anger towards imagery and messaging that suggested diagnostic imaging tests could be unnecessary and harmful. With further reflection and discussion, and after reading longer format information about overdiagnosis, the participants found some of the messages informative and useful. Participants appeared to gain a better understanding of the concept of overdiagnosis and the importance of not rushing to imaging. CONCLUSIONS: Public health campaigns including posters and leaflets displayed in waiting rooms could raise awareness about overuse of diagnostic imaging and the harms of overdiagnosis more broadly. However, negative reactions are possible and must be managed carefully. PATIENT OR PUBLIC CONTRIBUTION: We involved a community participation manager who provided advice on the focus group discussion guide, participant recruitment and manuscript presentation.

Ileocecal Anastomosis Type Significantly Influences Long-Term Functional Status, Quality of Life, and Healthcare Utilization in Postoperative Crohn's Disease Patients Independent of Inflammation Recurrence.

OBJECTIVES: Anastomotic reconstruction following intestinal resection in Crohn's disease (CD) may employ side-to-side anastomosis (STSA; anti-peristaltic orientation) or end-to-end anastomosis (ETEA). Our aim was to determine the impact of these two anastomotic techniques on long-term clinical status in postoperative CD patients. METHODS: We performed a comparative effectiveness study of prospectively collected observational data from consented CD patients undergoing their first or second ileocolonic bowel resection and re-anastomosis between 2008 and 2012, in order to assess the association between anastomosis type and 2-year postoperative quality of life (QoL), healthcare utilization, disease clinical or endoscopic recurrence, use of medications, and need for repeat resection. RESULTS: One hundred and twenty eight postoperative CD patients (60 STSA and 68 ETEA) were evaluated. At 2 years postoperatively, STSA patients had higher rates of emergency department visits (33.3% vs. 14.7%; P=0.01), hospitalizations (30% vs. 11.8%; P=0.01), and abdominal computed tomography scans (50% vs. 13.2%; P<0.001) with lower QoL (mean short inflammatory bowel disease questionnaire 47.9 vs. 53.4; P=0.007). There was no difference among the two groups in the 30 day surgical complications and 2-year patterns of disease activity, CD medication requirement, endoscopic recurrence, and need for new surgical management (all P > 0.05). CONCLUSIONS: At 2 years postoperatively, CD patients with ETEA demonstrated better QoL and less healthcare utilization compared with STSA, despite having similar patterns of disease recurrence and CD treatment. These findings suggest that surgical reconstruction of the bowel as an intact tube (ETEA) contribute to improved functional and clinical status in patients with CD.

We May Have Done Something Right: Composite Restorations at the College of Dentistry, University of Tennessee Health Science Center.

The success of composite restorations requires meticulous clinical technique in addition to reliable restorative materials and armamentarium. Early failure of restorations is undesirable and are usually replaced at no cost to patients. A metaanalysis study reported a mean annual failure rate of 1.46% for posterior composite restorations. At the University of Tennessee Health Science Center College of Dentistry (UTHSC CoD) predoctoral clinic the percentage of posterior composite restorations replaced within 12 months, retrieved from 2007-2014 electronic chart 'redo' records, was on average 0.58%. Several factors may have contributed to the quality of composite restorations placed by novice clinicians with modest experience. Student doctors are educated about composite placement in preclinical courses and then work under close supervision during their clinical training. This article describes restorative techniques for composites and the rationales taught at the UTHSC CoD Department of Restorative Dentistry. The objective is to share the information, which can be adopted or modified by general practitioners in daily practice.

Introduction to Clinical Practice in Dentistry: Transitioning from Pre-clinical to Clinical Student Doctors at The University of Tennessee Health Science Center College of Dentistry.

