3,080 research outputs found
Identification of areas of functioning and disability addressed in Inflammatory bowel disease-specific patient reported outcome measures
No full textInflammatory Bowel Disease (IBD) is a chronic disabling disease of the
gastrointestinal tract. The disease is strongly associated with limited performance
of everyday activities and restrictions in work and employment, recreation and
relationships to others, as well as reduced quality of life. Thus, suffering from IBD
includes not only impairments of body functions and body structures but also
limitations of activities in everyday life and restrictions in participation.
Consequentially, a comprehensive approach of functioning and disability is
required when addressing the impact of IBD.
There are a large number of outcome measures that assess health status
problems of persons with IBD. Many of these measures used in clinical practice or
research are classification or scoring systems that refer to disease activity and
symptomatology in IBD in terms of impaired body functions and structures (e.g.,
Crohn's Disease Activity Index (CDAI), Harvey Bradshaw Index). Hence, disability
and functioning from a comprehensive point of view are poorly addressed in these
measures and do not cover the whole spectrum of problems persons with IBD
have to deal with. Patient-reported outcome measures (PROMs) offer the
possibility to assess health status problems from the perspective of persons
suffering a disease. The number of IBD-specific PROMs which focus on aspects of
functioning, disability and health (e.g., Inflammatory Bowel Disease Questionnaire
(IBDQ-32), Rating Form of IBD Patient Concerns (RFIPC), Inflammatory Bowel
Disease Stress Index (IBDSI)) has increased over the last years so that the
selection of appropriate PROMs for specific purposes or subpopulations has
become a challenge for clinicians and researchers. However, up to now it remains
unclear whether currently used IBD-specific PROMs cover the whole spectrum of
functioning and disability.
This doctoral thesis examines the content of IBD-specific PROMs using the
International Classification of Functioning, Disability and Health (ICF) as a
reference to facilitate the selection of appropriate PROMs by clinicians and
researchers. The ICF endorsed by the World Health Organization as a common
language of functioning and disability is a proven and useful tool for the
examination and comparison of the content of outcome measures.
A systematic literature review was performed to identify IBD-specific PROMs used
in studies involving persons with IBD. Searches were performed in the literature
databases Medline®, EMBASE, PsycINFO, CINAHL and CENTRAL. Searches
were limited to English articles published between 1999 and 2009. Eligibility
checks of abstracts and full-texts were performed applying pre-defined inclusion
and exclusion criteria. IBD-specific PROMs reported in the selected studies, as
well as study-related characteristics, were extracted. The items of the identified
PROMs were translated (“linked”) to the most specific ICF category according to
standardized and established linking rules. The linked ICF categories provided the
basis of the descriptive analysis and the comparison of the content of the different
PROMs presented in this thesis.
A total of 9,728 papers were identified by the searches in the five electronic
databases. The randomly selected abstracts of 2,579 papers were checked on
inclusion and exclusion criteria according to the defined eligibility criteria. Based
on this abstract check, 221 studies were identified for further analysis. Screening
these 221 full-text articles, 46 studies were finally selected that reported the use of
IBD-specific PROMs. The following eight IBD-specific PROMs were identified:
Cleveland Global Quality of Life (Faszio Score) (CGQL), Inflammatory Bowel
Disease Quality of Life Questionnaire (IBDQOL), IBDQ-32, IBDSI, Inflammatory
Bowel Disease Questionnaire – short form (IBDQ-9), RFIPC, Short Inflammatory
Bowel Disease Questionnaire (SIBDQ) and Work Productivity and Activity
Impairment: Crohn’s Disease (WPAI:CD). In total, these eight IBD-specific PROMs
included 129 items which were linked to ICF categories. The most frequently
identified ICF categories are 'b1300 Energy level' and 'b5254 Flatulence'
(IBDQOL, IBDQ-32, IBDQ-9, RFIPC and SIBDQ), as well as 'd920 Recreation and
leisure' (IBDQOL, IBDQ-32, IBDSI, IBS-QOL and SIBDQ). Most of the analyzed
questionnaires do not cover a wide range of aspects needed to assess functioning
and disability from a comprehensive perspective; they only focus on selected
aspects of functioning and disability of persons with IBD (e.g., emotional functions,
pain, intimate relationships and remunerative employment).
