1,720,969 research outputs found
Adolescent IBD: recent data and practical management
No full textAdolescence represents a key period in the management of inflammatory bowel disease (IBD), encapsulating physical, psychological and social change. Increasing incidence of paediatric-onset IBD has led to a growing adolescent population. This review explores contemporary challenges in adolescent IBD management, including growth and development, psychosocial factors and treatment. Growth failure, once common in paediatric-onset IBD, has decreased; however, sarcopenic obesity is increasingly recognised, impacting long-term outcomes. Anxiety and depression are widely prevalent, with bidirectional relationships between disease activity and mental health contributing to increased disease burden. Poor sleep quality and fatigue further affect quality of life. The expanding therapeutic landscape offers new agents, yet licensing delays for adolescent use remain. Long-term safety concerns, including risks to fertility and cancer development, necessitate careful integration. Non-adherence is a significant barrier to effective treatment. Transitioning to adult care is a critical period requiring structured, patient-centred approaches to optimise disease control. Multidisciplinary teams caring for individuals with IBD must recognise relevant issues such as fertility and sexual health which remain unaddressed. Surgical considerations, including ‘ostomy’ procedures, require sensitive discussions incorporating patient autonomy and psychological support. Body image concerns contribute to anxiety and depression, underscoring the need for perioperative counselling. Social factors, including school absenteeism and employment concerns, highlight the importance of holistic, flexible multidisciplinary management. Healthcare engagement on social media may aid in disseminating reliable IBD information. This review emphasises the need for an integrated, developmentally appropriate, multidisciplinary approach to ensure optimal health and well-being in adolescents with IBD
Compliance with nutrition screening in a children's hospital
No full textINTRODUCTION:There has been an increased emphasis on the nutritional care of children in hospital with the recognition that those admitted to hospital, particularly with chronic conditions, are at significant nutrition risk. However, although nutrition risk screening tools (NRST) are widely used in acute hospital settings compliance with their use is poorly reported.METHODS:One-day cross-sectional audit of anthropometry/NRST records, Southampton Children's Hospital. Inclusion criteria were all in-patients present on the ward between 8 am and 4 pm. Comparison was made with previous data.RESULTS:One hundred and thirteen records were reviewed. Anthropometric measures; weight recorded in 96.4% length/height recorded in 64% . This reflects a significant improvement on previous length/height data of 19%. Compliance with NRST was poor; only 17% of records were completed.CONCLUSION:Compliance with basic anthropometry was high and better than previously reported although use of nutritional screening tools was poor. This raises questions about the usefulness of current tools in clinical practice and whether measurement of height, weight and assessment of intake and nutrition risk may be more appropriate
Epidemiology, management and outcome of ultrashort bowel syndrome in infancy
No full textUltrashort bowel syndrome (USBS) is a group of heterogeneous disorders where the length of small bowel is less than 10 cm or 10% of expected for the age. It is caused by massive loss of the gut which in the neonatal period can be a result of vanishing gastroschisis or surgical resection following mid-gut volvulus, jejunoileal atresia and/or extensive necrotising enterocolitis. The exact prevalence of USBS is not known although there is a clear trend towards increasing numbers because of increased incidence and improved survival. Long-Term parenteral nutrition (PN) is the mainstay of treatment and is best delivered by a multidisciplinary intestinal rehabilitation team. Promoting adaptation is vital to improving long-Term survival and can be achieved by optimising feeds, reducing intestinal failure liver disease and catheter-related bloodstream infections. Surgical techniques that can promote enteral tolerance and hence improve outcome include establishing intestinal continuity and bowel lengthening procedures. The outcome for USBS is similar to patients with intestinal failure due to other causes and only a small proportion of children who develop irreversible complications of PN and will need intestinal transplantation. In this review, we will summarise the available evidence focusing particularly on the epidemiology, management strategies and outcome
Risk stratification of IBD-associated liver disease using routinely collected biomarkers from a large-scale real-world dataset
No full textObjective: inflammatory bowel disease (IBD)-associated liver diseases (IBDALDs) are associated with hepatobiliary damage and malignancy, with diagnosis often delayed by heterogeneous presentation. We evaluated whether routinely collected biomarkers—at IBD diagnosis and during follow-up—can risk-stratify for IBDALD.Methods: this observational retrospective longitudinal study included 1571 patients with IBD at University Hospital Southampton. Biomarkers including alanine aminotransferase (ALT), alkaline phosphatase (ALP) and erythrocyte sedimentation rate (ESR) (n=335 605 results) were summarised as patient-level medians within ±6 months of IBD diagnosis. Patients with pre-existing IBDALD were excluded. A 1:4 matched case-control design (age, sex, IBD subtype) was applied. Conditional logistic regression assessed associations with biomarkers (continuous values and binary—abnormal vs normal) and IBDALD. Longitudinal trends were evaluated using locally estimated scatterplot smoothing (LOESS) and linear mixed-effects models (LMMs).Results: median age of IBD diagnosis was 18.0 years, median follow-up 11.5 years. Thirty-five IBDALD cases were identified (27 post-IBD); median time to IBDALD was 4.5 years. At IBD diagnosis, cases had elevated ALT, ALP and ESR (p<0.01). In case-control matching, ALT (OR=1.04 per U/L; 95% CI 1.01 to 1.07; p=0.012), ALP (OR=1.01; 95% CI 1.00 to 1.02; p=0.014) and ESR (OR=1.05; 95% CI 1.00 to 1.09; p=0.034) were associated with IBDALD. Any abnormal ALT (OR=5.10; 95% CI 1.57 to 16.59; p=0.0068) and ALP (OR=15.33; 95% CI 1.87 to 125.77; p=0.0110) were strongly associated. LOESS plots and LMMs demonstrated distinct biomarker trajectories (ALT, ALP) preceding IBDALD.Conclusion : real-world biomarker data can support early risk stratification for IBDALD. Elevated ALT and ALP at IBD diagnosis and distinct longitudinal trajectories highlight the need for follow-up to biomarker normalisation, with persistent abnormalities prompting earlier hepatobiliary investigation to reduce diagnostic delay and improve outcomes
Guidelines for the Management of inflammatory bowel disease in children in the United Kingdom
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
- …
