Pub Date : 2024-05-03DOI: 10.1136/flgastro-2024-102642
Michael Dawson, Melissa Rankin, Grahame Smith
The North West Endoscopy Academy is committed to ensuring endoscopy training is of a standardised high quality that is multidisciplinary. It seeks to address the historic lack of admin training by providing a core admin and clerical (A&C) skills in endoscopy course for all A&C staff. The competency framework used for this training is the first developed specifically for A&C staff in endoscopy and the early indications are that it has significantly contributed to the efficacy of a unit’s performance, highlighting that greater focus should be placed on providing these opportunities to A&C staff in the future. This article will explore the aims and methodology of the course and present evaluation data to discuss the successes and future recommendations. We have used a combination of teaching methods, such as small group work, case study analysis and traditional classroom teaching to provide an education programme which seeks to underline existing best practice and introduce new themes and ways of working. Our two-tiered evaluation has shown this approach to be effective, in the future, we intend to implement a further evaluation to establish the long-term added value of the training. In combination, we will begin work on advanced skills modules aimed at supervisory and management staff.
{"title":"Improving endoscopy unit efficacy and retention through the provision of role-specific admin and clerical training","authors":"Michael Dawson, Melissa Rankin, Grahame Smith","doi":"10.1136/flgastro-2024-102642","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102642","url":null,"abstract":"The North West Endoscopy Academy is committed to ensuring endoscopy training is of a standardised high quality that is multidisciplinary. It seeks to address the historic lack of admin training by providing a core admin and clerical (A&C) skills in endoscopy course for all A&C staff. The competency framework used for this training is the first developed specifically for A&C staff in endoscopy and the early indications are that it has significantly contributed to the efficacy of a unit’s performance, highlighting that greater focus should be placed on providing these opportunities to A&C staff in the future. This article will explore the aims and methodology of the course and present evaluation data to discuss the successes and future recommendations. We have used a combination of teaching methods, such as small group work, case study analysis and traditional classroom teaching to provide an education programme which seeks to underline existing best practice and introduce new themes and ways of working. Our two-tiered evaluation has shown this approach to be effective, in the future, we intend to implement a further evaluation to establish the long-term added value of the training. In combination, we will begin work on advanced skills modules aimed at supervisory and management staff.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1136/flgastro-2024-102720
R Mark Beattie
Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID pandemic FIT testing was used to triage patients referred to the cancer pathway. FIT-negative patients were assessed and safety netted in a FIT negative clinic. In this issue Nigam and colleagues report a case note review of 622 patients referred to a FIT negative clinic – 2020/21, median age 71.5 years, median follow-up 2.5 years. Patients were referred with a change in bowel habit (61%), iron deficiency (24%), anaemia (11%), weight loss (9%), blood per rectum (5%). Further investigation by endoscopy/radiology was only indicated in around a third. Malignancy rate was low (1.5%) including rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. The authors rightly suggest that using FIT as a triage in patients referred to the 2 week wait cancer pathway can result in fewer patients requiring further investigation and so more effective and efficient use of healthcare resources. (See page 190) A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. In this issue Bashir and colleagues report the impact of the local implementation of a FIT diagnostic pathway (figure one) on cancer detection rate. The authors use National Endoscopic Data to compare local diagnostic rates in 2019 (before pathway implantation) and 2021. There was a significant increase …
美国国家健康与护理优化研究所（National Institute for Health and Care Excellence）建议使用粪便免疫化学检验（FIT）来分流有不明症状但不符合疑似下消化道癌症路径标准的初级保健患者。在 COVID 大流行期间，FIT 检测被用于对转诊至癌症路径的患者进行分流。对 FIT 阴性患者进行评估，并在 FIT 阴性诊所进行安全防护。本期，Nigam 及其同事报告了转诊至 FIT 阴性诊所的 622 名患者的病例回顾（2020/21 年，中位年龄 71.5 岁，中位随访 2.5 年）。转诊患者的排便习惯改变（61%）、缺铁（24%）、贫血（11%）、体重下降（9%）、直肠带血（5%）。只有约三分之一的患者需要接受内窥镜/放射学进一步检查。恶性肿瘤发生率较低（1.5%），包括直肠乙状结肠神经内分泌瘤、食道癌和肺腺癌。作者正确地指出，将 FIT 作为癌症两周等待路径转诊患者的分流手段，可减少需要进一步检查的患者人数，从而更有效、高效地利用医疗资源。(见第 190 页）粪便免疫化学检验 (FIT) 结果≥10 µg 对于大肠癌 (CRC) 的检测具有很高的灵敏度和阴性预测值。本期，Bashir 及其同事报告了当地实施 FIT 诊断路径（图一）对癌症检出率的影响。作者利用国家内镜数据比较了 2019 年（路径植入前）和 2021 年的地方诊断率。结果显示，癌症检出率明显增加。
