Transition of Care in Inflammatory Bowel Disease

Abstract: The management of patients with chronic conditions, such as inflammatory bowel disease (IBD), requires specific attention and careful planning during the transition from pediatric to adult care. Early education about the transition process and the acquisition of self-management skills are crucial to fostering independent adolescents and young adults who have the knowledge and tools to manage life with a chronic disease. A growing body of literature describes the challenges and barriers to providing adolescent and transition care. Potential barriers to effective transition include the following: differences between adult-and pediatric-onset IBD; patients' lack of developmental maturity and readiness, self-efficacy, and knowledge of the disease; poor adherence to therapy; adolescent anxiety and depression; differences between pediatric and adult IBD care; and parental and provider reluctance to transition. Despite our ability to identify barriers and challenges, there remain significant gaps in our knowledge about how they should be addressed. Outcomes data on adolescents with IBD are limited, and there are even fewer data on how the transition of care affects long-term treatment and outcomes. More research is needed to truly understand the best way to facilitate care during transition and improve outcomes. Current research and transition guidelines acknowledge that providing support and guidance to patients and their families and establishing clear goals can ultimately equip patients with the skills needed to cope with a chronic disease as adults and can improve their long-term care. This paper provides an overview of the transition from pediatric to adult IBD care, a discussion of challenges and barriers, and recommendations and resources that can help patients, parents, and providers navigate this important process. T he management of patients with chronic conditions, such as inflammatory bowel disease (IBD), requires specific attention and careful planning during the transition from pediatric to adult care. Early education about the transition process and the acquisition of self-management skills are crucial to foster

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The role of ferric carboxymaltose in the treatment of iron deficiency anemia in patients with gastrointestinal disease

Iron deficiency anemia (IDA) is the most common form of nutritional anemia worldwide. Iron plays a pivotal role in vital functioning of almost every organ system. IDA affects both physical and psychological functioning of humans. Oral iron is considered as first-line therapy for the treatment of IDA due to low cost, good safety profile and ease of administration. However, the absorption of oral iron is affected by several factors and incidence of gastrointestinal side effects can lead to lack of adherence to therapy as well as poor efficacy. This has led to the emergence of intravenous iron therapy which is clearly superior to oral iron with higher increment of hemoglobin levels and rapid replenishment of iron stores. Ferric carboxymaltose (FCM) is a novel non-dextran intravenous iron form which has been approved for use in patients with iron deficiency who have had inadequate response to oral iron therapy, intolerance to oral iron, or nondialysis-dependent chronic kidney disease. The safety and efficacy of using FCM for the treatment of IDA has been demonstrated in several clinical trials. One dose can provide a large amount of iron and has a very short infusion time. It should be considered as first-line therapy in patients with active inflammation like inflammatory bowel disease when gastrointestinal absorption of oral iron may be compromised. It should also be given to patients who have inadequate response to oral iron therapy. It has been shown to be noninferior to other intravenous iron formulations with a good safety profile and produced fewer anaphylactic reactions

A Review on Central Pontine Myelinolysis and Correction of Hyponatremia in Hospitalized Patients

Pontine myelinolysis (PM) can be a nerve disorder represented by pons demyelination. it is characterized by damage to regions of the brain, most commonly tracts pontine substantia alba, after rapid correction of metabolic disorders such as hyponatremia. PM (Pontine Myelinolysis) is categorized into Central pontine myelinolysis (CPM) and extra pontine myelinolysis (EPM). The various studies revealed that quick correction of hyponatremia plays a vital role in the pathogenesis of ODS. Prevention of ODS must be conducted by gradually increasing sodium concentration of 4–6 mmol/Lin in any 24-h period. PubMed and Medline literature search was done using CPM and hyponatremia as keywords. The principal aim of this review is to encapsulate, the recent evidence from literature about the association between rapid correction of hyponatremia and central pontine myelinolysis. Keywords: Demyelination syndrome, EPM, CPM, Serum tonicity, Hyponatremia, Demyelinatio

Spectrophotometric determination of osmium(VIII) in trace amounts using ethylene thiourea (ETU) as chromogenic reagent

113-117A simple and highly sensitive spectrophotometric method has been described for the determination of trace amount of osmium(VIII) using ethylene thiourea (ETU) as a chromogenic reagent. The method is based on the formation of an instantaneous purple coloured complex at room temperature by the reaction of osmium(VIII) with ETU in strongly acidic (pH=1) solution having absorption maximum at 490 nm and is confirmed using derivative spectrophotometry. Linear calibration graphs are obtained for 0.03-3 µg/mL of the analyte. Sandell's sensitivity (1.13×10-3 µgcm-2), molar absorptivity (16.87×104 Lmol-1 cm-1), detection limit (0.0291 µg/mL) and quantitation limit (0.0833 µg/mL) are also calculated. The method is optimized and different analytical parameters were evaluated. The stoichiometry of the complex is found to be 1:3 by Job's method and mole ratio method. The stoichiometry of the complex is further confirmed by synthesizing the solid compound and characterizing it by various physicochemical methods

Imidazolidine-2-thione as corrosion inhibitor for mild steel in hydrochloric acid

366-374The inhibition effect of imidazolidine-2-thione (IMT) on the corrosion behaviour of mild steel (MS) in 1 N HCl was studied using potentiodynamic polarization, linear polarisation resistance (LPR), electrochemical impedance spectroscopy (EIS) and adsorption studies. The effects of inhibitor concentrations, temperature, corrosion rate and surface coverage are investigated. The corrosion rate and other parameters are evaluated for different inhibitor concentrations and the probable mechanism is also proposed. The results show that IMT possesses excellent inhibiting effect for the corrosion of the MS and the inhibitor acts as a mixed type inhibitor. The inhibitor does not affects the mechanism of the electrode processes and inhibits corrosion by blocking the reaction sites. The high inhibition efficiency of IMT was due to the adsorption of inhibitor molecules on the metal surface. The decrease of surface area available for electrode reactions to take place is due to the formation of a protective film. Activation energies and enthalpies of activation in the presence and absence of IMT were determined by measuring the temperature dependence of the corrosion current