66 research outputs found
Return of the mentoring programme for BSG members
No full textShellie Radford introduces a mentoring scheme for gastrointestinal specialist
Developing IBD Outcome Effect Size Thresholds to Inform Research, Guidelines, and Clinical Decisions
No full textBackgroundWhen designing clinical trials, interpreting trial outcomes for guideline development or sharing decisions with patients in clinical practice, the clinical outcomes used and the implicit choices on what constitutes a clinically significant finding can vary greatly. This can lead to diversity or even inequity in care offered to patients with inflammatory bowel disease. The GRADE approach to guideline development has proposed a process to address this prospectively to solve these issues, but this has never been used inflammatory bowel disease (IBD). We aimed to develop the first international consensus set of outcome thresholds to establish their use in Crohn’s disease and ulcerative colitis.MethodsA Delphi methodology was used to develop a consensus. An online survey was conducted by inviting stakeholders from the British Society of Gastroenterology (BSG) through a two-phase process. Participants were asked to select important clinically relevant outcomes and were asked about what magnitude of the effect they consider large, moderate, small, or trivial for each clinical trial outcome in line with the GRADE guidance. The results were fedback to all participants to ensure consensus agreement. Then, further surveys were sent to Europe and North America to ensure validity and international triangulation of the data set. Data are presented as mean percentages with standard deviation (SD).Results131 clinical stakeholders participated including clinicians, IBD nurses and a small number of patients with IBD. Clinical remission and serious adverse events were considered the most critical outcomes for Crohn’s disease while clinical remission and endoscopic remission were for ulcerative colitis. The consensus results for thresholds of small, moderate and large outcome effects size were agreed with as follows: clinical remission 11 (SD 6), 20 (8) and 31 (13), endoscopic remission 9 (5), 17 (9) and 28 (14), and serious adverse events 6 (6), 11 (9) and 17 (12) respectively. No significant differences were observed for responses for each condition.ConclusionThis is the first study to develop a consensus on magnitude thresholds for outcomes in IBD. These thresholds have been used in the development of the 2024 BSG guidelines for the management of IBD but can and should also be used by study designers and mostly importantly for clinicians when discussing evidence with patients as part of shared decision making. Future work to validate these findings globally and with other groups, including patients, is neede
British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
No full textIn response to recent advancements in inflammatory bowel disease (IBD) management, the British Society of Gastroenterology (BSG) Clinical Services and Standards Committee (CSSC) has commissioned the BSG IBD section to update its guidelines, last revised in 2019. These updated guidelines aim to complement the IBD standards and promote the use of the national primary care diagnostic pathway for lower gastrointestinal symptoms to enhance diagnostic accuracy and timeliness. Formulated through a systematic and transparent process, this document reflects a consensus of best practices based on current evidence. The guideline, while developed primarily for the UK, is structured to support IBD management internationally. It is endorsed by the BSG executive board and CSSC without external commercial funding, with involvement primarily supported through professional roles in public institutions and the National Health Service (NHS). Methodological revisions since the prior guidelines have enhanced rigor in technical review and development, with methodology details published independently following peer review. In developing the recommendations, 89 clinical experts and stakeholders participated in an online survey, identifying primary outcomes, such as clinical and endoscopic remission, as well as adverse event metrics, all stratified by clinically relevant effect sizes. These guidelines are intended to support clinical decision-making but are not prescriptive, recognizing that individual clinical scenarios may warrant tailored approaches. Further research may inform future revisions as new evidence emerges
Systematic review: The impact of inflammatory bowel disease-related fatigue on health-related quality of life
No full textBACKGROUND: Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on health-related quality of life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue., AIM: To investigate what impact IBD fatigue has on HRQoL in adults with IBD., METHODS: Systematic searches (CINAHL, EMBASE, PsychINFO, Medline) were conducted on 25 September 2018, restricted to 'human', 'adult', 'primary research' and 'English language'. Search terms encompassed concepts of 'fatigue', 'IBD' and 'HRQoL'. A 5-year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted and quality appraised by two authors. A narrative synthesis was conducted., RESULTS: Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial well-being and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably, use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool were some of the methodological shortcomings., CONCLUSION: Psychosocial factors, symptom management and acceptance and physical activity levels have significant impact on HRQoL. Results support application of psychosocial or exercise interventions for fatigue management. Further exploration of HRQoL factors in IBD fatigue is required, using validated fatigue and HRQoL measures., PROSPERO REGISTRATION NUMBER: CRD42018110005. Copyright © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.https://dx.doi.org/10.1136/flgastro-2019-10135
Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services
No full textBackground: Crohn’s disease (CD) is a long-term condition which requires repeated disease monitoring via medical imaging, where repeated burdensome medical investigations negatively impact on patients quality of life. Small bowel ultrasound scanning (SBUS) has been shown to be similar in accuracy when compared to magnetic resonance enterography (MRE), has the potential to be quicker, less costly and improve patient experience of care, but it is not routinely used in NHS IBD care.
Objectives: This thesis aims to provide insight on how best to support the implementation of SBUS in practice by collecting information about current national usage and appetite for SBUS uptake, stakeholder perceptions of the adoption of the intervention by health services and the potential impact of use of SBUS on care pathways in routine CD care. Findings from this work will contribute to the production of an implementation package to facilitate national uptake of SBUS in NHS IBD services.
Methods: A scoping literature review and three research studies were undertaken throughout this programme of work. The scoping literature review was undertaken to explore clinical utility of SBUS in IBD settings. A national survey was undertaken to uncover current usage and appetite for use of SBUS in IBD settings. A qualitative semi structured interview study was undertaken to explore stakeholder perceptions of SBUS use and implementation of ultrasound in IBD settings. A care pathway analysis and cost implications analysis were undertaken to gauge the impact of the introduction of SBUS into an NHS IBD service. The quantitative data were analysed using descriptive statistics. Qualitative data were analysed using template analysis.