Matriculation from the pre-clinical setting to the clinical environment is a tremendous accomplishment and exemplifies the student's perseverance in learning the fundamental concepts necessary for success in the clinical application of dentistry. In an effort to maximize its educational philosophy for the teaching program, the University of Tennessee's College of Dentistry has implemented Introduction to Clinical Practice I and II within the dental curriculum. Introduction to Clinical Practice I and II are designed to help the dental students effectively and smoothly transition to the clinical setting from the classroom and pre-clinical setting. This article describes the university's efforts and continuous improvements within the pre-clinical dental curriculum for advancing students to the clinics. The purpose of this article is to provide helpful information to other dental educational institutions on how to assist their pre-clinical dental students in transitioning to clinical student-doctors.

Technological Innovations in the Restorative Department at the University of Tennessee College of Dentistry.

The UT College of Dentistry has been one of the leaders in the introduction of the CAD/CAM delivery of dentistry to the dental students. The integration of technology into a dental school curriculum requires a change in thinking and a modification of the curriculum in order to introduce it to the present day students This article updates the integration of the CEREC system into the UT Dental School curriculum, discussing the changes in equipment and teaching techniques since the last article in 2012.

The possible ocular hazards of LED dental illumination applications.

The use of high-intensity illumination via Light-Emitting Diode (LED) headlamps is gaining in popularity with dentists and student dentists. Practitioners are using LED headlamps together with magnifying loupes, overhead LED illumination and fiber-optic dental handpieces for long periods of time. Although most manufacturers of these LED illuminators advertise that their devices emit "white" light, these still consist of two spectral bands - the blue spectral band, with its peak at 445 nm, and the green with its peak at 555 nm. While manufacturers suggest that their devices emit "white" light, spectral components of LED lights from different companies are significantly different. Dental headlamp manufacturers strive to create a white LED, and they advertise that this type of light emitted from their product offers bright white-light illumination. However, the manufacturing of a white LED light is done through selection of a white LED-type based on the peak blue strength in combination with the green peak strength and thus creating a beam-forming optic, which determines the beam quality. Some LED illuminators have a strong blue-light component versus the green-light component. Blue-light is highly energized and is close in the color spectrum to ultraviolet-light. The hazards of retinal damage with the use of high-intensity blue-lights has been well-documented. There is limited research regarding the possible ocular hazards of usage of high-intensity illuminating LED devices. Furthermore, the authors have found little research, standards, or guidelines examining the possible safety issues regarding the unique dental practice setting consisting of the combined use of LED illumination systems. Another unexamined component is the effect of high-intensity light reflective glare and magnification back to the practitioner's eyes due to the use of water during dental procedures. Based on the result of Dr. Janet Harrison's observations of beginning dental students in a laboratory setting, the aim of this review is to raise awareness of the potential risk for eye damage when singular or combinations of LED illumination are used.

Efficacy of Ustekinumab and Vedolizumab Among Postoperative Crohn's Disease Patients as Postoperative Prophylaxis and Rescue Therapy: Real-world Data.

BACKGROUND: Almost half of patients with Crohn's disease (CD) require bowel surgeries in their lifetime. Due to the high risk of postoperative disease recurrence and high rate of previous antitumor necrosis factor (anti-TNF) failure, often alternative therapy options such as ustekinumab (UST) and vedolizumab (VDZ) are used. We aimed to evaluate the efficacy of UST and VDZ among postoperative CD patients as postoperative prophylaxis and rescue therapy. METHODS: Consented CD patients who underwent initial ileocecal resection and were treated with UST and VDZ were included in this study. Demographics, clinical characteristics, health care utilization, endoscopy scores, and surgery outcomes were collected. Postoperative early CD recurrence was defined as a Rutgeerts endoscopic score ≥i2 within the first 2 years. The rescue therapy group was defined as patients who received either UST or VDZ after having Rutgeerts endoscopic score ≥i2 postoperatively. RESULTS: During 2009 to 2019, 98 CD patients were treated with UST or VDZ postoperatively. Postoperative early recurrence rates were 5% (n = 1 out of 20) and 6% (1 out of 15) for the UST and VDZ groups, respectively. Two patients from the UST group and 1 patient from the VDZ group required bowel surgery during follow-up with median drug exposure of 51 (95% confidence interval [CI], 29-61) and 30 (95% CI, 14-63) months, respectively; 55% and 69% of patients had at least 1 point of improvement on postoperative endoscopic Rutgeerts score, respectively, for UST and VDZ. Only 3 out of 40 and 1 out of 23 patients required bowel surgery during follow-up while receiving UST and VDZ as rescue therapy. CONCLUSIONS: Both UST and VDZ were effective as postoperative therapies either as prophylaxis or rescue therapy.