This doctoral thesis provides an item-based examination of the content of IBD-
specific PROMs using the ICF as a reference. It offers a clear and precise picture
of the addressed PROMs and their contents and enable physicians and researchers a direct comparison of these contents. The ICF was established as a
useful framework for examining and comparing IBD-specific PROMs and their
items with respect to the areas of functioning and disability covered. This
information can be useful in selecting PROMs for clinical practice, as well as for
any kind of investigations in which functioning and disability of persons with IBD is
a relevant study outcome
IBD BioResource: an open-access platform of 25 000 patients to accelerate research in Crohn's and Colitis.
No full textAn alliance of clinicians, academics, research nurses, funders, coordinators, programmers and, most importantly, patients has come together in the UK to deliver a powerful new platform to accelerate Crohn’s and colitis research – the Inflammatory Bowel Disease (IBD) BioResource. As part of the NIHR BioResource for translational research, 25,000 patients in over 90 hospitals UK-wide have signed up since we launched in January 2016 (Fig 1). All have detailed phenotypes databased including Montreal classification1, treatment response history (updated annually), surgical history and comorbidities (IBD BioResource panel descriptive, Clinical data collection sheet and Health and Lifestyle questionnaire). Serum, plasma and DNA samples are banked; and genome-wide genetic profiling undertaken. Participants’ data and samples can be studied, and they themselves surveyed or recalled for resampling or downstream studies (see Fig 2). Critically such studies can be lead by any UK or overseas investigator whether from the worlds of clinical research, pharmacovigilance, science or industry
Differential regulation of interleukin-17 and interferon-y production in inflammatory bowel disease
No full textPhDBackground and Aims. Interleukin (IL)-17 is now known to be involved in a number of chronic inflammatory disorders. However, the mechanisms regulating its production in inflammatory bowel disease (IBD) are still unclear. Methods. Endoscopic biopsies or surgical specimens were taken from inflamed and uninflamed colonic mucosa of 72 IBD patients (38 with Crohn’s disease and 34 with ulcerative colitis), and normal colon of 38 control subjects. IL-17 and interferon (IFN)- were detected by ELISA in the supernatants of biopsies cultured ex vivo, and anti-CD3/CD28-stimulated lamina propria mononuclear cells (LPMCs) incubated with IL-12, IL-23, IL-1β plus IL-6, transforming growth factor (TGF)-β1, or anti-IL-21 neutralising antibody. Intracellular flow cytometry was performed to analyse mucosal Th17 and Th1/Th17 cells. Results. IL-17 production by organ culture biopsies was higher in IBD inflamed mucosa than IBD uninflamed mucosa and controls, and was equivalent in amount to IFN-. Anti-CD3/CD28-stimulated IBD LPMCs produced higher IL-17 amounts compared to controls. The percentages of Th17 and Th1/Th17 cells were increased in IBD patients than controls. IL-23 and IL-1 plus IL-6 had no effect on IBD LPMC production of IL-17, however IL-12 markedly increased IFN- production and decreased IL-17 production. TGF-β1 dose-dependently decreased IFN-, but had no significant inhibitory effect on IL-17 production. Blocking IL-21 significantly down-regulated IL-17 production. Conclusions. Our findings support a role for IL-12, TGF- and IL-21 in modulating IL-17/IFN- production in IBD. The abundant IL-17 in inflamed IBD mucosa may help explain the relative lack of efficacy of anti-IFN- antibodies in clinical trials of Crohn’s disease
When IBD is not IBD
No full textEntamoeba histolytica colitis can mimic Crohn's disease. However, a fulminant infection can be life-threatening, especially after exposure to systemic steroids. We present a case of the patient who was initially diagnosed with ileocolonic Crohn's disease, but developed a hepatic E histolytica abscess while undergoing anti-TNF therapy. After revision of the initial diagnostic biopsies, the diagnosis was questioned and E histolytica was confirmed using PCR and histopathology. As intestinal amoebiasis is the most common form of amoebic infection, care should be taken in case of refractory IBD or at initial diagnosis in patients who travelled to endemic areas. We therefore discuss the epidemiology, clinical features, diagnostic tools and pathophysiology of E Histolytica in order to raise awareness among gastroenterologists treating patients with inflammatory bowel disease.sponsorship: B Verstockt is a doctoral fellow and S Vermeire, G Van Assche and M Ferrante are Senior Clinical Investigators of the Research Foundation Flanders (FWO), Belgium. B Verstockt has also received research grants by the Belgium Week of Gastroenterology, the Belgian IBD Research and Development (BIRD) and the European Crohn's and Colitis Organisation (ECCO). (Belgium Week of Gastroenterology, Belgian IBD Research and Development (BIRD), European Crohn's and Colitis Organisation (ECCO))status: Publishe
