'Quit During COVID-19'-staying smokefree in mental health in-patient settings.

Cigarette smoking is one of the main preventable causes of cancers globally. At this time of global emergency, mental health professionals all over the world are joining hands with the public health and other healthcare communities to focus on acute measures to save lives from COVID-19. This has been particularly challenging in mental health hospital settings where numerous additional factors need to be considered, including difficulties of implementing social distancing, potential impacts of social isolation, increased stress levels and implications of all this on smoking. In this article, we will briefly discuss the prevalence of smoking in mental health patients, especially in those in mental health hospital settings and also what is the possible impact of COVID-19 pandemic in these people. Then we will go through the main reasons as to why encouraging smoking cessation in mental health patients is so important and measures we can take for supporting mental health patients quit smoking even during COVID-19 times. The smoking cessation interventions have a direct bearing on preventing future cancers and achieving smoking cessation among cancer patients in this already disadvantaged group.

IBD2020 global forum: results of an international patient survey on quality of care.

BACKGROUND/AIMS: IBD2020 is a global forum for standards of care in inflammatory bowel disease (IBD). The aim of the IBD2020 survey was to identify and describe variations in quality care of IBD. METHODS: Patients with IBD from Finland, Italy, France, Canada, Germany, UK, Spain and Sweden were surveyed during 2013 to 2014, covering: disease characteristics; impact on life and work; organization and perceived quality of care. RESULTS: Seven thousand five hundred and seven patients participated (median age, 39 years [range, 10-103 years]; 2,354 male [31.4%]), including 4,097 (54.6%) with Crohn's disease (CD) and 3,410 (45.4%) with ulcerative colitis (UC). Median time from symptom onset to diagnosis was 1 year for both CD (range, 0-47 years) and UC (range, 0-46 years), with no clear evidence of improvement in diagnostic delay over the preceding 24 years. Half of the patients (3,429; 50.0%) rated their care as "excellent" or "very good," with similar results for CD and UC across countries. Five factors were significantly (P<0.01) associated with perceived good quality of care: quality of specialist communication; review consultation being long enough; failure to share information; no access to a dietician; speed of advice. CONCLUSIONS: The IBD2020 survey has highlighted areas related to quality of care of IBD from the patients' perspective, with scope for improvement.

Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus.

BACKGROUND AND AIMS: Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease [IBD], for use in different healthcare settings. METHODS: An international working group [n = 25] representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure [PROM] methodologists participated in a series of teleconferences incorporating a modified Delphi process. Systematic review of existing literature, registry data, patient focus groups and open review periods were used to reach consensus on a minimum set of standard outcome measures and risk adjustment variables. Similar methodology has been used in 21 other disease areas [www.ichom.org]. RESULTS: A minimum Standard Set of outcomes was developed for patients [aged ≥16] with IBD. Outcome domains included survival and disease control [survival, disease activity/remission, colorectal cancer, anaemia], disutility of care [treatment-related complications], healthcare utilization [IBD-related admissions, emergency room visits] and patient-reported outcomes [including quality of life, nutritional status and impact of fistulae] measured at baseline and at 6 or 12 month intervals. A single PROM [IBD-Control questionnaire] was recommended in the Standard Set and minimum risk adjustment data collected at baseline and annually were included: demographics, basic clinical information and treatment factors. CONCLUSIONS: A Standard Set of outcome measures for IBD has been developed based on evidence, patient input and specialist consensus. It provides an international template for meaningful, comparable and easy-to-interpret measures as a step towards achieving value-based healthcare in IBD.

The organisation and structure of inflammatory bowel disease services for children and young people in the UK in 2010: significant progress but still room for improvement.

