Improving the quality of care for inflammatory bowel disease

예병덕,Simon Travis 대한장연구학회 2019 Intestinal Research Vol.17 No.1

Great strides have been achieved in the development of quality-of-care measures and standards for inflammatory bowel disease(IBD) over the last decade. The central structural component of care in IBD revolves around the multidisciplinary team,which should be equipped with the necessary resources to operate and implement decisions. Process measures have been definedby interest groups and can be adapted into process tools for the delivery of care for various patient subgroups and clinicalscenarios. The emerging treat-to-target approach to IBD management may be used to achieve optimal long-term and holisticpatient-centred outcomes, such as survival, control of inflammation and disease progression, symptomatic remission, quality oflife and complications. Other important quality-of-care outcome measures for IBD include disutility of care, healthcare utilizationand other patient-reported outcomes such as nutritional status and impact of fistulae. The current challenge for healthcareproviders and health systems is the integration of quality-of-care structures and processes into clinical practice, and the consistentdelivery of updated evidence-based quality IBD care to various patient populations by individual health care providers. Finally, the awareness and appreciation for quality of care in IBD is increasing in Asia, and Asian healthcare institutions shouldbe encouraged to take the lead in improving the quality of care in IBD. (Intest Res 2019;17:45-53)

What’s app? Electronic health technology in inflammatory bowel disease

Alissa Walsh,Simon Travis 대한장연구학회 2018 Intestinal Research Vol.16 No.3

Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.

JAK inhibitor, a new player for treatment-refractory microscopic colitis

( Anne Druez ),( Simon Travis ),( Jean-françois Rahier ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3

Molecular sensing and discrimination by a luminescent terbium–phosphine oxide coordination material

Ibarra, Ilich A.,Hesterberg, Travis W.,Chang, Jong-San,Yoon, Ji Woong,Holliday, Bradley J.,Humphrey, Simon M. The Royal Society of Chemistry 2013 Chemical communications Vol.49 No.64

<P>PCM-15 is a robust and recyclable sensor for the effective discrimination of a wide range of small molecules. Sensing is achieved by direct attenuation of the luminescence intensity of Tb(<SMALL>III</SMALL>) ions within the material. A competition study involving trace amounts of NH<SUB>3</SUB> in H<SUB>2</SUB> gas shows that PCM-15 can be used to quantitatively detect trace analytes.</P> <P>Graphic Abstract</P><P>PCM-15 is a robust and recyclable sensor for the effective discrimination of a wide range of small molecules. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c3cc44575e'> </P>

Why is it so difficult to evaluate faecal microbiota transplantation as a treatment for ulcerative colitis?

( Natalie Grace Fairhurst ),( Simon P. L. Travis ) 대한장연구학회 2018 Intestinal Research Vol.16 No.2

Faecal microbiota transplantation (FMT) has recently re-emerged as a viable therapeutic option for colonic disorders. Its efficacy has been proved in the treatment of Clostridium difficile infection which has encouraged research into the use of FMT for other disorders involving gut dysbiosis, such as ulcerative colitis (UC), a chronic inflammatory disease characterized by relapsing and remitting colonic inflammation. Although the FMT protocol for C. difficile treatment is well established, there are numerous additional factors to consider when applying FMT to treat inflammatory diseases. Various studies have attempted to address these factors but technical inconsistency between reports has resulted in a failure to achieve clinically significant findings. Case reports of FMT in UC have shown favorable outcomes yet demonstrating these effects on a larger scale has proved difficult. The following review aims to explore these issues and to analyze why they may be hindering the progression of FMT therapy in UC. (Intest Res 2018;16:209-215)

REVIEW : “Lemonade Legs”: Why do Some Patients Get Profound Hypomagnesaemia on Proton-Pump Inhibitors?

