Risk factors for malignancy and serious infection in patients with inflammatory bowel disease: a retrospective analysis.

BACKGROUND: Patients with inflammatory bowel disease (IBD) are at increased risk of malignancy and infection compared to the general population. AIMS: We aim to identify risk factors for malignancy or serious infection in our IBD cohort. METHODS: Patients with IBD from a single tertiary referral centre were included. Demographic and clinical details, including immunosuppressant exposure, were collected and medical records retrospectively screened for adverse events, including malignancy or infection requiring hospitalisation. Logistic regression was used to evaluate risk factors for adverse events. RESULTS: Five hundred and forty-nine patients with IBD (340 Crohn disease (CD) and 209 ulcerative colitis (UC)) were studied. Forty-eight malignancies, including 39 (81.3%) non-melanoma skin cancers, 3 (6.3%) haematologic malignancies and 6 (15.4%) solid-organ malignancies, were identified, and 92 cases of serious infection were detected. IBD duration (odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.03-1.13) and ileocolonic CD (OR = 4.96; 95% CI = 1.13-21.71) were associated with increased odds of overall cancer. Compared with patients not previously exposed to the given class of immunosuppression assessed, the development of overall malignancy was not higher with thiopurine exposure (OR = 1.00; 95% CI = 0.50-2.24) or anti-tumour necrosis factor-alpha (TNF-α) exposure (OR = 0.78; 95% CI = 0.37-1.64). Similarly, compared with patients not exposed, infection risk was not affected by thiopurine (OR = 0.74; 95% CI = 0.46-1.20) or anti-TNF exposure (OR = 0.60; 95% CI = 0.38-0.95). CONCLUSIONS: Factors including ileocolonic CD and increasing IBD duration were associated with higher malignancy risk in this cohort. Compared with non-exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti-TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment.

Outcomes of a Comprehensive Specialist Inflammatory Bowel Disease Nursing Service.

BACKGROUND: Inflammatory bowel disease (IBD) is best managed by a multidisciplinary team within a dedicated IBD service. IBD nurses play an important role within this team. We aimed to evaluate the contribution of our comprehensive outpatient IBD nursing service on patient outcomes, quality of care, and healthcare costs. METHODS: We performed a retrospective review of all IBD nurse encounters with patients over a 12-month period from October 2020 to September 2021 at a tertiary IBD referral center. Each nurse encounter was classified with respect to its clinical context, activities, and outcomes. Descriptive statistics were used to characterize these encounters and an economic analysis was performed to estimate the cost savings to the hospital. RESULTS: A total of 2537 nurse encounters occurred with 682 patients; 41% of encounters were nurse-initiated contacts with patients and 34% were patient-initiated contacts with the nurse helpline (26% via email, 8% via telephone). Most encounters involved clinical assessments (66%), providing education, counseling or updates (47%), and reviewing investigation results (38%). A gastroenterologist was consulted for advice in 35% of contacts. An estimated 29 emergency department visits, 1925 outpatient clinic visits, and 137 general practitioner visits were avoided. After deducting costs incurred, a net estimated annual saving of up to AUD $570 838 was achieved. Nurses commonly facilitated faster access to investigations (29%), education provision (28%), delivery of biologic services (25%), and medication changes (19%). CONCLUSIONS: A comprehensive IBD nursing service is associated with improved patient outcomes and quality of care, and reduced healthcare costs. This study supports the expanding role of IBD nurses in a modern multidisciplinary IBD service and the need for greater funding and integration of IBD nurses into IBD services.

A conceituaçao de fatos clínicos no processo analítico / Conceptualisation of clinical facts in the analytic process

A autora discute neste artigo o que considera como fato clínico, enfatizando que este ocorre dentro da situaçao analítica, entre pacien te e analista. É no processo de conceituar o fato que o analista vem a defini- lo. A fim de operar a conceituaçao, o analista precisa ter um quadro de referên cia, uma base teórica através da qual ele percebe as comunicacçoes de seu paciente e pode dar sentido a elas. No trabalho analítico, o analista utiliza sua teo ria de dois modos principais: ao trabalhar com o paciente, a teoria opera principalmente de modo inconsciente, mas intercalada por um pensamento rápido mais consciente. Quando afastado do paciente, é preciso que a teoria venha ao primeiro plano da mente do analista, sendo entao conscientemente utilizada por ele. A au tora faz uso de caso clínico para ilustrar esses dois aspectos do trabalho teórico. No material apresentado, alguns aspectos de uma primeira sessao sao tentati vamente conceituados. Em seguida, a autora descreve parte do material da mesma paciente depois de alguns anos e discute o método de trabalho e o modo de compreender, podendo dessa forma ilustrar o processo de conceituaçao. O tema da espe rança foi destacado como ponto de ligaçao entre os fragmentos iniciais e poste riores do material

A conceituacao de fatos clinicos no processo analitico

A autora discute neste artigo o que considera como fato clinico, enfatizando que este ocorre dentro da situacao analitica, entre paciente e analista. E no processo de conceituar o fato que o analista vem a defini-lo. A fim de operar a conceituacao, o analista precisa ter quadro de referencia, uma base teorica atraves da qual ele percebe as comunicacoes de seu paciente e poder dar sentido a elas. No trabalho analico, o analista utiliza sua teoria de dois modos principais: ao trabalhar com o paciente, a teoria opera principalmente de modo inconsciente, mas intercalada por um pensamento rapido mais consciente. Quando afastado do paciente, e preciso que a teoria venha ao primeiro plano da mente do analista, sendo entao conscientemente utilizada por ele. A autora faz uso de um caso clinico para ilustrar esses dois aspectos do trabalho teorico. No material apresentado, alguns aspectos de uma primeira sessao sao tentativamente conceituados. Em seguida, a autora descreve parte do material da mesma paciente depois de alguns anos e discute o metodo de trabalho e o modo de compreender, podendo dessa forma ilustrar o processo de conceituacao. O tema da esperanca foi destacado como ponto de ligacao entre os fragmentos iniciais e posteriores do material.