BACKGROUND: Inflammatory bowel disease (IBD) is becoming more common in children. While treatment options remain limited the appropriate organisation and delivery of services are an integral part of good care. METHODS: All eligible UK paediatric sites were invited to submit data for organisation of paediatric IBD services as of 1 September 2010. Comparison, when relevant, was made with the previous paediatric audit (2008) and the concurrently running adult audit. RESULTS: 24/25 (96%) of sites submitted data. The median number of patients managed and the median number of new IBD (ulcerative colitis and Crohn's disease only) cases per annum was 178 (IQR 136-281) and 32 (IQR 23-50), respectively. There was an increase in the IBD workforce including whole-time equivalent (WTE) IBD nurses (1.0 vs 1.5 WTE nurses, p=0.02). 1023 patients 16 years and younger were looked after in the 202 adult sites who submitted data; only 78/202 sites indicated they cared for 16-year-old and younger children; approximately half of these 78 sites had age-appropriate support facilities. Most paediatric sites have access to urgent endoscopy (83%), telephone advice (100%) and urgent clinic appointments (91%). Most sites did not have: shared care pathways with primary care (74%), annual reviews (71%), real time patient management systems (83%) and research network trial participation (78%). CONCLUSIONS: Many aspects of paediatric IBD care in the UK are good and have shown significant improvement over recent years. There are areas in need of further change and specific regional and national action plans should address identified deficiencies before any future audit of paediatric and adult IBD services.

Inflammatory bowel disease in the UK: is quality of care improving?

OBJECTIVE: A national audit conducted in 2005/6 showed unacceptable quality of care for inpatients with inflammatory bowel disease (IBD) in the UK. This was re-audited in 2007/8 and 2010/11. The aim of this study is to examine the quality of care provided for inpatients with IBD in the UK. DESIGN: A programme of engagement and re-audit in 128 hospitals in the UK providing care for adult patients with IBD admitted to hospital between 1 June 2005 and 31 May 2006, 1 September 2007 and 31 August 2008 and 1 September 2010 and 31August 2011. INTERVENTIONS: Wide dissemination of the results, selected site visits, development of national service standards, and the development of an online document repository. MAIN OUTCOME MEASURES: Mortality, medical and surgical treatment, specialist nursing and dietetic care were audited. RESULTS: Data from 1953, 2016 and 1948 patients with ulcerative colitis (UC) and 2074, 2109 and 1900 patients with Crohn's disease (CD) were audited in 2005/6, 2007/8 and 2010/11, respectively. The mortality rate fell from 1.7% to 0.8% (p=0.034) in UC and from 1.3% to 0.8% (p=0.226) in CD. The proportion of inpatients reviewed by an IBD specialist nurse has risen from 23.7% to 44.9% in UC and from 18.1% to 39.9% (p<0.001) in CD. Anti-tumour necrosis factor therapy has increased in UC and CD (p<0.001) while ciclosporin prescription has slightly fallen in UC. Laparoscopic surgeries have significantly increased in UC and CD (p<0.001). CONCLUSIONS: The results show clear evidence of improvement in most aspects of the quality of care for IBD inpatients.

The future of gastroenterology: patient choice, patient voice.

The policy context for patient choice and public and patient involvement (PPI) in the NHS is set out. Both have become increasingly prominent since 2000. A series of NHS systems and policies have been put in place to enable greater patient choice in the belief that the exercise of choice by patients will influence providers to improve quality. This has had some success in elective surgery. One focus has been the publication of outcome data and this may have led to quality improvement through the inherent competitiveness of professionals and institutions. PPI has suffered from a series of unsuccessful reorganisations of patient involvement organisations but has ensured that most health bodies include patient representatives. Capturing patient experience and providing information to enable patient choice have been constantly developed over this time. A particular framework developed by Angela Coulter is used to review current levels of patient engagement in Inflammatory Bowel Disease (IBD), exploring the extent to which patient choice and patient voice are supported and enhanced within current IBD services locally and in national IBD strategy.1 A 2017 vision of the way in which IBD services might maximise patient choice and patient voice is put forward, based on the adoption of present good practice and current service developments, followed by a few rather more radical thoughts about possibilities for after 2017.