This retrospective 11-year data examines the efficacy of ustekinumab and vedolizumab among postoperative Crohn's disease patients. When utilizing postoperative Rutgeerts score, this study confirms that both ustekinumab and vedolizumab were effective as postoperative therapies either as prophylaxis or rescue therapy.

The status of health librarianship and libraries in the Republic of Ireland (SHELLI): a mixed methods review to inform future strategy and sustainability.

BACKGROUND: This paper summarises the main points of a review of the Status of Health Librarianship & Libraries in Ireland (SHELLI). The review was commissioned to gain a broad understanding of what was happening in practice in Ireland; acquire knowledge about international best practice, and to inform strategic plans to develop and sustain health libraries and librarianship in Ireland. METHODS: A Mixed Methods approach was used: a literature review; an online survey distributed to health librarians; Semi structured interviews with key stakeholders; a focus group drawing participants from the survey. All evidence was triangulated. RESULTS: New roles for health librarians needed development and the changing educational needs of health librarians warranted attention. Increased collaboration across institutional boundaries needed more consideration, especially in relation to access to e-resources. Marketing of library services was crucial. Irish health library standards, needed to be updated and enforced and a proper evidence base established. The literature provided a number of examples of potentially useful initiatives. CONCLUSIONS: A strategic plan of action was drawn up in three areas: (i) to identify champions and promote visibility of health service libraries, (ii) to establish a body of evidence and (iii) to support service development and staff mentoring.

The possible ocular hazards of LED dental illumination applications.

The use of high-intensity illumination via Light-Emitting Diode (LED) headlamps is gaining in popularity with dentists and student dentists. Practitioners are using LED headlamps together with magnifying loupes, overhead LED illumination and fiber-optic dental handpieces for long periods of time. Although most manufacturers of these LED illuminators advertise that their devices emit "white" light, these still consist of two spectral bands--the blue spectral band, with its peak at 445 nm, and the green with its peak at 555 nm. While manufacturers suggest that their devices emit "white" light, spectral components of LED lights from different companies are significantly different. Dental headlamp manufacturers strive to create a white LED, and they advertise that this type of light emitted from their product offers bright white-light illumination. However, the manufacturing of a white LED light is done through selection of a white LED-type based on the peak blue strength in combination with the green peak strength and thus creating a beam-forming optic, which determines the beam quality. Some LED illuminators have a strong blue-light component versus the green-light component. Blue-light is highly energized and is close in the color spectrum to ultraviolet-light. The hazards of retinal damage with the use of high-intensity blue-lights has been well-documented. There is limited research regarding the possible ocular hazards of usage of high-intensity illuminating LED devices. Furthermore, the authors have found little research, standards, or guidelines examining the possible safety issues regarding the unique dental practice setting consisting of the combined use of LED illumination systems. Another unexamined component is the effect of high-intensity light reflective glare and magnification back to the practitioner's eyes due to the use of water during dental procedures. Based on the result of Dr. Janet Harrison's observations of beginning dental students in a laboratory setting, the aim of this review is to raise awareness of the potential risk for eye damage when singular or combinations of LED illumination are used.

Oral Health and Behavior Patterns of Women with Eating Disorders-A Clinical Pilot Study.