{"title":"UpFront","authors":"R Mark Beattie","doi":"10.1136/flgastro-2024-102720","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102720","url":null,"abstract":"Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence to triage symptomatic primary care patients who have unexplained symptoms but do not meet the criteria for a suspected lower gastrointestinal cancer pathway. During the COVID pandemic FIT testing was used to triage patients referred to the cancer pathway. FIT-negative patients were assessed and safety netted in a FIT negative clinic. In this issue Nigam and colleagues report a case note review of 622 patients referred to a FIT negative clinic – 2020/21, median age 71.5 years, median follow-up 2.5 years. Patients were referred with a change in bowel habit (61%), iron deficiency (24%), anaemia (11%), weight loss (9%), blood per rectum (5%). Further investigation by endoscopy/radiology was only indicated in around a third. Malignancy rate was low (1.5%) including rectosigmoid neuroendocrine tumour, oesophageal cancer and lung adenocarcinoma. The authors rightly suggest that using FIT as a triage in patients referred to the 2 week wait cancer pathway can result in fewer patients requiring further investigation and so more effective and efficient use of healthcare resources. (See page 190) A faecal immunochemical test (FIT) result of ≥10 µg has high sensitivity and negative predictive value for colorectal cancer (CRC) detection. In this issue Bashir and colleagues report the impact of the local implementation of a FIT diagnostic pathway (figure one) on cancer detection rate. The authors use National Endoscopic Data to compare local diagnostic rates in 2019 (before pathway implantation) and 2021. There was a significant increase …","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"158 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140582640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29DOI: 10.1136/flgastro-2023-102606
Ahmir Ahmad, Anna Buenaventura, Belma Motes, Ravi Misra, Ripple Man, Angad Dhillon, Paul Bassett, Kowshika Thiruvilangam, Brian P Saunders
Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used. This study aimed to evaluate whether a hybrid or water exchange technique allows more efficient colonoscopy. Methods This prospective, randomised controlled trial was conducted between March 2021 and June 2022. Participants were randomised 1:1 to hybrid or water exchange colonoscopy, performed by four experienced colonoscopists. The primary outcome was total procedure time with secondary outcomes of caecal intubation time, caecal intubation rate, polyp detection, loop formation, number of ancillary manoeuvres, sedation use and patient comfort. Results 256 patients were invited, and 246 were randomised to either hybrid or water exchange colonoscopy. 122 patients were included in each arm of the primary analysis. Total procedure time was greater in the water exchange group compared with hybrid (29 vs 25 min, p=0.009). Patient reposition episodes occurred more frequently in the water exchange group vs hybrid group (5.5 vs 5, p=0.003) and left colon Boston Bowel Preparation Scale (BBPS) score was improved. No difference was seen in all other outcomes. Conclusion A hybrid technique, compared with water exchange, enabled faster colonoscopy without adversely impacting sedation requirement, caecal intubation, overall bowel cleansing and patient comfort. This technique appears to maximise the advantages of both water and CO2 to enable more efficient colonoscopy. Trial registration number [NCT04710706][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04710706&atom=%2Fflgastro%2Fearly%2F2024%2F04%2F29%2Fflgastro-2023-102606.atom
{"title":"Randomised trial of ‘hybrid’ water-assisted colonoscopy (modified water immersion) versus water exchange colonoscopy: WAVE study","authors":"Ahmir Ahmad, Anna Buenaventura, Belma Motes, Ravi Misra, Ripple Man, Angad Dhillon, Paul Bassett, Kowshika Thiruvilangam, Brian P Saunders","doi":"10.1136/flgastro-2023-102606","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102606","url":null,"abstract":"Background and aims Colonoscopy practice has evolved with a trend towards water-assisted insertion. A recent national survey suggests a hybrid approach to colonic distension during insertion, with water used predominately to the splenic flexure and carbon dioxide (CO2) with water used thereafter to the caecum, is commonly used. This contrasts with the water exchange technique where no CO2 is used. This study aimed to evaluate whether a hybrid or water exchange technique allows more efficient colonoscopy. Methods This prospective, randomised controlled trial was conducted between March 2021 and June 2022. Participants were randomised 1:1 to hybrid or water exchange colonoscopy, performed by four experienced colonoscopists. The primary outcome was total procedure time with secondary outcomes of caecal intubation time, caecal intubation rate, polyp detection, loop formation, number of ancillary manoeuvres, sedation use and patient comfort. Results 256 patients were invited, and 246 were randomised to either hybrid or water exchange colonoscopy. 