Gastroenterology Patients Research Articles

Transformation of a gastroenterology inpatient service

Numerous studies have demonstrated that consultant delivered care can lead to: increases in productivity, reduction of length of stay as well as increasing patient satisfaction.[1][1] The gastroenterology inpatient (IP) service at Kettering General Hospital was reconfigured to implement NHS

Transformation of a gastroenterology inpatient service

Numerous studies have demonstrated that consultant delivered care can lead to: increases in productivity, reduction of length of stay as well as increasing patient satisfaction.[1][1] The gastroenterology inpatient (IP) service at Kettering General Hospital was reconfigured to implement NHS

Sa1089 – A Retrospective Review of Intravenous Iron Therapy in Gastroenterology Inpatients: A Single Center Experience

Sa1089 – A Retrospective Review of Intravenous Iron Therapy in Gastroenterology Inpatients: A Single Center Experience

Sa1010 – Lack of Recommended Pneumococcal Conjugate Vaccine Uptake Among Gastroenterology Patients At High Risk

Sa1010 – Lack of Recommended Pneumococcal Conjugate Vaccine Uptake Among Gastroenterology Patients At High Risk

Tu1602 – Measurement of Stress and Anxiety and the Associated Factors in Pediatric Gastroenterology Patients

Tu1602 – Measurement of Stress and Anxiety and the Associated Factors in Pediatric Gastroenterology Patients

Developing Nursing Care Standards for Postoperative Gastrointestinal Patients

Background: The postoperative arena is a unique environment that includes many challenging variables: complex clinical care performed by teams; high cost, sophisticated technologies that often do not interoperate; and a large array of supplies, instruments, and implants that are difficult to manage. Study aim : to develop a standard of nursing care for postoperative gastrointestinal patients. The study setting : was conducted at three postoperative gastrointestinal wards in the Gastro-Enterology Center at Mansoura University Hospitals. The subject: consisted of 90 juries, and 70 nurses working at the postoperative gastrointestinal care wards. The study tools : were two juries’ opinionnaire and two observation checklists. The results : indicated that the observation checklist entailing nursing care for postoperative gastrointestinal patients was valid through full acceptance by juries. The checklist entailing structure items of postoperative gastrointestinal units was also validated by experts' consensus. Application of the checklist showed that the performance of bachelor nurses was higher than that diploma nurses. The reliability was tested through verifying internal consistency using the Cronbach’s alpha coefficient and showed high reliability of the tool. All items of the initial checklist of nursing care for postoperative gastroenterology patients and an initial checklist of structure items were used in developing the nursing care standard for postoperative gastroenterology patients, which was also validated by experts. Conclusion and Recommendations : The developed standard for postoperative gastrointestinal patients is recommended to be applied at postoperative gastrointestinal units. Nurses working at postoperative gastrointestinal units should have a copy of the developed standards in Arabic and English languages. Keywords: Nursing care standard, postoperative gastrointestinal DOI : 10.7176/JHMN/59-09

Impact of a Quality Improvement Initiative to Optimize the Discharge Process of Pediatric Gastroenterology Patients at an Academic Children's Hospital.

Introduction:Discharge is an important and complex process that can be optimized to reduce inpatient healthcare inefficiency and waste. This study aimed to increase the percentage of patients discharged before 1 pm by 20% from an academic inpatient pediatric gastroenterology service (IPGS), over 6 months.Methods:We conducted a preintervention and postintervention study of patients discharged from IPGS. Patients discharged from January to June 2016, and those following our intervention from June to December 2016, were studied. Interventions included (1) implementation of the electronic medical record medical and logistical discharge criteria checklists for the 4 most common IPGS discharge diagnoses, (2) standardization of the rounds process to prioritize discharge, (3) education of nursing staff and families about the role they played in discharge. Process, outcome, and balancing measures were analyzed.Results:Three hundred fifty-five total discharges were studied. Between the preintervention and postintervention groups, there were no significant improvements in discharge order time, physical discharge time, discharge response time, or discharges before 1 pm. The balancing measure of 30-day readmission was unaffected. However, length of stay (LOS) index, calculated as the ratio of actual to expected LOS, improved; when translated into days, LOS declined by 1 day, with potential associated savings of $373,000.Conclusions:Interventions to improve discharge timeliness on IPGS service demonstrated mixed effectiveness. Only LOS index improved. Further iterative quality improvement interventions are needed to continue optimizing discharge timeliness and change the culture of pediatric discharge on inpatient subspecialty services in academic children’s hospitals.