BACKGROUND: Chronic stomach regurgitation associated with eating disorders (EDs) poses a high risk for tooth erosion. This study investigated oral health conditions, behavioral patterns, and tooth erosion in women with EDs. METHODS: 16 ED and 13 healthy women were enrolled; 14 ED and 10 healthy control subjects completed the study. Subjects completed demographic, medical, oral, and behavioral health history questionnaires. Dental caries status was recorded as Decayed, Missing and Filled Teeth (DMFT)index and the severity of tooth erosion as Basic Erosive Wear Examination (BEWE) scores. Saliva was collected for flow rate, pH, and buffering capacity analysis. RESULTS: The ED group had a lower stimulated saliva flow rate and higher DMFT index but no significant difference in BEWE scores compared to the controls (t-test, significance level 0.05). Five of the fourteen ED subjects exhibited extensive tooth erosion, which may have been exacerbated by their tooth-brushing behavior. CONCLUSIONS: Although some ED subjects showed extensive tooth erosion in this pilot study, the average BEWE score of the ED group was not significantly different from the controls. Extensive tooth erosion in ED may relate to the low stimulated salivary flow. A larger-scale clinical study is necessary to validate these results.

Granuloma Presence at Initial Surgery Predicts Need for Repeat Surgery Independent of Rutgeerts Score in Crohn's Disease.

BACKGROUND: Approximately half of Crohn's disease (CD) patients experience recurrence and need for repeat resections, highlighting need for prognostic biomarkers. Presence of epithelioid granuloma on surgical tissue and high Rutgeerts endoscopic score are associated with postoperative CD clinical recurrence. We sought to evaluate presence of epithelioid granuloma at first surgery and Rutgeerts score as a combined risk assessment for CD surgical recurrence. METHODS: Our study included consented CD patients who underwent initial ileocecal resection and were prospectively followed postoperatively. From 2009 to 2019, 418 CD patients underwent initial ileocecal resection with >4 years of follow-up, including postoperative endoscopic assessment (Rutgeerts score). RESULTS: Postoperative CD patients were grouped based on granuloma presence (30.6%; n = 128) or absence (69.4%; n = 290). Endoscopic recurrence (defined as Rutgeerts score ≥i2) was similar between the granuloma (26%) and no granuloma (25%) groups, respectively (P = .82). Patients with granuloma and CD endoscopic recurrence at first postoperative endoscopy had higher number of bowel surgeries compared with all other groups (no granuloma or CD endoscopic recurrence, P = .007; no granuloma but CD endoscopic recurrence present, P = .04; granuloma present and no CD endoscopic recurrence, P = .04). Epithelioid granuloma presence was associated with 1.65 times higher risk of subsequent surgery independently from first postoperative endoscopic recurrence Rutgeerts score. CONCLUSIONS: Granuloma presence on initial surgical histology is immediately available and identifies high-risk CD patients who may benefit from early postoperative treatment, and these precision intervention trials are warranted.

This study shows the presence of epithelioid granuloma as a risk factor for repeat Crohn's disease­related surgery, which is independent of first postoperative Rugteerts score. These 11-year observational data provide a risk factor that is immediately available after surgery and identifies high-risk CD patients who may benefit from early postoperative treatment.

Integrating the CEREC technology at UT College of Dentistry.

The computer-aided design/computer-aided manufacturing (CAD/CAM) has evolved during the past 25 years, and this evolution has improved the speed and precision in which dentists can deliver high quality esthetic restorations. CEREC is an acronym for "ceramic reconstruction" and is one of the CAD/CAM systems available to dentists in private practice. The University of Tennessee College of Dentistry was one of the first dental schools in the United States to embrace this technology and integrate it into the four-year curriculum. In a dental school setting, this technology can prove to be an educational tool for the dental students, cost effective for the University and provide exceptional service for the patients.

'Talking about my generation': a state-of-the-art review of health information for men in the andropause.

The focus of this article is the availability and use of information in the UK about the male menopause or as it's beginning to be known by the general public and health professionals, the andropause. The experiences of men suffering from the andropause today are reflective of menopausal women some 20 or 30 years ago. Ignorance and fear of the andropause condition abounds in the general public and amongst health professionals. There is a paucity of information in the literature about the symptoms and condition of the andropause. The review considers the provision and use of information available for men in the andropause in the public domain, examining both NHS and condition specific sources. The use of electronic sources is specifically reviewed, including an online forum. The use of electronic sources is indicative of other health information users. The reviewer concludes by suggesting that increased knowledge sharing is required by health professionals and the general public about the symptoms and condition of the andropause. It is recommended that men in the andropause identify a 'champion' to assist their cause. This will help in gaining greater recognition and understanding of the condition and attract the most appropriate treatment.