Guidelines for the management of inflammatory bowel disease in adults.

The management of inflammatory bowel disease represents a key component of clinical practice for members of the British Society of Gastroenterology (BSG). There has been considerable progress in management strategies affecting all aspects of clinical care since the publication of previous BSG guidelines in 2004, necessitating the present revision. Key components of the present document worthy of attention as having been subject to re-assessment, and revision, and having direct impact on practice include: The data generated by the nationwide audits of inflammatory bowel disease (IBD) management in the UK in 2006, and 2008. The publication of 'Quality Care: service standards for the healthcare of people with IBD' in 2009. The introduction of the Montreal classification for Crohn's disease and ulcerative colitis. The revision of recommendations for the use of immunosuppressive therapy. The detailed analysis, guidelines and recommendations for the safe and appropriate use of biological therapies in Crohn's disease and ulcerative colitis. The reassessment of the role of surgery in disease management, with emphasis on the importance of multi-disciplinary decision-making in complex cases. The availablity of new data on the role of reconstructive surgery in ulcerative colitis. The cross-referencing to revised guidelines for colonoscopic surveillance, for the management of metabolic bone disease, and for the care of children with inflammatory bowel disease. Use of the BSG discussion forum available on the BSG website to enable ongoing feedback on the published document http://www.bsg.org.uk/forum (accessed Oct 2010). The present document is intended primarily for the use of clinicians in the United Kingdom, and serves to replace the previous BSG guidelines in IBD, while complementing recent consensus statements published by the European Crohn's and Colitis Organisation (ECCO) https://www.ecco-ibd.eu/index.php (accessed Oct 2010).

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines.

BACKGROUND: Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. AIM: To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. DESIGN OF STUDY: Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. SETTING: Community-based practice in England, UK. METHODS: Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. RESULTS: A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. CONCLUSION: This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions.

Patients' attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease.

BACKGROUND: Nonadherence has been reported in over 40% of patients taking maintenance therapies (MT) for inflammatory bowel disease (IBD). Studies in other illness groups have shown that nonadherence is related to negative attitudes to treatment. The aim of this study was to assess patients' attitudes to MT for IBD (beliefs about personal need for MT and potential adverse effects) and to identify whether such beliefs are associated with adherence to MT. METHODS: A cross-sectional survey was conducted in which 1871 members of the National Association for Colitis and Crohn's Disease (NACC) completed validated questionnaires assessing beliefs about MT and adherence to MT. RESULTS: Low adherence to MT was reported by 29% of participants and was associated with doubts about personal need for MT (odds ratio [OR] = 0.56; 95% confidence interval [CI]: 0.48-0.64; P < 0.001) and concerns about potential adverse effects (OR = 1.66; 95% CI: 1.42-1.94; P < 0.001). Attitudinal analysis showed that while almost half (48%) of the participants were "accepting" of MT (high necessity, low concerns), a large proportion of the sample (42%) were "ambivalent" about MT (high necessity, high concerns), 6% were "sceptical" (low necessity, high concerns) and 4% were "indifferent" (low necessity, low concerns). Compared to those who were "accepting" of MT, participants in all 3 other attitudinal groups were significantly more likely to be nonadherent. CONCLUSIONS: The way in which patients judge their personal need for MT relative to their concerns about MT can be a significant barrier to adherence. Interventions to facilitate optimal adherence to MT for IBD should address such perceptual barriers.

Mental health outcomes in police personnel after Hurricane Katrina.