( Nathan S. S. Atkinson ),( D. John M. Reynolds ),( Simon P. L. Travis ) 대한장연구학회 2015 Intestinal Research Vol.13 No.3

Proton pump inhibitors (PPIs) are widely used though an association with hypomagnesaemia and hypocalcaemia has only been described since 2006. Patients typically present after years of stable dosing with musculoskeletal, neurological or cardiac arrhythmic symptoms, but it is likely that many cases are under-recognised. Magnesium levels resolve rapidly on discontinuation of PPI therapy and hypomagnesaemia recurs rapidly on rechallenge with any agent in the class. The cellular mechanisms of magnesium homeostasis are increasingly being understood, including both passive paracellular absorption through claudins and active transcellular transporters, including the transient receptor potential channels (TRPM6) identified in the intestine and nephron. PPIs may alter luminal pH by modulating pancreatic secretions, affecting non-gastric H+K+ATPase secretion, altering transporter transcription or channel function. A small reduction in intestinal absorption appears pivotal in causing cumulative deficiency. Risk factors have been associated to help identify patients at risk of this effect but clinical vigilance remains necessary for diagnosis. (Intest Res 2015;13:227-232)

Artificial intelligence in inflammatory bowel disease: implications for clinical practice and future directions

( Harris A. Ahmad ),( James E. East ),( Remo Panaccione ),( Simon Travis ),( James B. Canavan ),( Keith Usiskin ),( Michael F. Byrne ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3

Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis and is characterized by uncontrolled, relapsing, and remitting course of inflammation in the gastrointestinal tract. Artificial intelligence represents a new era within the field of gastroenterology, and the amount of research surrounding artificial intelligence in patients with inflammatory bowel disease is on the rise. As clinical trial outcomes and treatment targets evolve in inflammatory bowel disease, artificial intelligence may prove as a valuable tool for providing accurate, consistent, and reproducible evaluations of endoscopic appearance and histologic activity, thereby optimizing the diagnosis process and identifying disease severity. Furthermore, as the applications of artificial intelligence for inflammatory bowel disease continue to expand, they may present an ideal opportunity for improving disease management by predicting treatment response to biologic therapies and for refining the standard of care by setting the basis for future treatment personalization and cost reduction. The purpose of this review is to provide an overview of the unmet needs in the management of inflammatory bowel disease in clinical practice and how artificial intelligence tools can address these gaps to transform patient care. (Intest Res 2023;21:283-294)

IBD2020 global forum: results of an international patient survey on quality of care

( Peter Irving ),( Johan Burisch ),( Richard Driscoll ),( Mats Olsson ),( John R Fullarton ),( Barry S Rodgers-gray ),( Simon Pl Travis ) 대한장연구학회 2018 Intestinal Research Vol.16 No.4

Background/Aims: IBD2020 is a global forum for standards of care in inflammatory bowel disease (IBD). The aim of the IBD2020 survey was to identify and describe variations in quality care of IBD. Methods: Patients with IBD from Finland, Italy, France, Canada, Germany, UK, Spain and Sweden were surveyed during 2013 to 2014, covering: disease characteristics; impact on life and work; organization and perceived quality of care. Results: Seven thousand five hundred and seven patients participated (median age, 39 years [range, 10-103 years]; 2,354 male [31.4%]), including 4,097 (54.6%) with Crohn’s disease (CD) and 3,410 (45.4%) with ulcerative colitis (UC). Median time from symptom onset to diagnosis was 1 year for both CD (range, 0-47 years) and UC (range, 0-46 years), with no clear evidence of improvement in diagnostic delay over the preceding 24 years. Half of the patients (3,429; 50.0%) rated their care as “excellent” or “very good,” with similar results for CD and UC across countries. Five factors were significantly (P<0.01) associated with perceived good quality of care: quality of specialist communication; review consultation being long enough; failure to share information; no access to a dietician; speed of advice. Conclusions: The IBD2020 survey has highlighted areas related to quality of care of IBD from the patients’ perspective, with scope for improvement. (Intest Res 2018;16:537-545)

Real-time data monitoring for ulcerative colitis: patient perception and qualitative analysis