Serum IgG4 Subclass Deficiency Defines a Distinct, Commonly Encountered, Severe Inflammatory Bowel Disease Subtype.

BACKGROUND: Immunoglobulin G subclass 4 (IgG4) is hypothesized to play an immunomodulatory role, downregulating humoral immune responses. The role of this anti-inflammatory molecule in inflammatory bowel disease (IBD) has not been fully characterized. We sought to define alterations in serum IgG4 in patients with IBD and their association with multiyear disease severity. METHODS: We analyzed metadata derived from curated electronic health records from consented patients with IBD prospectively followed at a tertiary center over a 10-year time period. Patients with IBD with IgG4 serum levels available formed the study population. Demographics and multiyear clinical data were collected and analyzed. We stratified patients with IBD with low, normal, or high serum IgG4 levels. RESULTS: We found IgG4 characterized in 1193 patients with IBD and low IgG4 levels in 233 patients (20%) and elevated IgG4 levels in 61 patients (5%). An IgG4 deficiency did not significantly correlate with other antibody deficiencies. In a multiple Poisson regression analysis, low IgG4 was associated with more years on biologic agents (P = 0.002) and steroids (P = 0.049) and more hospital admissions (P < 0.001), clinic visits (P = 0.010), outpatient antibiotic prescriptions (P < 0.001), and CD-related surgeries (P = 0.011) during the study period after controlling for certain confounders. Elevated IgG4 was only associated with primary sclerosing cholangitis (P = 0.011). A cohort of patients with IgG4-deficient severe IBD received intravenous Ig replacement therapy, which benefited and was continued in 10 out of 11 individuals. CONCLUSIONS: An IgG4 subclass deficiency, distinct from other antibody deficiencies, occurred commonly in a referral IBD population and was associated with multiple markers of disease severity. This is the first association of IgG4 subclass deficiency with an inflammatory disease process. Further work is needed to define the mechanistic role of IgG4 deficiency in this severe IBD subgroup.

Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.

BACKGROUND: This study sought to establish the long-term effects of Covid-19 following hospitalisation. METHODS: 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). FINDINGS: 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. INTERPRETATION: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females. FUNDING: National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation.

Changes in in-hospital mortality in the first wave of COVID-19: a multicentre prospective observational cohort study using the WHO Clinical Characterisation Protocol UK.

BACKGROUND: Mortality rates in hospitalised patients with COVID-19 in the UK appeared to decline during the first wave of the pandemic. We aimed to quantify potential drivers of this change and identify groups of patients who remain at high risk of dying in hospital. METHODS: In this multicentre prospective observational cohort study, the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK recruited a prospective cohort of patients with COVID-19 admitted to 247 acute hospitals in England, Scotland, and Wales during the first wave of the pandemic (between March 9 and Aug 2, 2020). We included all patients aged 18 years and older with clinical signs and symptoms of COVID-19 or confirmed COVID-19 (by RT-PCR test) from assumed community-acquired infection. We did a three-way decomposition mediation analysis using natural effects models to explore associations between week of admission and in-hospital mortality, adjusting for confounders (demographics, comorbidities, and severity of illness) and quantifying potential mediators (level of respiratory support and steroid treatment). The primary outcome was weekly in-hospital mortality at 28 days, defined as the proportion of patients who had died within 28 days of admission of all patients admitted in the observed week, and it was assessed in all patients with an outcome. This study is registered with the ISRCTN Registry, ISRCTN66726260. FINDINGS: Between March 9, and Aug 2, 2020, we recruited 80 713 patients, of whom 63 972 were eligible and included in the study. Unadjusted weekly in-hospital mortality declined from 32·3% (95% CI 31·8-32·7) in March 9 to April 26, 2020, to 16·4% (15·0-17·8) in June 15 to Aug 2, 2020. Reductions in mortality were observed in all age groups, in all ethnic groups, for both sexes, and in patients with and without comorbidities. After adjustment, there was a 32% reduction in the risk of mortality per 7-week period (odds ratio [OR] 0·68 [95% CI 0·65-0·71]). The higher proportions of patients with severe disease and comorbidities earlier in the first wave (March and April) than in June and July accounted for 10·2% of this reduction. The use of respiratory support changed during the first wave, with gradually increased use of non-invasive ventilation over the first wave. Changes in respiratory support and use of steroids accounted for 22·2%, OR 0·95 (0·94-0·95) of the reduction in in-hospital mortality. INTERPRETATION: The reduction in in-hospital mortality in patients with COVID-19 during the first wave in the UK was partly accounted for by changes in the case-mix and illness severity. A significant reduction in in-hospital mortality was associated with differences in respiratory support and critical care use, which could partly reflect accrual of clinical knowledge. The remaining improvement in in-hospital mortality is not explained by these factors, and could be associated with changes in community behaviour, inoculum dose, and hospital capacity strain. FUNDING: National Institute for Health Research and the Medical Research Council.