Gender-stratified analysis of DLG5 R30Q in 4707 patients with Crohn disease and 4973 controls from 12 Caucasian cohorts
No full textBackground: DLG5 p. R30Q has been reported to be associated with Crohn disease ( CD), but this association has not been replicated in most studies. A recent analysis of gender-stratified data from two case-control studies and two population cohorts found an association of DLG5 30Q with increased risk of CD in men but not in women and found differences between 30Q population frequencies for males and females. Male-female differences in population allele frequencies and male-specific risk could explain the difficulty in replicating the association with CD.
Methods: DLG5 R30Q genotype data were collected for patients with CD and controls from 11 studies that did not include gender-stratified allele counts in their published reports and tested for male-female frequency differences in controls and for case-control frequency differences in men and in women.
Results: The data showed no male-female allele frequency differences in controls. An exact conditional test gave marginal evidence that 30Q is associated with decreased risk of CD in women (p= 0.049, OR= 0.87, 95% CI 0.77 to 1.00). There was also a trend towards reduced 30Q frequencies in male patients with CD compared with male controls, but this was not significant at the 0.05 level (p = 0.058, OR= 0.87, 95% CI 0.74 to 1.01). When data from this study were combined with previously published, gender-stratified data, the 30Q allele was found to be associated with decreased risk of CD in women (p= 0.010, OR= 0.86, 95% CI 0.76 to 0.97), but not in men.
Conclusion: DLG5 30Q is associated with a small reduction in risk of CD in women
Discourse on formation of investigators’ competencies
No full textOne of the most important aims of law enforcement agencies is crime investigation and
prevention. Consequently, one of the main activities of the law enforcement agencies, especially in the
pre-trial investigation sphere, is to optimise the organisation of the pre-trial investigation in order to
save the experienced skilled and competent specialists. The author of this research offers a new
approach and analyses the qualification and competence of the pre-trial investigation subjects not only
in terms of personnel management, but all elements of the model of pre-trial investigation to make
pre-trial investigation organisation more effective. It should be noted that the content of an
investigators‘ qualification or levels of competence are still not determined or strictly regulated and
this is the reason for many discussions in this area. These discussions surround what qualification and level of competence the investigators should have in pre-trial investigation, what general and special
competencies they should acquire and how the content of the competencies should be determined. In the present article the author analyses the investigators‘ qualification and competence as a
presumption that it is an essential aspect of an effective pre-trial investigation. Analysing this question
the author compares other subjects such as the regulation of qualifications and levels of competence of
the prosecutors and pre-trial investigation judges. The author also identifies the problem of how to
define an investigators qualification and level of competence making recommendations to create a
Description of Investigators Competencies. Qualification requirements should be determined in this
legal act and general, occupational and special competencies should be identified with the content also
being determined within this framework. Formation of the Description of Investigators‘ Competencies
should determine not only the content of the investigators‘ required level of competence but also this
process should be consistent with the assessment and career development of investigators‘ including
the process of gaining the investigators‘ qualification. The aim of this research is to identify the problems associated with defining an investigators‘
qualification and levels of competence and to propose recommendations on how this could be
achieved. The subject of this research is limited to only looking at investigators‘ qualification and
level of competence. The author is using a qualitative method for this research based upon the contents of documents.
