Evaluation of Crohn's disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin.

OBJECTIVES: To develop an MRI enterography global score (MEGS) of Crohn's disease (CD) activity compared with a reference standard of faecal calprotectin (fC), C-reactive protein (CRP) and Harvey-Bradshaw index (HBI). METHODS: Calprotectin, CRP and HBI were prospectively recorded for 71 patients (median age 33, male 35) with known/suspected CD undergoing MRI enterography. Two observers in consensus scored activity for nine bowel segments, grading mural thickness, T2 signal, mesenteric oedema, T1 enhancement and pattern, and haustral loss. Segmental scores were multiplied according to disease length. Five points each were added for lymphadenopathy, comb sign, fistulae and abscesses to derive the MEGS. A previously validated MRI CD activity score (CDAS) was also calculated. MRI scores were correlated with clinical references using Spearman's rank. A logistic regression diagnostic model was built to discriminate active (fC > 100 µg/g) from inactive disease. RESULTS: MEGS and CDAS were significantly correlated with fC (r = 0.46, P < 0.001) and (r = 0.39, P = 0.001) respectively. MEGS correlated with CRP (r = 0.39, P = 0.002). The model for discriminating active from inactive disease achieved an area under the receiver-operating curve of 0.75 and 0.66 after leave-one-out analysis. CONCLUSION: A magnetic resonance enterography global score (MEGS) of CD activity correlated significantly with fC levels. KEY POINTS: • Magnetic resonance imaging is now widely used to assess Crohn's disease. • Existing MRI activity scores depend on local segmental endoscopic/histological reference standards. • Scores including assessment of disease extent/complications better demonstrate full disease burden. • This new global Crohn's disease burden score correlates with calprotectin and CRP. • The MRI enterography score of disease activity can complement existing clinical markers.

Quality Practice Award and teamworking: the perceptions of Primary Health Care Team members in Scotland.

Evidence exists that those teams which complete an agreed task experience an improvement in team functioning. The aim of this study was to investigate whether completion of the Royal College of General Practitioners Quality Practice Award (QPA) improved the team members' perception of teamworking within their Primary Health Care Teams (PHCTs). A postal questionnaire was sent to all 158 PHCT members in 6 Scottish practices that achieved QPA in 2001 followed by selected telephone interviews. General practitioners (GPs), nurses and administrative staff showed a statistically significant improvement in their perception of teamworking as a result of completing QPA, but nurses reported this to a lesser degree. Protocols and audit work, followed by improvements in communication were perceived to have had the most beneficial effect on teamwork. After completing QPA, 79% of GPs, 64% of nurses and 84% of administrative staff perceived an improvement in the standard of care provided. Qualitative data confirmed that team functioning improved by completing QPA, but that a certain level of team functioning was necessary before a practice begins the QPA process. Teams also hoped to maintain the high standards inherent in QPA in the future but had concerns regarding workload.