122 patients were included in each arm of the primary analysis. Total procedure time was greater in the water exchange group compared with hybrid (29 vs 25 min, p=0.009). Patient reposition episodes occurred more frequently in the water exchange group vs hybrid group (5.5 vs 5, p=0.003) and left colon Boston Bowel Preparation Scale (BBPS) score was improved. No difference was seen in all other outcomes. Conclusion A hybrid technique, compared with water exchange, enabled faster colonoscopy without adversely impacting sedation requirement, caecal intubation, overall bowel cleansing and patient comfort. This technique appears to maximise the advantages of both water and CO2 to enable more efficient colonoscopy. Trial registration number [NCT04710706][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04710706&atom=%2Fflgastro%2Fearly%2F2024%2F04%2F29%2Fflgastro-2023-102606.atom","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"60 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1136/flgastro-2023-102499
Judith Chantal Eling, Jennifer Barker, Stefi Barna
The healthcare sector is a significant producer of greenhouse gas emissions. Gases that contribute to climate change include carbon dioxide, methane, nitrous oxide and chlorofluorocarbons. Climate change will impact the types and prevalence of diseases seen in clinical practice. Practising preventive medicine in gastroenterology can protect population health and reduce the need for health services, thus reducing the carbon footprint of the health sector. Increasing patient empowerment, making care pathways leaner and minimising the environmental impact of treatments and interventions could also make healthcare more sustainable.
{"title":"Climate change for gastroenterologists: understanding the basics","authors":"Judith Chantal Eling, Jennifer Barker, Stefi Barna","doi":"10.1136/flgastro-2023-102499","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102499","url":null,"abstract":"The healthcare sector is a significant producer of greenhouse gas emissions. Gases that contribute to climate change include carbon dioxide, methane, nitrous oxide and chlorofluorocarbons. Climate change will impact the types and prevalence of diseases seen in clinical practice. Practising preventive medicine in gastroenterology can protect population health and reduce the need for health services, thus reducing the carbon footprint of the health sector. Increasing patient empowerment, making care pathways leaner and minimising the environmental impact of treatments and interventions could also make healthcare more sustainable.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"94 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.1136/flgastro-2024-102668
Alexander Thomas Elford, Maria Bishara, Nikolas Plevris, Beatriz Gros, Nathan Constantine-Cooke, James Goodhand, Nicholas A Kennedy, Tariq Ahmad, Charlie W Lees
Background Upadacitinib is a Janus kinase inhibitor, which has recently been approved for treating Crohn’s disease. There are limited real-world studies on the outcomes of upadacitinib in Crohn’s disease. Objective Our aim was to evaluate the outcomes of upadacitinib in a real-world Crohn’s disease cohort. Methods We conducted a retrospective, multicentre, cohort study over a 2-year period across National Health Service (NHS) Lothian and Royal Devon University Healthcare NHS Foundation Trust. The primary outcome was treatment persistence at week 24. Secondary endpoints were corticosteroid-free clinical remission (Harvey-Bradshaw Index (HBI)<5) and biomarker remission (C-reactive protein (CRP)≤5 mg/L and faecal calprotectin (FCAL)<250 µg/g) at 12, 24 and 52 weeks. We recorded adverse events. Results 135 patients commenced upadacitinib as of the 1 January 2024, of which 93 patients with active Crohn’s disease were included with a minimum of 12 weeks follow-up. The median follow-up time was 25 weeks (IQR 15–42 weeks). 82% of the cohort had exposure to at least two classes of advanced therapies, and 52% had exposure to at least three classes of advanced therapies. Treatment persistence was 87.1% at week 12, 81.7% at week 24 and 62.8% at week 52. Rates of clinical remission were 64% (42/66), 48% (22/46) and 38% (8/21) at weeks 12, 24 and 52, respectively. Significant reductions in HBI, CRP and FCAL were observed during follow-up. 14% (13/91) had a hospitalisation due to Crohn’s disease. Adverse events occurred in 40% (37/93) of the cohort, of which 12% (11/93) were serious. Conclusion Upadacitinib was effective in a real-world, highly refractory, Crohn’s disease cohort with good persistence. Data are available on reasonable request.