Herbs and Spices in the Treatment of Functional Gastrointestinal Disorders: A Review of Clinical Trials.

More than fifty percent of all new patient visits to pediatric gastroenterology clinics consult for functional abdominal pain disorders (FAPDs). In 2005, a technical report of the American Academy of Pediatrics and the North American Pediatric Gastroenterology, Hepatology and Nutrition society (NASPGHAN) found limited or inconclusive evidence for most therapeutic interventions for this group of disorders. The report did not include studies on herbs and spices. Since then, there has been an increasing interest in the use of complementary and alternative medicine (CAM) for the treatment of chronic pain disorders in children. About 40% of parents of pediatric gastroenterology patients have utilized CAM. This review evaluated the published literature on the effectiveness of CAM, specifically the use of herbs and spices, for the treatment of FAPDs. We found little evidence for most of the commonly used herbs and spices. Despite its common use, research on the efficacy, safety, and optimal dosage remains limited. There is evidence to suggest the benefit of peppermint oil and STW 5 for the treatment of FAPDs in children. The paucity of data on most therapies underscores the need for large clinical trials to assess their efficacy.

Refeeding syndrome in the gastroenterology practice: how concerned should we be?

Clinical nutrition is emerging as a major area in gastroenterology practice. Most gastrointestinal disorders interfere with digestive physiology and compromise nutritional status. Refeeding syndrome (RS) may increase morbidity and mortality in gastroenterology patients. Literature search using the keywords "Refeeding Syndrome", "Hypophosphatemia", "Hypomagnesemia" and "Hypokalemia". Data regarding definition, pathophysiology, clinical manifestations, risk factors, management and prevention of RS were collected. Most evidence comes from case reports, narrative reviews and scarse observational trials. RS results from the potentially fatal shifts in fluid and electrolytes that may occur in malnourished patients receiving nutritional therapy. No standard definition is established and epidemiologic data is lacking. RS is characterized by hypophosphatemia, hypomagnesemia, hypokalemia, vitamin deficiency and abnormal glucose metabolism. Oral, enteral and parenteral nutrition may precipitate RS. Awareness and risk stratification using NICE criteria is essential to prevent and manage malnourished patients. Nutritional support should be started using low energy replacement and thiamine supplementation. Correction of electrolytes and fluid imbalances must be started before feeding. Malnourished patients with inflammatory bowel disease, liver cirrhosis, chronic intestinal failure and patients referred for endoscopic gastrostomy due to prolonged dysphagia present high risk of RS, in the gastroenterology practice. RS should be considered before starting nutritional support. Preventive measures are crucial, including fluid and electrolyte replacement therapy, vitamin supplementation and use of hypocaloric regimens. Gastroenterology patients must be viewed as high risk patients but the impact of RS in the outcome is not clearly defined in current literature.

Differences in Referral Access to Care Between Gastrointestinal Subspecialty Patients: Barriers and Opportunities.

