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1.
PLoS One ; 19(3): e0298374, 2024.
Article in English | MEDLINE | ID: mdl-38451904

ABSTRACT

OBJECTIVE: Quality Improvement initiatives aim to improve care in Inflammatory Bowel Disease (IBD). These address a range of aspects of care including adherence to published guidelines. The objectives of this review were to document the scope and quality of published quality improvement initiatives in IBD, highlight successful interventions and the outcomes achieved. DESIGN/METHOD: We searched MEDLINE, EMBASE, CINAHL and Web of Science. Two reviewers independently screened and extracted data. We included peer reviewed articles or conference proceedings reporting initiatives intended to improve the quality of IBD care, with both baseline and prospectively collected follow-up data. Initiatives were categorised based on problems, interventions and outcomes. We used the Quality Improvement Minimum Quality Criteria Set instrument to appraise articles. We mapped the focus of the articles to the six domains of the IBD standards. RESULTS: 100 studies were identified (35 full text; 65 conference abstracts). Many focused on vaccination, medication, screening, or meeting multiple quality measures. Common interventions included provider education, the development of new service protocols, or enhancements to the electronic medical records. Studies principally focused on areas covered by the IBD standards 'ongoing care' and 'the IBD service', with less focus on standards 'pre-diagnosis', 'newly diagnosed', 'flare management', 'surgery' or 'inpatient care'. CONCLUSION: Good quality evidence exists on approaches to improve the quality of a narrow range of IBD service functions, but there are many topic areas with little or no published quality improvement initiatives. We highlight successful quality improvement interventions and offer recommendations to improve reporting of future studies.


Subject(s)
Inflammatory Bowel Diseases , Quality Improvement , Humans , Exercise , Exercise Therapy , Inflammatory Bowel Diseases/therapy
2.
Cureus ; 15(9): e44660, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37799219

ABSTRACT

A woman and man in their 20s presented to the accident and emergency (A&E) department with abdominal pain, vomiting, and absolute constipation. They both presented as atypical candidates for faecal impaction with few medical and lifestyle risk factors. On CT imaging, a faecolith was visualised in the sigmoid colon as a cause of the large bowel obstruction (LBO) in both patients. A faecolith obstruction can be a life-threatening sequela of faecal impaction. The first line of treatment for LBO is conservative management with oral laxatives and enemas. If this is unsuccessful, interventions such as flexible sigmoidoscopy with the placement of enemas above the blockage can be used. In the event of a compromise to bowel vascularity or if previous interventions prove unsuccessful, there is also scope for surgery. After the resolution of the blockage, follow-up investigations should be performed to elicit an underlying cause in the hope of preventing a recurrence.

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