{"title":"Real-world effectiveness of upadacitinib in Crohn’s disease: a UK multicentre retrospective cohort study","authors":"Alexander Thomas Elford, Maria Bishara, Nikolas Plevris, Beatriz Gros, Nathan Constantine-Cooke, James Goodhand, Nicholas A Kennedy, Tariq Ahmad, Charlie W Lees","doi":"10.1136/flgastro-2024-102668","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102668","url":null,"abstract":"Background Upadacitinib is a Janus kinase inhibitor, which has recently been approved for treating Crohn’s disease. There are limited real-world studies on the outcomes of upadacitinib in Crohn’s disease. Objective Our aim was to evaluate the outcomes of upadacitinib in a real-world Crohn’s disease cohort. Methods We conducted a retrospective, multicentre, cohort study over a 2-year period across National Health Service (NHS) Lothian and Royal Devon University Healthcare NHS Foundation Trust. The primary outcome was treatment persistence at week 24. Secondary endpoints were corticosteroid-free clinical remission (Harvey-Bradshaw Index (HBI)<5) and biomarker remission (C-reactive protein (CRP)≤5 mg/L and faecal calprotectin (FCAL)<250 µg/g) at 12, 24 and 52 weeks. We recorded adverse events. Results 135 patients commenced upadacitinib as of the 1 January 2024, of which 93 patients with active Crohn’s disease were included with a minimum of 12 weeks follow-up. The median follow-up time was 25 weeks (IQR 15–42 weeks). 82% of the cohort had exposure to at least two classes of advanced therapies, and 52% had exposure to at least three classes of advanced therapies. Treatment persistence was 87.1% at week 12, 81.7% at week 24 and 62.8% at week 52. Rates of clinical remission were 64% (42/66), 48% (22/46) and 38% (8/21) at weeks 12, 24 and 52, respectively. Significant reductions in HBI, CRP and FCAL were observed during follow-up. 14% (13/91) had a hospitalisation due to Crohn’s disease. Adverse events occurred in 40% (37/93) of the cohort, of which 12% (11/93) were serious. Conclusion Upadacitinib was effective in a real-world, highly refractory, Crohn’s disease cohort with good persistence. Data are available on reasonable request.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140582467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1136/flgastro-2023-102619
Sandeep Joshi, Alice Moore, Joel Mawdsley, Barbara Carey
Orofacial symptoms are common in patients with inflammatory bowel disease (IBD). They may present as a primary manifestation of the disease in the oral cavity with oral Crohn’s disease, or as a secondary manifestation of the disease such as iron deficiency, or due to side effects to medications used in treatment. Orofacial manifestations of IBD may result in significant morbidity which can impact patients’ quality of life. Systematic examination and a timely diagnosis are fundamental in initiating appropriate management. This article provides a guide for gastroenterologists to systematically perform an extraoral and intraoral examination of the orofacial region. The extraoral examination includes evaluation of lymph nodes, lips and perioral skin. Common extraoral features of IBD include lip swelling, lip fissuring, angular cheilitis, perioral erythema and cervicofacial lymphadenopathy. The intraoral examination involves a systematic inspection of all areas of the oral cavity. Intraoral IBD features include ulceration, cobblestoning of the buccal mucosa, gingival erythema and mucosal tags. Examining the orofacial region is important in the complete assessment of patients with IBD, to diagnose orofacial conditions, to initiate tailored treatments and to identify those patients who would benefit from input from oral medicine specialists.