The author will analysis eight legal acts related to the qualification and competence of pre-trial
investigation and fifty different investigators‘ job descriptions.Straipsnyje nagrinėjama ikiteisminio tyrimo pareigūnų (tyrėjų) kvalifikacija ir kompetencija kaip viena iš veiksmingo ikiteisminio tyrimo organizavimo prielaidų. Analizuojant tyrėjų kvalifikacijos ir kompetencijos turinį ir jo reglamentavimą, lyginama kitų ikiteisminio tyrimo subjektų – prokurorų ir ikiteisminio tyrimo teisėjų – kvalifikacijos ir kompetencijos turinio reglamentavimo ypatumai, identifikuojamos tyrėjų kvalifikacijos ir kompetencijos apibrėžties problemos ir pateikiami sprendimo būdai – siūlomas ikiteisminio tyrimo pareigūnų (tyrėjų) kompetencijų aprašas, kuriame būtų tiksliai nustatyti tyrėjų kvalifikaciniai reikalavimai, identifikuotos bendrosios, profesinės ir specialiosios kompetencijos ir apibrėžtas šių kompetencijų turinys. Ikiteisminio tyrimo pareigūnų kompetencijų aprašo suformavimas sudarytų galimybę ne tik aiškiai apibrėžti tyrėjo kompetencijos turinį, bet ir šį procesą nuosekliai susieti su tyrėjo veiklos vertinimu, karjera ir kvalifikacijos tobulinimu. Straipsnį sudaro įvadas ir dvi dalys. Pirmoje dalyje nagrinėjama tyrėjo kvalifikacijos apibrėžties problematika, gretinama ikiteisminio tyrimo pareigūno, prokuroro ir teisėjo kvalifikacijos apibrėžtys. Šioje dalyje siūloma tiksliai nustatyti ir apibrėžti tyrėjo kvalifikacinius reikalavimus. Antrojoje dalyje analizuojama tyrėjo kompetencijos turinys. Nagrinėjant prokurorų, teisėjų kompetencijos turinį ir jo reglamentavimo ypatumus, siūloma sudaryti tyrėjo kompetencijų aprašą, kuriame būtų tiksliai apibrėžtas tyrėjo kompetencijos turinys
Sepsis-driven temporal variability in cytokine secretion and heart rate is potentiated by withdrawing vagal innervation: Evidence of higher order neuroimmunological communication via the cholinergic anti-inflammatory pathway in the ovine fetus near term
No full textFetal brain-gut communication is disrupted during sepsis and associated with a higher degree of intestinal inflammation: Implications for non-evasive monitoring
No full textInternet technologies relevant to private investigators’ working practices
No full textMuch has been written and discussed especially in the various US media and in legislative organs, about how the Internet is used illegally (hacking, stalking for instance), but hardly if any research has been done as to how the investigative industry employs the new medium to its benefit. The author described in this thesis how private investigators (PIs) execute their profession these days using the facilities the Internet avail them in contrast to the time before the dawn of the Internet. This contrast is also investigated in an international context, an important part of the thesis, drawn from the author's 32 years of international business experience and that of PIs worldwide. The availability of the various online facilities in different countries are compared. To better understand the new medium, and its facilities a short outline of the Internet’s history, it’s set up in general and for the use of PIs in particular is supplied. PIs also face limitations in their daily work, limitations originating from online, legal, educational, financial and international causes. The new medium not only helps PIs in their investigative, but also in their office work. Finally PIs' wishes for new tools to facilitate their daily investigative work and their outlook as to where the new medium will head are also discussed
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