OBJECTIVE: We examined symptoms of depression and posttraumatic stress disorder (PTSD) among New Orleans Police Department (NOPD) personnel who provided law enforcement and relief services to affected communities following Hurricane Katrina. METHODS: We conducted a cross-sectional survey of mental health outcomes related to personal and work-related exposures of police personnel 8 weeks after the Hurricane. RESULTS: Of the 912 police personnel who completed the questionnaire, 227 (26%) reported symptoms consistent with depression and 170 (19%) reported symptoms consistent with PTSD. Risk factors associated with PTSD include recovery of bodies, crowd control, assault, and injury to a family member. Depressive symptoms were associated with rare family contact, uninhabitable home, isolation from the NOPD, assault, and injury to a family member. CONCLUSIONS: Police personnel reported symptoms of PTSD and depression associated with work-related and personal factors following Hurricane Katrina.

Floodwater exposure and the related health symptoms among firefighters in New Orleans, Louisiana 2005.

BACKGROUND: Concerns over increased reports of physical health symptoms thought to be related to floodwater exposure among New Orleans firefighters prompted a health hazard evaluation of firefighters following Hurricane Katrina. METHODS: A questionnaire assessing health symptoms possibly related to the response to Hurricane Katrina was administered to all New Orleans Fire Department (NOFD) personnel within 3 months of the disaster. Descriptive statistics were compiled and prevalence ratios (PR) were estimated for covariates using generalized linear models with Log link and Poisson distribution. RESULTS: Of the 525 firefighters who completed the questionnaire (77% participation), 201 (38%) reported one or more new-onset respiratory symptoms, such as sinus congestion (145 [28%]), throat irritation (92 [17%]), and cough (124 [24%]). Skin rash was reported by 258 (49%) of respondents, 414 (79%) reported skin contact with floodwater, and 165 (32%) reported contact with floodwater on multiple days. In multivariate analyses adjusting for age, gender, and smoking, firefighters who had floodwater contact with skin and either nose/mouth or eyes (224, 44%) had an increased rate of new-onset upper respiratory symptoms (PR = 1.9; 95% confidence interval [CI], 1.1, 3.1), and skin rash (PR = 2.1; 95% CI, 1.4, 3.2) compared to those not exposed to the floodwater. CONCLUSIONS: Response workers involved with floodwater should minimize direct skin and mucosal contact with floodwater if possible through the use of appropriate personal protective equipment, such as goggles, safety glasses with side shields, or full-face shields.

Depressive symptoms among firefighters and related factors after the response to Hurricane Katrina.

The National Institute for Occupational Safety and Health conducted an evaluation regarding physical and psychological health symptoms among New Orleans firefighters 13 weeks after Hurricane Katrina struck the U.S. Gulf Coast on August 29, 2005. This report examines associations between depressive symptoms and concurrent comorbidity. Depressive symptoms were twice as likely among those with either lower respiratory symptoms or skin rash. Firefighters housed with their families were less likely to report depressive symptoms compared to those not living with their families. Perceived low supervisor support was associated with depressive symptoms, whereas participating in group counseling was not. The results underscore the need for the incorporation of physical and psychological health follow-up of emergency responders after natural disasters to better understand, monitor, and treat their health conditions.

Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks.

BACKGROUND: On September 11, 2001, 600-800 New York City transit (NYCT) workers were working near the World Trade Center (WTC) Towers. After the disaster, employees reported physical and mental health symptoms related to the event. METHODS: Two hundred sixty-nine NYC transit employees were surveyed for mental and physical health symptoms 7(1/2) months after the WTC disaster. RESULTS: Workers in the dust cloud at the time of the WTC collapse had significantly higher risk of persistent lower respiratory (OR = 9.85; 95% CI: 2.24, 58.93) and mucous membrane (OR = 4.91; 95% CI: 1.53, 16.22) symptoms, depressive symptoms (OR = 2.48; 95% CI: 1.12, 5.51), and PTSD symptoms (OR = 2.91; 95% CI: 1.003, 8.16) compared to those not exposed to the dust cloud. Additional WTC exposures and potential confounders were also analyzed. CONCLUSIONS: Clinical follow up for physical and psychological health conditions should be provided for public transportation workers in the event of a catastrophic event.