{"title":"Oral manifestations of inflammatory bowel disease: a guide to examination","authors":"Sandeep Joshi, Alice Moore, Joel Mawdsley, Barbara Carey","doi":"10.1136/flgastro-2023-102619","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102619","url":null,"abstract":"Orofacial symptoms are common in patients with inflammatory bowel disease (IBD). They may present as a primary manifestation of the disease in the oral cavity with oral Crohn’s disease, or as a secondary manifestation of the disease such as iron deficiency, or due to side effects to medications used in treatment. Orofacial manifestations of IBD may result in significant morbidity which can impact patients’ quality of life. Systematic examination and a timely diagnosis are fundamental in initiating appropriate management. This article provides a guide for gastroenterologists to systematically perform an extraoral and intraoral examination of the orofacial region. The extraoral examination includes evaluation of lymph nodes, lips and perioral skin. Common extraoral features of IBD include lip swelling, lip fissuring, angular cheilitis, perioral erythema and cervicofacial lymphadenopathy. The intraoral examination involves a systematic inspection of all areas of the oral cavity. Intraoral IBD features include ulceration, cobblestoning of the buccal mucosa, gingival erythema and mucosal tags. Examining the orofacial region is important in the complete assessment of patients with IBD, to diagnose orofacial conditions, to initiate tailored treatments and to identify those patients who would benefit from input from oral medicine specialists.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1136/flgastro-2023-102612
Sandeep Shivananda Siddhi, Mhairi Donnelly
We are in a climate emergency—this is anthropogenic, and we can do something about it. An awareness of carbon footprinting is essential to allow us to understand and address this issue, both in our personal and professional lives. The aim of this article is to demystify carbon footprinting and to make the concept relevant to the gastrointestinal healthcare professional.
{"title":"Carbon footprinting for the gastroenterologist","authors":"Sandeep Shivananda Siddhi, Mhairi Donnelly","doi":"10.1136/flgastro-2023-102612","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102612","url":null,"abstract":"We are in a climate emergency—this is anthropogenic, and we can do something about it. An awareness of carbon footprinting is essential to allow us to understand and address this issue, both in our personal and professional lives. The aim of this article is to demystify carbon footprinting and to make the concept relevant to the gastrointestinal healthcare professional.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1136/flgastro-2023-102478
Sascha C A T Verbruggen, Suzan Cochius den Otter, Johanna Bakker, George Briassoulis, Ilia Stavoula, Lynne Latten, Koen Joosten, Shancy Rooze, Eva van Zanten, R Mark Beattie, Luise V Marino
The climate emergency presents a profound threat to global health, adversely affecting the health and well-being of children who are projected to bear a substantial disease burden, as well as impacting children’s right to food, water, healthcare and education. The healthcare sector strives to prioritise preventative healthcare policies improving the health of individuals across the life course. However, current healthcare practices significantly contribute to greenhouse gas (GHG) emissions and waste generation, in which (medical) nutrition plays an important role. Plant-based proteins offer sustainability benefits, and potential health advantages, and have a lower climate footprint, although there may also be unintended consequences of land-use change and deforestation for certain crops. However, to develop suitable plant-based alternatives to medical nutrition, it will be necessary to address regulatory obstacles as well as ensure nutritional profiles are suitable, particularly protein (amino acid) and micronutrient composition. Additionally, the development of heat-tolerant and water-efficient plant genotypes could bolster adaptation to changing climatic conditions. Effective waste management, including wasted food and medical nutrition, emerges as a key strategy in mitigating the climate impact of medical nutrition. While research on food waste in healthcare settings is limited, minimising waste spillage in medical nutrition is a crucial area to explore. Healthcare professionals must acknowledge their roles in curbing the climate footprint of medical nutrition as well as recommendations for food-based approaches. This review aims to investigate the sustainability of medical nutrition for paediatric care, focusing on factors contributing to GHG emissions, plant-based alternatives, waste management and plastic packaging. Such an exploration is vital for healthcare professionals to fulfil their responsibilities in addressing the climate crisis while advocating for change.