Purpose: Referral access to subspecialty care for patients with gastrointestinal (GI) diseases is not well defined, but has significant importance to patients. We hypothesized that patients experience barriers to care in two common gastroenterology subspecialties, Hepatology and Motility, in a university medical center.Methods: Two hundred thirteen clinic patients (mean age 46.5 years; 66.5% female; 85.6% Caucasians) completed a formatted questionnaire on access to care. Hepatology patients were older (49.7 years, p=0.008); motility patients predominantly female (76.8%, p<0.001). Gender distribution was even for hepatology (51.2% female). Both groups were overweight (mean body mass index 28.4).Results: Patients waited a mean 89.5 days to be seen by a subspecialist. There were differences by subspecialty (107.6 days for motility vs. 64.3 days for hepatology, p=0.022). A larger percentage of motility patients were told nothing was wrong with them (16.8%, p<0.01) and could not be helped (42.1%, p=0.000).Conclusions: Access to care for subspecialty gastroenterology patients in a university center appears to be impacted by a number of variables. While there are similarities, differences exist between these two subspecialties. Motility patients were more likely to have been told they have nothing wrong with them, suffer setbacks financially, and suffer mood problems. Their wait time for appointments was also greater than hepatology patients. Further investigations of referral access for gastroenterology patients may yield additional insights into disease-specific barriers to accessing subspecialty care.

Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years.

Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care. To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients. Randomised controlled trial. Five general hospitals in London, Middlesex and Nottinghamshire. A total of 444 patients aged 16-75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not. Cognitive-behaviour therapy for health anxiety - between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. Primary - researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes - costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years. Of the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overall p < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment. Many eligible patients were not randomised and the population treated may not be representative. CBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings. Current Controlled Trials ISRCTN14565822. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.

The impact on patients of a nurse-led clinical service in gastroenterology

Higher rates of chronic liver disease have resulted in a significant increase in the number of patients needing regular abdominal paracentesis for ascites. Waiting times for admission at the Royal Wolverhampton NHS Trust had become longer and delays in intervention and treatment became inevitable. In 2014, the Trust developed a nurse-led abdominal paracentesis day-case service. A qualitative evaluation of the service was conducted using in-depth patient interviews and surveys to determine the impact of the service, including how the new nursing role affected the patient experience. The results show that the nurse-led clinical service in gastroenterology positively impacts patients' experiences. Following this innovation, the service was extended to provide intravenous infusions for gastroenterology patients via the day-case unit. With appropriate training and competency assessments, nurses can now perform selected medical procedures safely and effectively, thereby facilitating nursing staff to expand and develop their roles. This development has substantial implications for nursing and is an important contribution to the debate on the future direction of the nursing profession.

Determination of frequency dispensary examinations of school-age children with peptic ulcer disease of the duodenum with the help of a formalized model

The current state of public health in Ukraine is characterized as a crisis. The article is discussed the frequency of clinical dispensary surveys by mathematical modeling using. Gastrointestinal patients are among those patients for which clinical dispensary surveys should be provided necessarily. Now there are some practical recommendations on the frequency of clinical dispensary surveys based on clinical grounds. At the same time, these recommendations are not possible to determine the quantitative effect of frequency of clinical dispensary surveys on the effectiveness of clinical examinations.The objective: is the study of the frequency of clinical dispensary surveys to ensure maximum efficiency of school children with duodenal ulcer regard to their level of disease, the characteristics of health care, the level of applications for health care, duration of treatment and so on. Patients and methods. The mathematical modeling method; system and process analysis methods.Results. According to the research program, we studied and analyzed the modern mathematical models that can be used to describe a real health care system. Given the peculiarities of dispensary health care system (its formal modeling) for school age children with duodenal ulcer we included the following main considerations: 1) health care of Patients is in the form of mandatory clinical dispensary surveys at regular intervals along the possibility to Patients’ appeal for health care in time intervals between the clinical dispensary surveys; 2) Patients do not always seek treatment for various reasons in the range between clinical dispensary surveys; 3) there are a number of false Patients applications for health care; 4) the Patients’ disease level is one of the main factors that determine the volume as medical care and clinical dispensary surveys; 5) it is important to determine the frequency of clinical dispensary surveys for the average interval between diseases; 6) the actual level of health care quality – namely timeliness and accuracy of diagnostic in Primary Health Care Centers (family medicine clinics) and in hospital; 7) time wasting of Patients’ rehabilitation and spent time on the clinical examination when Patients apply for medical care and clinical dispensary surveys; 8) most of the indicators is random. The health care formalized model of Patients is proposed the various options trajectory random process model is discussed in the article.Conclusions. The results enable General Practitioners – Family Physicians and Health Care Managers to optimize the organization of medical care of gastroenterology patients usage by forecasting a patient and patient groups level of efficiency.

