Washington University Record, October 31, 2003

https://digitalcommons.wustl.edu/record/1982/thumbnail.jp

Diagnostics of inflammatory bowel disease using fecal microbiota: Diagnostic markers and commercial potential

Mastergradsoppgave i næringsrettet bioteknologi, Avdeling for lærerutdanning og naturvitenskap, Høgskolen i Hedmark, 2010. Master of applied and commercial biotechnology.Establishing the diagnosis of Inflammatory Bowel Disease (IBD) with its two main sub forms Crohn‟s Disease (CD) and Ulcerative colitis (UC) are based on medical history, clinical evaluation, laboratory tests, endoscopy, radiology and histology. However no gold standard exists. The lack of appropriate diagnostic tools leads to delayed and incorrect treatment of IBD patients. A substantial amount of patients diagnosed as CD are later reclassified as UC and opposite. Also the type of colitis remains unclassified in many patients. In addition, non- IBD patients presenting with similar symptoms as IBD are unnecessarily investigated with invasive tests leading to increased hospitals costs. The cause of IBD is not yet completely described, but most evidence points to a combination of genetic predisposition, immunological factors, environmental triggers, and gastro intestinal (GI) microbes. However, neither the types of microbes responsible for the diseases nor changes in the microbiota as a result of the diseases have been sufficiently identified. The aim of this thesis was to evaluate the potential of using the fecal microbiota for IBD diagnostics. This was achieved through a combination of a literature study, lab study and investigations of the commercial potential including a patent search. The literature study revealed conflicting evidence related to the amounts of bacteria in IBD patients relative to controls. Nevertheless, a majority of the articles agreed in decreased amounts of Clostridia species and increased amounts of Gammaproteobacteria species in the GI microbiota of IBD patients. The lab study comprised an evaluation of a genetic test, GA-map™, commercialized by Genetic Analysis AS (GA). By using variable regions in the 16S rRNA gene, simultaneous detection and identification of multiple bacteria in a complex mixture of DNA is possible. Probes and analytic methods are suitable for several types of diagnostic tests among other IBD. A sequence analysis of fecal samples from 152 IBD patients and 105 non-IBD controls was performed. Significantly a probe detecting increased relative amounts of Proteobacteria and Bacteroidetes species was identified as a new possible diagnostic test for CD patients. A search in European and American patent databases revealed several patents related to IBD diagnostics. Especially important, a patent application from George Mason University comprised claims referring to IBD diagnostics by using the microbial community of the digestive tract and lumen. If issued, this application could influence the freedom to operate to companies focusing on bacterial markers in IBD diagnostics. Few other patents or patent applications from the search query include claims for identification of bacteria in fecal samples. A concluding remark from examining the commercial potential of IBD diagnostics in this thesis is to tailor make a diagnostic test separating IBD from irritating bowel syndrome (IBS), a common functional disease frequently confused with IBD. Based on estimations of price and profit per test, a €7Mill research budget was recommended for the normal case scenario. Finally it is concluded that development of a diagnostic test based on fecal microbiota has a commercial potential within the proposed framework

Evaluating the role of Kinesiology, as an adjunct therapy, in the management of patients with Crohn's disease

Bibliography: leaves 132-154.This randomized controlled experimental study was designed to determine whether Kinesiology, as an adjunct to medical therapy, would improve the management of patients with Crohn's disease. One hundred and fifty consecutive Crohn's disease patients, attending the Gastrointestinal Clinic at Groote Schuur Hospital, were randomly assigned to a Kinesiology (n=50) and a Control Group (n=50). In order to assess the effect of physical contact, a third group who received Massage (n=50), was also included. All participants attended their monthly hospital visits and continued taking their prescribed medication

Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease—an International, Cross-disciplinary Consensus

Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease (IBD), for use in different healthcare settings.An international working group (n=25) representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure (PROM) methodologists participated in a series of teleconferences incorporating a modified Delphi process. Systematic review of existing literature, registry data, patient focus groups and open review periods were used to reach consensus on a minimum set of standard outcome measures and risk adjustment variables. Similar methodology has been used in 21 other disease areas (www.ichom.org).A minimum Standard Set of outcomes was developed for patients (aged ≥16) with IBD. Outcome domains included survival and disease control (survival, disease activity/remission, colorectal cancer, anaemia), disutility of care (treatment-related complications), healthcare utilisation (IBD-related admissions, emergency room visits) and patient-reported outcomes (including quality of life, nutritional status and impact of fistulae) measured at baseline and at 6 or 12 month intervals. A single PROM (IBD-Control questionnaire) was recommended in the Standard Set and minimum risk adjustment data collected at baseline and annually were included: demographics, basic clinical information and treatment factors.A Standard Set of outcome measures for IBD has been developed based on evidence, patient input and specialist consensus. It provides an international template for meaningful, comparable and easy-to-interpret measures as a step towards achieving value-based healthcare in IBD

Outcome Measurement: The Key to Achieving Value Based Health Care and Positively Shaping Team Dynamics in Inflammatory Bowel Disease