Results: Ultrasound is reported as quicker, more acceptable to patients and safer when compared to MRE and has been shown to be similarly accurate in detecting presence and extent of small bowel CD. Ultrasound is used widely in central Europe and Canada but has not yet been embraced in the UK. Survey responses indicated that there is an appetite for the uptake of SBUS in NHS services. There is disparity in confidence levels when using ultrasound to make clinical decisions, compared to MRE. The interview study revealed that stakeholders believe that the introduction of SBUS into clinical services would be beneficial to patient experience, outcomes and cost reduction. There are concerns in relation to the availability of training for health care professionals and the belief that there are still concerns relating to accuracy of SBUS compared to MRE. Interview participants believed that the largest barriers to implementation of SBUS in the NHS were the existing practices, beliefs and behaviours of healthcare professionals which are likely to be difficult to amend. Care pathway and costs implications analysis’ showed that there are significant potential cost saving and waiting time reduction implications to the introduction of SBUS into NHS IBD services.
Conclusions: Recommendations from this work which will contribute to the generation of an implementation package for SBUS include the need for well-structured and supported training for health care professionals, tools for identifying and fostering leadership roles in promoting and sustaining change and mechanisms for reviewing and adapting SBUS over time to ensure it meets the needs of stakeholders and IBD services
Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services
No full textBackground: Crohn’s disease (CD) is a long-term condition which requires repeated disease monitoring via medical imaging, where repeated burdensome medical investigations negatively impact on patients quality of life. Small bowel ultrasound scanning (SBUS) has been shown to be similar in accuracy when compared to magnetic resonance enterography (MRE), has the potential to be quicker, less costly and improve patient experience of care, but it is not routinely used in NHS IBD care.
Objectives: This thesis aims to provide insight on how best to support the implementation of SBUS in practice by collecting information about current national usage and appetite for SBUS uptake, stakeholder perceptions of the adoption of the intervention by health services and the potential impact of use of SBUS on care pathways in routine CD care. Findings from this work will contribute to the production of an implementation package to facilitate national uptake of SBUS in NHS IBD services.
Methods: A scoping literature review and three research studies were undertaken throughout this programme of work. The scoping literature review was undertaken to explore clinical utility of SBUS in IBD settings. A national survey was undertaken to uncover current usage and appetite for use of SBUS in IBD settings. A qualitative semi structured interview study was undertaken to explore stakeholder perceptions of SBUS use and implementation of ultrasound in IBD settings. A care pathway analysis and cost implications analysis were undertaken to gauge the impact of the introduction of SBUS into an NHS IBD service. The quantitative data were analysed using descriptive statistics. Qualitative data were analysed using template analysis.
Results: Ultrasound is reported as quicker, more acceptable to patients and safer when compared to MRE and has been shown to be similarly accurate in detecting presence and extent of small bowel CD. Ultrasound is used widely in central Europe and Canada but has not yet been embraced in the UK. Survey responses indicated that there is an appetite for the uptake of SBUS in NHS services. There is disparity in confidence levels when using ultrasound to make clinical decisions, compared to MRE. The interview study revealed that stakeholders believe that the introduction of SBUS into clinical services would be beneficial to patient experience, outcomes and cost reduction. There are concerns in relation to the availability of training for health care professionals and the belief that there are still concerns relating to accuracy of SBUS compared to MRE. Interview participants believed that the largest barriers to implementation of SBUS in the NHS were the existing practices, beliefs and behaviours of healthcare professionals which are likely to be difficult to amend. Care pathway and costs implications analysis’ showed that there are significant potential cost saving and waiting time reduction implications to the introduction of SBUS into NHS IBD services.
Conclusions: Recommendations from this work which will contribute to the generation of an implementation package for SBUS include the need for well-structured and supported training for health care professionals, tools for identifying and fostering leadership roles in promoting and sustaining change and mechanisms for reviewing and adapting SBUS over time to ensure it meets the needs of stakeholders and IBD services
Opportunities for research in gastroenterology and hepatology nursing
No full textPatients have better outcomes through engaging in research and being treated in hospitals or NHS Trusts with active research programmes. The role of research nurses is diverse and multifactorial, calling on clinical expertise alongside research, project management, and communication skills. Nurse researchers undertake their own research, usually as part of their job or academic progression. Opportunities for research and research funding come from a range of sources, and social media may be the best way to monitor projects and calls for participants.https://www.bsg.org.uk/web-education-articles-list/nurse-articles/opportunities-for-research-in-gastroenterology-and-hepatology-nursing
Fatigue in inflammatory bowel disease: Understanding research needs through an exploratory narrative review
No full text© 2019 MA Healthcare Ltd Aims: To summarise the main findings from research on current understanding of fatigue in inflammatory bowel disease (IBD). Methods: A narrative review of relevant literature corresponding to IBD fatigue was conducted. Results: IBD fatigue is multidimensional and has a complex aetiology. The subjective nature and the lack of a standardised measure of fatigue add to the challenge of developing suitable and effective management methods. Although IBD fatigue is highlighted as a top-five priority research area by N-ECCO, it remains a complex and relatively unexplored area, especially when considering health-related quality of life (HRQoL) and patient experience. Conclusions: Research on the pathogenesis of IBD-related fatigue, effective measurement and its impact on IBD patients will allow the discovery of predictors of severe fatigue that requires clinical intervention, as well as the development of clear treatment pathways and structured support for IBD patients
Connect on campus
No full textNews and professional development from the committee of the British Society of Gastroenterology Nurses' Associationhttps://dx.doi.org/10.12968/gasn.2021.19.1.
- …
