A quality assessment of inflammatory bowel disease nursing care in Finland: a nationwide cross-sectional descriptive study.

OBJECTIVES OF THE ARTICLE: Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research. MATERIALS AND METHODS: Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool. RESULTS: Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol. CONCLUSION: In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

Inflammatory bowel disease and anemia: intravenous iron treatment.

OBJECTIVES: The main objective of our study was to determinate the effectiveness of intravenous iron treatment with ferric carboxymaltose in inflammatory bowel disease (IBD) patients. Our other objectives were to study parameters that would predict a good response to the treatment and to chart out possible side-effects of the treatment. MATERIALS AND METHODS: In our retrospective chart review study we collected clinical data and laboratory results related to IBD from medical records of 87 IBD patients who were treated with ferric carboxymaltose in Helsinki University Hospital between 2014 and 2016. RESULTS: The mean increase in hemoglobin levels of the patients was 24.6 g/l (+ 24%) after one month, 27.6 g/l (+ 27%) after three months and 26.0 g/l (+ 27%) after six months. Nine out of 87 treated patients (10.3%) reported side-effects during the iron infusion. A linear regression model assessing the change in hemoglobin levels after six months demonstrated close correlation with transferrin receptor count (p = .004) and ferritin (p = .016) with an adjusted R square of 0.463. CONCLUSION: Ferric carboxymaltose was found to be an effective and well tolerated treatment for iron deficiency anemia in patients with IBD. The results of our study further strengthen the current knowledge of the effectiveness and safety of the treatment.

Clostridium difficile infection in patients with inflammatory bowel disease: a case control study.

OBJECTIVE: Characterization of predisposing factors for Clostridium difficile infection recurrence (rCDI) and outcome in inflammatory bowel disease (IBD) patients. METHODS: Clinical characteristics of 167 inflammatory bowel disease patients with Clostridium difficile infection (IBD-CDI cohort) treated in Helsinki University Central Hospital were gathered. Medical history of the last three months preceding a toxin positive CDI test was recorded. Parameters, including ribotype of C. difficile, mortality and recurrence were compared with age and gender-matched C. difficile patients (CDI cohort). RESULTS: No difference was found in rCDI between IBD-CDI and CDI cohorts. As compared with IBD subtypes, rCDI was least common among patients with Crohn's disease. The use of immunosuppressant therapy was higher in IBD patients with two or more CDI episodes. C. difficile ribotype 027 increased the rates for rCDI in IBD patients but not in non-IBD-CDI patients. The prevalence of 027 ribotype and mortality rates did not differ significantly among the cohorts. None of the IBD patients underwent colectomy upon CDI. CONCLUSION: IBD patients are not more susceptible for rCDI than non-IBD patients. Predisposing factors for rCDI among IBD patients are associated with immunosuppressant treatments, colon affecting IBD and CDI caused by ribotype 027. CDI does not worsen the prognosis of IBD patients.

The impact of an adaptation course on health-related quality of life and functional capacity of patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD) has a substantial impact on patients health-related quality of life (HRQoL). In this study, we examined the impact of adaptation courses on HRQoL, psychological well-being, depression and number of sick-leave days of IBD patients. METHODS: The study recruited 142 IBD patients attending an adaptation course of 5-12 days. The courses were specially designed for IBD patients and included multidisciplinary information about IBD, peer support, group activities and encouragement for adequate physical exercise. The participants completed the study questionnaire at the beginning and the end of the course and after six and 12 months of follow-up. HRQoL was assessed with the generic 15-dimensional (15D) tool and depression with Beck's Depression Inventory (BDI). Utilization of health care services and work absenteeism was also assessed. Visual analog scales were used for assessing psychological functioning. RESULTS: 15D, BDI scores and scores describing psychological well-being were significantly better at the end of the course when compared to baseline (15D 0.82 vs. 0.84, p < .001; BDI 11.8 vs. 8.5, p < .001). Positive results were maintained during follow up. The percentage of patients receiving peer support rose from 32 to 70% and those with peer support had better HRQoL at the 12-month follow-up (p = .01). No significant change in health care utilization or number of sick-leave days was observed. CONCLUSION: Adaptation training appears to have a positive impact on the psychological well-being of IBD patients. Peer support appears to be an important factor.