Outcome of Pediatric Gastroenterology Outpatients With Fever and Central Line.

Although management algorithms for fever and central venous catheters (CVCs) have been implemented for pediatric oncology (PO) patients, management of pediatric outpatients with noncancer diagnoses and CVCs lacks clear protocols. The aim of the study was to assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and CVC. Using a microbiology database and emergency department records, we created a database of pediatric gastroenterology (PGI) and PO outpatients with fever and a CVC who presented to our emergency department or clinics from January 2010 through December 2012. We excluded patients who had severe neutropenia (absolute neutrophil count, <500/mm). We performed chart reviews to assess demographic and clinical characteristics. A total of 334 episodes in 144 patients were evaluated. Fifty-three percent (95% confidence interval, 38%-68%) of PGI patients had a bloodstream infection, whereas only 9% (95% confidence interval, 5%-14%) of PO patients had a bloodstream infection (P < 0.001). Among patients with a bloodstream infection, the PGI patients were more likely than the PO patients to have polymicrobial infections (46% vs 15%), gram-negative infections (57% vs 27%), and/or infection with enteric organisms (61% vs 23%). The PGI patients had higher rates of CVC removal (19% vs 4%) but no statistical difference in intensive care unit needs (11% vs 4%). Pediatric gastroenterology outpatients with fever and a CVC have a high prevalence of bloodstream infection. Algorithms for management need to be subspecialty specific. Pediatric gastroenterology patients presenting to emergency departments or clinics with fever and CVC require admission for monitoring and management.

Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study.

Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. 1821 patients were tested, 13.1% had low FEL-1 (<200µg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200µg/g (mild insufficiency) and 7.6% having faecal elastase readings <100µg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761). Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation.

PTH-130 Attitudes of Medical Students Towards Gastroenterology Teaching in The UK: A BSG Survey

Introduction Little is known about how undergraduate gastroenterology teaching is delivered in the UK. Our project aims to inform how the BSG could assist in this and to build links with students with an interest in gastroenterology. Methods A survey containing 27 questions related to undergraduate gastroenterology training was compiled on surveymonkey.com. We emailed the UK medical school deans and local gastroenterology champions asking them to send out the survey to their medical students. In 10 weeks, 110 students from 12 medical schools responded. Results 83% felt that there was adequate exposure to gastroenterology. 75% felt that their training made them confident in managing gastroenterology patients. 9% had a student gastroenterology society (41% don’t have one, 50% not sure). They usually interact via email or Facebook. 59% would consider a career in gastroenterology (53% interested in subject, 24% inspirational consultants, 24% clinic experience, 10% endoscopy experience). 41% would not consider a career in gastroenterology (49% mind set on another specialty, 14% too much endoscopy, 14% out of hours requirement, 7% don’t want to be medical registrar, 6% don’t want to do CMT training, 3% complexity of patients, 3% low financial reward compared to other specialties). Year group sizes ranged from 40–400. 71% had an integrated curriculum whilst 29% had traditional. 20-100% would have a gastroenterology block in their training. Gastroenterology blocks lasted from 1–12 weeks usually in 3 rd year. Teaching consisted of lectures (99%), small group work (65%), PBL (63%), bedside teaching (65%) and others (13%> GP, home visit, prosection). 65% had gastroenterology and surgical training integrated. 72% said there was a copy of the Gastroenterology syllabus/set of learning objectives within the MBBS curriculum and 60% had read them. Medical final exams involved SBA (83%), short answers (36%), MCQs (65%) and OSCEs (26%). Suggestions for improving gastroenterology training: More consultant training Expert patients as a learning tool Online teaching tools Simulation days Mandatory gastroenterology block More hepatology Conclusion There appears to be adequate exposure to gastroenterology training in UK medical schools. Training seems to enable medical students to feel comfortable managing gastroenterology patients in their foundation years. However, there remains scope for enhancing gastroenterology training with students wanting longer dedicated attachments to gastroenterology firms and BSG to do taster days/revision courses/simulation days. Student gastroenterology societies are rare and BSG can help in promoting these. 60% students would consider a career in gastroenterology with interest in the subject being the overriding reason. BSG should capitalise on this and establish links with medical students early in their training. Disclosure of Interest None Declared