{"title":"Call for sustainable food systems including (medical) nutrition for hospitalised children and their families","authors":"Sascha C A T Verbruggen, Suzan Cochius den Otter, Johanna Bakker, George Briassoulis, Ilia Stavoula, Lynne Latten, Koen Joosten, Shancy Rooze, Eva van Zanten, R Mark Beattie, Luise V Marino","doi":"10.1136/flgastro-2023-102478","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102478","url":null,"abstract":"The climate emergency presents a profound threat to global health, adversely affecting the health and well-being of children who are projected to bear a substantial disease burden, as well as impacting children’s right to food, water, healthcare and education. The healthcare sector strives to prioritise preventative healthcare policies improving the health of individuals across the life course. However, current healthcare practices significantly contribute to greenhouse gas (GHG) emissions and waste generation, in which (medical) nutrition plays an important role. Plant-based proteins offer sustainability benefits, and potential health advantages, and have a lower climate footprint, although there may also be unintended consequences of land-use change and deforestation for certain crops. However, to develop suitable plant-based alternatives to medical nutrition, it will be necessary to address regulatory obstacles as well as ensure nutritional profiles are suitable, particularly protein (amino acid) and micronutrient composition. Additionally, the development of heat-tolerant and water-efficient plant genotypes could bolster adaptation to changing climatic conditions. Effective waste management, including wasted food and medical nutrition, emerges as a key strategy in mitigating the climate impact of medical nutrition. While research on food waste in healthcare settings is limited, minimising waste spillage in medical nutrition is a crucial area to explore. Healthcare professionals must acknowledge their roles in curbing the climate footprint of medical nutrition as well as recommendations for food-based approaches. This review aims to investigate the sustainability of medical nutrition for paediatric care, focusing on factors contributing to GHG emissions, plant-based alternatives, waste management and plastic packaging. Such an exploration is vital for healthcare professionals to fulfil their responsibilities in addressing the climate crisis while advocating for change.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140202335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1136/flgastro-2024-102666
Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry
Metastatic oesophageal adenocarcinoma (OAC) is associated with a poor prognosis, but patients with a good performance status may be offered palliative oncological intervention. Oesophageal cryoablation is an emerging therapy for the palliation of malignant dysphagia that can be given over multiple sessions with relatively few side effects. Emerging evidence suggests that cryoablation may provide a synergistic effect with modern immunotherapies as cryonecrosis leads to the release of many tumour-specific autoantigens that induce a systemic antitumour response. We present the case of a 39-year-old man who presented with several months of non-specific upper abdominal pain and heartburn. He was subsequently diagnosed with metastatic OAC and proceeded to self-funded genomic tumour profiling. This enabled initiation of a personalised oncological treatment plan involving immunotherapy and a neoantigen cancer vaccination regimen. To facilitate continued oral intake and avoid the risk of endoscopic stenting, the patient underwent a concurrent programme of oesophageal balloon cryoablation over eight sessions. At 15 months following his diagnosis, he had complete histological remission of luminal disease and a preserved systemic treatment response. In summary, oesophageal cryoablation is an endoscopic option for luminal control among patients undergoing immunotherapy for metastatic OAC. This would provide a synergistic treatment effect and mitigate against the risk of endoscopic stenting.