Outcome of inflammatory bowel disease patients treated with TNF-α inhibitors: two-year follow-up.

BACKGROUND: Biological medications, particularly TNF-α inhibitors, are used increasingly for active inflammatory bowel disease (IBD). Even though they are superior to many older medications in achieving remission and mucosal healing, primary nonresponse and loss of response remain significant problems, and a remarkable proportion of patients still need surgery at some point. OBJECTIVE: To study the outcome of IBD patients treated with TNF-α inhibitors, either infliximab or adalimumab, with a two-year follow-up. PATIENTS AND METHODS: Patient data from the hospital electronic patient documents of IBD patients treated with TNF-α inhibitors were studied. The main targets of interest were treatment response, the remission rate and the number of patients operated, as well as reasons for the discontinuation of treatment. Remission was defined both endoscopically and by faecal calprotectin. RESULTS: Altogether 100 patients were included. Only 29% of the patients achieved remission during the two-year follow-up. 26% of the Crohn's disease patients and 36% of the ulcerative colitis patients underwent surgery during the follow-up. A significant proportion of patients experienced side effects of the medication (21%) or discontinued the therapy for other reasons (altogether 63%). CONCLUSIONS: In this single centre study of 100 IBD patients treated with TNF-α inhibitors, less than one-third of the patients achieved remission, and a significant proportion had side effects and needed surgery during the two-year follow-up. There is an obvious need for more effective therapies with less side effects for IBD patients.

[Interruption of biological drugs in patients affected with inflammatory diseases]. / Biologisten lääkkeiden tauotus tulehduksellisia tauteja sairastavilla.

The use of biological drugs in the treatment of inflammatory rheumatic diseases, bowel diseases, and psoriasis has increased. Patients receiving a biological drug are invariably under the supervision of a specialized physician, but many are also attending basic healthcare clinics. Every physician taking care of a patient receiving a biological drug should be aware of the principles of interruption. In the present article we will focus on common situations, where an interruption of a biological drug must be considered in the treatment of these inflammatory diseases.

Health-related quality of life among patients with primary sclerosing cholangitis.

BACKGROUND & AIMS: To assess health-related quality of life (HRQoL) of patients with primary sclerosing cholangitis (PSC), and to compare it with that of the general population. Also, to examine changes in HRQoL in newly diagnosed PSC patients at a follow-up 1-2 years later, and to compare their HRQoL with HRQoL of newly diagnosed inflammatory bowel disease (IBD) patients. Furthermore, sources of and need for disease-related information among PSC patients were surveyed. METHODS: Primary sclerosing cholangitis patients filled in the survey questionnaire when attending an endoscopic retrograde cholangiography examination. The 15D served as a general HRQoL instrument. The follow-up questionnaire was mailed to the newly diagnosed patients 1-2 years later. RESULTS: No significant difference was seen in 15D scores between PSC patients and general population, but the dimensions of excretion (P < 0.001), depression (P = 0.003), distress (P = 0.003) and vitality (P = 0.005) were significantly lower in PSC. Age and symptoms affected HRQoL but severity of biliary changes did not. Those with newly diagnosed IBD had lower 15D scores than those with PSC. No significant changes were observed in 15D scores of new PSC patients in the follow-up. Many patients were dissatisfied with information received. CONCLUSION: Newly diagnosed PSC patients have better HRQoL than do IBD patients, and no significant HRQoL changes were observed in the mean follow-up of 1.58 years after PSC diagnosis. ERC findings did not correlate with HRQoL or symptoms. HRQoL of PSC patients was mostly comparable with that of general population, but special attention should be paid to patients' psychological well-being.

The burden of inflammatory bowel disease on health care utilization and quality of life.