732 Improvements in Listing Decompensated Cirrhotic Patients for Liver Transplant in a Specialized Gastroenterology Inpatient Service

732 Improvements in Listing Decompensated Cirrhotic Patients for Liver Transplant in a Specialized Gastroenterology Inpatient Service

The Pediatric Symptom Checklist: Comparison of symptom profiles using three factor structures between pediatric gastroenterology and general pediatric patients

ABSTRACTThis study evaluated and compared three different factor structures of the Pediatric Symptom Checklist (PSC) in a gastroenterology (GI) and a general pediatrics (GP) sample. Parents of GP (n = 169) and GI (n = 177) patients completed the PSC. Each structure includes internalizing, externalizing, and attention problems. Only one structure includes school problems. Hierarchical regression analyses revealed higher internalizing symptoms for GI patients across factor structures. The relationship between internalizing symptoms and age was moderated by group. The PSC seems sensitive to internalizing difficulties in GI patients regardless of factor structure. Older pediatric GI patients may be at increased risk for internalizing symptoms.

Cannabis Abuse Is Increasing and Associated with Increased Emergency Department Utilization in Gastroenterology Patients.

The role of cannabinoids in gastrointestinal diseases is controversial and of great interest, yet their use in patients has not been critically examined. To determine the prevalence and effects of cannabis abuse on healthcare utilization, as measured by emergency department (ED) visits, in a large, tertiary gastroenterology practice. All patients seen in the gastroenterology clinic at a tertiary care center during a 27-year period (1986-2013) were included in our study to determine the overall prevalence of cannabis abuse. We matched cannabis abusers 1:2 with non-abusing controls to determine the effect of cannabis on ED utilization, our primary outcome. We used multivariate linear regression to adjust for confounders and define the independent effect of cannabis abuse on ED utilization. Our prevalence study cohort included 190,303 GI clinic patients with an overall cannabis abuse prevalence of 0.80% (1520 patients). From 1986 to 2012, the prevalence of cannabis abuse in this clinic increased by 0.73% (0.03%/year) (p<0.0001). From the 1520 cannabis abusers identified, 467 patients were randomly selected as cases and were matched to 934 controls. From this retrospective cohort, the median ED visits/year for cannabis abusers was 1.88 versus 0.89 for non-abusers (p<0.0001). After multivariate adjustment, cannabis abuse was associated with a 1.47-fold increase (95% CI 1.23-1.76, p<0.0001) in median ED visits/year. Reported cannabis abuse in GI clinic patients is less prevalent than in the adult US population, but is increasing. Cannabis abuse among gastroenterology patients is associated with increased ED visits.

Current trend of utilization of new generation proton pump inhibitors in gastric disorders among people in Jessore city, Bangladesh

Appropriateness of Helicobacter pylori eradication therapy in gastroenterology patients of a tertiary care hospitalSreerag K. Vijayan, Emmanuel James, Ramakrishna P. Venugopal