anti tnf biosimilars in crohn s disease a patient centric interdisciplinary approach

ABSTRACTIntroduction: The purpose of this review is to highlight the role of biosimilars in early treatment in IBD and introduce ways to facilitate a patient-centric switching process through multi..

Where To From Here? The Potential for Climate Change-Related Migration: What is the State of the International Approach to the Potential Problem of Climate Change-Related Migration, and what Contribution does Hodgkinson, Anderson, Burton and Young's Proposed Climate Change Displaced Persons Convention Make to the International Approach?

Climate change may be a relatively new phenomenon, but its effects are being felt throughout the world and having a significant impact on peoples’ lives in many countries. Some of those most keenly feeling the effects live in areas that are particularly vulnerable to destabilizing factors acting in conjunction with existing challenges. The effects of climate change are an exacerbating factor in sometimes already difficult lives. In some areas, the effects of climate change are or may become such that the inhabitants contemplate migration to find a more viable life elsewhere, either in their own country or in another country. It is by no means guaranteed that the effects of climate change will inexorably lead people, such as those in low-lying small island states, to migrate outside their country, particularly if there are adequate measures taken to mitigate and adapt to the effects of climate change. However, it is becoming increasingly clear that the potential for climate change-related migration is drawing near, if it has not already arrived, as a factor for some people’s decisions to migrate internally or externally. Some work currently underway considers approaches to dealing with climate change-related migration and the possible related issues around human rights protections and practical management. Climate change is an amorphous, complex and politically challenging issue for governments and stakeholders to deal with. Its effects on peoples’ lives can be significant, especially in conjunction with existing development, environmental, and economic challenges. It is important to ensure that any approach created is necessary, in light of existing mechanisms and available resources, and that it does not disadvantage any other groups of people through its creation or functioning. This thesis considers the state of the international approach to the potential problem of climate change-related migration. One recently developed approach was a proposed Climate Change Displaced Persons Convention, which has been formulated by Hodgkinson, Burton, Anderson and Young (2010). A range of information was considered to try and find a balance between the attempt to deal with climate change as a public and foreign policy issue and the human reactions and subsequent choices people make in dealing with the effects of climate change. Due to the complications of holding a position as a public servant working in the field of responses to climate change, I decided to use a methodology that would enable me to remain a step removed from the process, to avoid influencing responses. The thesis reviews current literature and experiences on climate change and migration, particularly in the Pacific, identifies key issues, and assesses the potential effectiveness of the Convention in addressing the issues identified. Information sources included drawing on reports of first hand experience of climate change related migration and those living in the front line on the islands, experiences of working in the public and NGO sectors, and academic considerations of how to address climate change and migration

British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic.

The COVID-19 pandemic is putting unprecedented pressures on healthcare systems globally. Early insights have been made possible by rapid sharing of data from China and Italy. In the UK, we have rapidly mobilised inflammatory bowel disease (IBD) centres in order that preparations can be made to protect our patients and the clinical services they rely on. This is a novel coronavirus; much is unknown as to how it will affect people with IBD. We also lack information about the impact of different immunosuppressive medications. To address this uncertainty, the British Society of Gastroenterology (BSG) COVID-19 IBD Working Group has used the best available data and expert opinion to generate a risk grid that groups patients into highest, moderate and lowest risk categories. This grid allows patients to be instructed to follow the UK government's advice for shielding, stringent and standard advice regarding social distancing, respectively. Further considerations are given to service provision, medical and surgical therapy, endoscopy, imaging and clinical trials

Travel health and pretravel preparation in the patient with inflammatory bowel disease

BACKGROUND AND AIMS: Foreign travel for people with inflammatory bowel disease (IBD) carries an increased risk of travel-related morbidity. There is limited research looking specifically at travel-associated health risks and travel preparation in patients with IBD. The aims of this study are to explore the experience of travel, pretravel preparation undertaken by the patient with IBD and examine IBD healthcare professionals’ (HCP) confidence at providing travel advice and the content of that advice. METHODS: A survey of patients with IBD attending an outpatient clinic with a separate online survey sent to IBD HCPs recruited using regional and international network databases. RESULTS: A total of 132 patients with IBD, Crohn's disease (67/132, 51%), male (60/132, 45%) and 128 HCPs (IBD nurse specialist 113, 88%; IBD physician 15, 12%) completed the questionnaires. IBD affected travel to some extent in 62% (82/132) of patients, and 64% (84/132) had experienced an IBD flare, of whom 64% still travelled overseas during this time. Only 23% (31/132) travellers sought pretravel medical advice and 40% (53/132) obtained travel insurance. Forty-eight per cent of respondents on immunomodulator therapy were unaware of the need to avoid live vaccines. Twenty-seven per cent (34/128) of IBD HCPs are not confident at providing pretravel advice; vaccination advice (54%), obtaining travel insurance (61%) and healthcare abroad (78%) are the areas of most uncertainty. CONCLUSIONS: Patients do not seek adequate pretravel advice and consultations for those who do are often deficient. The majority of IBD professionals are not confident to provide comprehensive travel advice. Greater IBD-specific travel education and awareness is needed for both patients with IBD and professionals