OBJECTIVE: The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors. MATERIAL AND METHODS: 556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients. RESULTS: During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p < 0.001). The use of health services did not differ between diagnostic (Crohn's disease or ulcerative colitis) or age groups, marital status, education, or time elapsed since diagnosis. Women were absent from work more frequently than men (p = 0.01). The amount of physician visits, work absenteeism, and a higher amount of undergone procedures were related to impaired HRQoL (p < 0.001 on all accounts). CONCLUSIONS: Despite comprehensive public health services and specialized care for IBD patients in Finland, a majority expressed disturbing IBD symptoms. Since the amount of physician visits, work absenteeism and a higher amount of procedures were related to a diminished HRQoL, the patients who are most often met by professional caregivers are often those whose HRQoL needs to be more adequately addressed.

Medication use among inflammatory bowel disease patients: excessive consumption of antidepressants and analgesics.

OBJECTIVE: Little is known about differences in the use of medications between inflammatory bowel disease (IBD) patients and the general population. The aims of this study were to observe those differences and to discuss reasons for them. The relation between medication use and HRQoL of IBD patients was examined. MATERIAL AND METHODS: The use of prescribed medication of 2831 IBD patients and 5662 control subjects were scrutinized and compared by utilizing a national reimbursement register. Annual costs and number of defined daily doses (DDD) of medications were calculated. The relationship between medications and health-related quality of life (HRQoL) of IBD patients was examined by using a postal questionnaire including a generic (15D) and a disease-specific (IBDQ) HRQoL tool. The questionnaire also included demographic questions and questions about IBD patients' use of biological medications. RESULTS: Use of antidepressants (OR: 1.44, 95% CI: 1.28-1.61), anxiolytics (OR: 1.52, 95% CI: 1.31-1.78), oral bisphosphonates (OR: 6.08, 95% CI: 4.56-8.11), cardiovascular medications (OR: 1.38, 95% CI: 1.24-1.54), antibiotics (OR: 4.01, 95% CI: 3.57-4.51), proton pump inhibitors (OR: 3.90, 95% CI: 3.48-4.36), and nonsteroidal anti-inflammatory analgesics (OR: 1.17, 95% CI: 1.07-1.28) was significantly more common in IBD than among the controls. Those who used antidepressants, anxiolytics, or analgesics had significantly impaired HRQoL (p < 0.001). CONCLUSIONS: IBD patients and general population differ in terms of their medicine use in many respects, and especially use of analgesics and antidepressants is more common among IBD patients. Use of antidepressants, anxiolytics, and analgesics was related to impaired HRQoL.

Fecal calprotectin and S100A12 have low utility in prediction of small bowel Crohn's disease detected by wireless capsule endoscopy.

OBJECTIVE: Data on fecal calprotectin and S100A12 in predicting wireless capsule endoscopy (WCE) findings in suspicion of Crohn's disease (CD) are scarce. Our aim was to study the role of calprotectin and S100A12 in predicting inflammatory lesions of small bowel in patients undergoing WCE. MATERIAL AND METHODS: 84 patients undergoing WCE (77 for suspicion of CD and 7 CD patients for evaluation of disease extent) were prospectively recruited. WCE findings were scored. Patients provided a stool sample for measurements of biomarkers. Patients underwent an esophagogastroduodenoscopy and ileocolonoscopy before WCE. RESULTS: WCE was abnormal in 35 (42%) of 84 patients: 14 patients with CD, 8 with NSAID enteropathies, 8 with angioectasias, 4 with polyps or tumors, and 1 with ischemic stricture. Median calprotectin concentration in the study population was 22 µg/g (range 2-342) and S100A12 concentration 0.048 µg/g (range 0.003-1.215). Fecal calprotectin was significantly higher in CD patients (median 91, range 2-312) compared with those with normal WCE or other abnormalities (p = 0.008), whereas fecal S100A12 (0.087 µg/g, range 0.008-0.896) did not differ between the groups (p = 0.166). In detecting inflammatory small bowel lesions, sensitivity, specificity, positive predictive value, and negative predictive value for fecal calprotectin (cutoff 50 µg/g) were 59%, 71%, 42%, and 83%, and for S100A12 (cutoff 0.06 µg/g) these were 59%, 66%, 38%, and 82%. CONCLUSIONS: In predicting small bowel inflammatory changes, fecal biomarkers calprotectin and S100A12 have moderate specificity, but low sensitivity. Neither fecal calprotectin nor S100A12 can be used for screening or excluding small bowel CD.