Alissa Walsh,Lawrence Matini,Christopher Hinds,Vanashree Sexton,Oliver Brain,Satish Keshav,John Geddes,Guy Goodwin,Gary Collins,Simon Travis,Michele Peters 대한장연구학회 2019 Intestinal Research Vol.17 No.3

Background/Aims: TrueColours ulcerative colitis (TCUC) is a comprehensive web-based program that functions through email, providing direct links to questionnaires. Several similar programs are available, however patient perspectives are unexplored. Methods: A pilot study was conducted to determine feasibility, usability and patient perceptions of real-time data collection (daily symptoms, fortnightly quality of life, 3 monthly outcomes). TCUC was adapted from a web-based program for patients with relapsing-remitting bipolar disorder, using validated UC indices. A semi-structured interview was developed and audio-recorded face-to-face interviews were conducted after 6 months of interaction with TCUC. Transcripts were coded in NVivo11, a qualitative data analysis software package. An inductive approach and thematic analysis was conducted. Results: TCUC was piloted in 66 patients for 6 months. Qualitative analysis currently defies statistical appraisal beyond “data saturation,” even if it has more influence on clinical practice than quantitative data. A total of 28 face-to-face interviews were conducted. Six core themes emerged: awareness, control, decision-making, reassurance, communication and burden of treatment. There was a transcending overarching theme of patient empowerment, which cut across all aspects of the TCUC experience. Conclusions: Patient perception of the impact of real-time data collection was extremely positive. Patients felt empowered as a product of the self-monitoring format of TCUC, which may be a way of improving self-management of UC whilst also decreasing the burden on the individual and healthcare services.

Adalimumab induction and maintenance therapy achieve clinical remission and response in Chinese patients with Crohn`s disease

( Kai Chun Wu ),( Zhi Hua Ran ),( Xiang Gao ),( Minhu Chen ),( Jie Zhong ),( Jian Qiu Sheng ),( Michael A Kamm ),( Simon Travis ),( Kori Wallace ),( Nael M Mostafa ),( Marisa Shapiro ),( Yao Li ),( Ro 대한장연구학회 2016 Intestinal Research Vol.14 No.2

Background/Aims: This was a Phase 2 study (NCT02015793) to evaluate the pharmacokinetics, safety, and efficacy of adalimumab in Chinese patients with Crohn`s disease (CD). Methods: Thirty, adult Chinese patients with CD (CD Activity Index [CDAI] 220-450; high-sensitivity [hs]-C-reactive protein [CRP] ≥3 mg/L) received double-blind adalimumab 160/80 mg or 80/40 mg at weeks 0/2, followed by 40 mg at weeks 4 and 6. An open-label extension period occurred from weeks 8-26; patients received 40 mg adalimumab every other week. Serum adalimumab concentration and change from baseline in fecal calprotectin (FC) were measured during the double-blind period. Clinical remission (CDAI <150), response (decrease in CDAI ≥70 points from baseline), and change from baseline in hs-CRP were assessed through week 26. Nonresponder imputation was used for missing categorical data and last observation carried forward for missing hs-CRP/FC values. No formal hypothesis was tested. Adverse events were monitored. Results: Mean adalimumab serum concentrations during the induction phase were 13.9-18.1 μg/mL (160/80 mg group) and 7.5-9.5 μg/mL (80/40 mg group). During the double-blind period, higher remission/ response rates and greater reductions from baseline in hs-CRP and FC were observed with adalimumab 160/80 mg compared to that with 80/40 mg. Adverse event rates were similar among all treatment groups. Conclusions: Adalimumab serum concentrations in Chinese patients with CD were comparable to those observed previously in Western and Japanese patients. Clinically meaningful remission rates and improvement in inflammatory markers were achieved with both dosing regimens; changes occurred rapidly with adalimumab 160/80 mg induction therapy. No new safety signals were reported. (Intest Res 2016;14:152-163)