Infliximab prevents Crohn's disease recurrence after ileal resection.

BACKGROUND & AIMS: Crohn's disease commonly recurs after intestinal resection. We evaluated whether the administration of infliximab after resective intestinal surgery for Crohn's disease reduces postoperative recurrence. METHODS: We randomly assigned 24 patients with Crohn's disease who had undergone ileocolonic resection to receive intravenous infliximab (5 mg/kg), administered within 4 weeks of surgery and continued for 1 year, or placebo. The primary end point was the proportion of patients with endoscopic recurrence at 1 year. Secondary end points were clinical recurrence and remission and histologic recurrence. RESULTS: The rate of endoscopic recurrence at 1 year was significantly lower in the infliximab group (1 of 11 patients; 9.1%) compared with the placebo group (11 of 13 patients; 84.6%) (P = .0006). There was a nonsignificant higher proportion of patients in clinical remission in the infliximab group (8 of 10; 80.0%) compared with the placebo group (7 of 13; 53.8%) (P = .38). The histologic recurrence rate at 1 year was significantly lower in the infliximab group (3 of 11 patients; 27.3%) compared with the placebo group (11 of 13 patients; 84.6%) (P = .01). The occurrence of adverse events was similar between the placebo and infliximab groups, and none occurred in the immediate postoperative period. CONCLUSIONS: Administration of infliximab after intestinal resective surgery was effective at preventing endoscopic and histologic recurrence of Crohn's disease.

Clinical librarians, a new tribe in the UK: roles and responsibilities.

AIMS: The aims of this research were to determine the background, education, training experience, roles and responsibilities of practising Clinical Librarians (CL) in the UK. This paper reports the findings of a survey undertaken in 2007 at the third Clinical Librarian conference. This research builds on research undertaken by Harrison and Sargeant in 2002 and Ward in 2004, and can be considered as part of a longitudinal study of the role of the CL in the UK. OBJECTIVES: The objectives of the research were to define and gain a broad understanding of the role of the CL in the UK highlighting similarities and differences amongst the professionals and provide evidence for a baseline of skills and activities for the CL role. The type of sampling used was Judgmental. RESULTS/ANALYSIS: Results/analysis detail the skills and activities undertaken by CLs. Searching for information for Clinicians was the activity most frequently undertaken. Developing good relationships with other healthcare professionals was considered essential. Two-thirds of the respondents held a postgraduate library qualification. CONCLUSIONS: Crucially a new model for the UK CL role is derived drawing on the findings of this study and the existing literature.

Disease Characteristics and Severity in Patients With Inflammatory Bowel Disease With Coexistent Diabetes Mellitus.

BACKGROUND: Given the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM. METHODS: Data of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment. RESULTS: Out of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn's disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P < 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P < 0.001, gastroenterology clinic visits P < 0.001, and median annual charges P < 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations. CONCLUSIONS: This study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.