ABSTRACT
INTRODUCTION: Crohn's Disease (CD) and Ulcerative Colitis (UC) are chronic, systemic Inflammatory Bowel Diseases (IBDs) that need a multidisciplinary approach involving not only different medical specialists but also qualified nurses. AIM: We evaluated the concordance between IBD-nurse and physician in computing Clinical Activity Scores in IBD-patients treated with biologics. METHODS: We enrolled all consecutive IBD-patients treated with biologics in two referral centers for IBD-care. For each patient, a gastroenterologist and a nurse blindly filled-out a form to assess the Harvey-Bradshaw Index (HBI) in CD or the partial MAYO score in UC. All data were recorded to assess the beyond chance agreement (concordance) using the k statistic. RESULTS: 87 patients were enrolled. The agreement in all patients by k value was substantial (66%), ranging from moderate to substantial (95% CI from 51% to 80%). The main reason of disagreement was about the scoring of remission versus mild activity, and that of mild versus moderate activity, both in CD and UC. For the HBI, the best agreement was for well-being on the previous day (k 62%) and the least one for abdominal mass (k 35%). CONCLUSIONS: Our study shows an acceptable strength of agreement among nurse and gastroenterologist in evaluating the disease activity of IBD-patients through the calculation of clinical scores.
Subject(s)
Colitis, Ulcerative , Crohn Disease , Gastroenterology , Nurse's Role , Nursing Staff, Hospital , Symptom Assessment , Adolescent , Adult , Aged , Aged, 80 and over , Child , Colitis, Ulcerative/complications , Crohn Disease/complications , Female , Health Status , Humans , Male , Middle Aged , Observer Variation , Pilot Projects , Severity of Illness Index , Young AdultABSTRACT
AIM: To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS: From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram). RESULTS: Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01). CONCLUSION: DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.