Through a small, highly selected sample, this work explores the possible effects of systematic outcome measurement on team dynamics and culture and analyzes its position within the framework of Value Based Health Care (VBHC). Six interviews were conducted with international Inflammatory Bowel Disease (IBD) specialists who do and do not systematically measure outcomes. After literature review, it was anticipated that the groups who did measure outcomes would report experiences of increased communication, a more inclusive definition of an IBD care delivery team, a more defined concept of success, and an increased sense of work satisfaction or diminished burnout. Analysis of the interviews indicated that there may in fact be a relationship between outcome measurement and team dynamics, which paralleled what has been described so far in supporting literature. This research indicates outcome measurement is imperative to achieving VBHC and care delivery improvement.Dell Medical Schoo

A retrospective data analysis in veterans with inflammatory bowel disease: Using Wagner\u27s Chronic Care Model to explore medication adherence

Background Medication adherence in inflammatory bowel disease (IBD) ranges between 7-72% . Increased healthcare utilization has been associated with non-adherence in IBD. Wagner\u27s Chronic Care Model (CCM) posits that care coordination between primary and gastroenterology (GI) specialty care could improve adherence and healthcare utilization. Methods Guided by the CCM, a retrospective analysis was conducted in veterans with IBD to: describe medication adherence rates; describe healthcare utilization measured by ER visits and inpatient admissions; and describe care coordination measured by primary care and GI specialty care use. A secondary study aim was to explore the relationships between those key outcome variables and select demographic/health history characteristics. A local Veteran\u27s Affairs database was used to extract a cohort of individuals with Crohn\u27s disease and ulcerative colitis for fiscal year (FY) 2011. Medical utilization and IBD medication refills were collected. A dichotomized medication possession ratio (MPR .80) was used in logistic regression to identify factors affecting medication adherence. Logistic regression was also used to examine factors affecting ER visits, inpatient utilization, and care coordination. Results The cohort consisted of 165 White male veterans 75 with Crohn\u27s disease and 89 with ulcerative colitis. The overall rate of adherence was 50.9% with a median MPR of .82. Regression models did not render any statistically significant predictors of adherence. ER utilization was significantly associated with adherence (OR=.314, 95%CI=.111-.886, p=.029) and care coordination (OR=45.73,95%CI=9.053-231,p=.001) in multivariate analysis. Inpatient admission was associated with: younger age (OR=.108,95%CI:.019-.609,p=.012), adherence (OR=.113,95%CI=.014-.939,p=.044), IBD diagnosis (OR=.117,95%CI=.017-.784,p=.027), and care coordination (OR=11.89,95%CI=1.228-115,p=.033). Logistic regression identified statistically significance associations with care coordinated between primary and GI specialty care and the following factors: taking both a 5-ASA and immunomodulating medication (OR=5.122,95%CI=1.874-14.00, p=.001), younger age (OR=.905,95%CI=.871-.940,p=.001), and having a comorbidity (OR=2.643,95%=1.171-5.965,p=.027). Conclusions No predictors of medication adherence emerged. However, the CCM element of care coordination provided additional insight into the healthcare utilization of veterans with IBD as statistically significant associations between care ER visits and hospitalization were identified. Further inquiry into the influences of medication adherence and healthcare utilization in this population is warranted

Australian inflammatory bowel disease (IBD) patients want biopsychosocial healthcare: a content analysis.

This item is only available electronically.Background & Aims: Inflammatory Bowel Disease (IBD) is a biopsychosocial illness. The prevalence of IBD is increasing in Australia, which presses the need to improve healthcare for patients with IBD. To date, no study has examined the views or preferences that Australian IBD patients have for their healthcare. This article reports on Australian patient’s with IBD perspectives and preferences for healthcare. Methods: Patients with IBD (n=477) responded to an open-ended survey question ‘What changes if any would you make for your IBD healthcare? And why?’ within a larger, previously conducted cross-sectional survey. These previously unanalysed responses were content analysed with open coding using NVivo. Results: Nine categories were formulated. Respondents expressed a desire to have greater access to (1) multidisciplinary services (17.70%), (2) proactive healthcare with increased follow up and long-term care planning (8.50%), and (3) treatment, services and specialist care (16.40%). Participants also requested (4) better communication (23.52%), and (5) whole of person care (10.24%). In addition, participants wanted (6) health promotion (i.e. public awareness and support groups) (10.42%). Finally, a proportion of participants were (7) happy with their healthcare (9.72%). Two minor categories – (8) administrative issues, (2.34%) and (9) improving the hospital experience also emerged (1.04%). Conclusions: The results support existing research outlining multidisciplinary care is better suited to meet the needs of patients with IBD. Healthcare professionals should focus on facilitating patients’ access to multidisciplinary services (i.e. psychologists, IBD nurses and dieticians), and increasing proactive care (i.e. follow up and long-term care planning). Asking patients about their mental health and communicating respectfully should also be priorities.Thesis (M.Psych(Health)) -- University of Adelaide, School of Psychology, 202