{"title":"Role of oesophageal balloon cryoablation in combination with personalised immunotherapy to achieve luminal control in metastatic oesophageal cancer: a case report","authors":"Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Margaret Duku, Imran Chaudhry, Alberto Murino, Gavin Johnson, Charles Murray, Rehan Haidry","doi":"10.1136/flgastro-2024-102666","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102666","url":null,"abstract":"Metastatic oesophageal adenocarcinoma (OAC) is associated with a poor prognosis, but patients with a good performance status may be offered palliative oncological intervention. Oesophageal cryoablation is an emerging therapy for the palliation of malignant dysphagia that can be given over multiple sessions with relatively few side effects. Emerging evidence suggests that cryoablation may provide a synergistic effect with modern immunotherapies as cryonecrosis leads to the release of many tumour-specific autoantigens that induce a systemic antitumour response. We present the case of a 39-year-old man who presented with several months of non-specific upper abdominal pain and heartburn. He was subsequently diagnosed with metastatic OAC and proceeded to self-funded genomic tumour profiling. This enabled initiation of a personalised oncological treatment plan involving immunotherapy and a neoantigen cancer vaccination regimen. To facilitate continued oral intake and avoid the risk of endoscopic stenting, the patient underwent a concurrent programme of oesophageal balloon cryoablation over eight sessions. At 15 months following his diagnosis, he had complete histological remission of luminal disease and a preserved systemic treatment response. In summary, oesophageal cryoablation is an endoscopic option for luminal control among patients undergoing immunotherapy for metastatic OAC. This would provide a synergistic treatment effect and mitigate against the risk of endoscopic stenting.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"91 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-14DOI: 10.1136/flgastro-2024-102641
Robbie Hughes, Daniel Richardson, Colin Fitzpatrick
Objective Entamoeba histolytica is parasitic infection that can cause a proctocolitis (amoebiasis) and extraintestinal sequelae (eg, liver abscess) and can be sexually transmitted in men who have sex with men (MSM). We aimed to identify factors associated with E. histolytica in MSM to provide insight for future control strategies. Design/methods We searched MEDLINE, Embase, CINAHL and Web of Science Core Collections for manuscripts published up to November 2022. One author screened abstracts; two authors independently conducted a full-text review. We included manuscripts that contained primary data on factors associated with transmission in MSM. Quality and risk of bias were assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis method to synthesise narrative data. Results Nine manuscripts consisting of 832 individuals with E. histolytica were included; six cross-sectional studies, two case-control studies and one cohort study. E. histolytica in MSM was associated with: increasing age, transmission in warm seasons, lower educational achievement, concurrent sexually transmitted infection (STI) ( Treponema pallidum , Neisseria gonorrhoeae , Chlamydia trachomatis ), hepatitis B core antibody positivity, hepatitis C antibody positivity, concurrent sexually transmitted enteric infection ( Shigella spp, Giardia duodenalis ), having a previous STI ( T. pallidum, N. gonorrhoeae ), oral-anal sex, exclusively/majority receptive anal sex and having an increased number of sexual partners. Conclusion This review has highlighted some important demographic, biological and behavioural factors associated with E. histolytica in MSM which can inform future clinical guidelines and public health control strategies. PROSPERO registration number CRD42022366168. Data sharing not applicable to this article as no data sets were generated or analysed during the current study.
{"title":"Factors associated with Entamoeba histolytica proctocolitis in men who have sex with men: a systematic review","authors":"Robbie Hughes, Daniel Richardson, Colin Fitzpatrick","doi":"10.1136/flgastro-2024-102641","DOIUrl":"https://doi.org/10.1136/flgastro-2024-102641","url":null,"abstract":"Objective Entamoeba histolytica is parasitic infection that can cause a proctocolitis (amoebiasis) and extraintestinal sequelae (eg, liver abscess) and can be sexually transmitted in men who have sex with men (MSM). We aimed to identify factors associated with E. histolytica in MSM to provide insight for future control strategies. Design/methods We searched MEDLINE, Embase, CINAHL and Web of Science Core Collections for manuscripts published up to November 2022. One author screened abstracts; two authors independently conducted a full-text review. We included manuscripts that contained primary data on factors associated with transmission in MSM. Quality and risk of bias were assessed independently by two authors using the Joanna Briggs Institute critical appraisal tools. We used the nine-point synthesis method to synthesise narrative data. Results Nine manuscripts consisting of 832 individuals with E. histolytica were included; six cross-sectional studies, two case-control studies and one cohort study. E. histolytica in MSM was associated with: increasing age, transmission in warm seasons, lower educational achievement, concurrent sexually transmitted infection (STI) ( Treponema pallidum , Neisseria gonorrhoeae , Chlamydia trachomatis ), hepatitis B core antibody positivity, hepatitis C antibody positivity, concurrent sexually transmitted enteric infection ( Shigella spp, Giardia duodenalis ), having a previous STI ( T. pallidum, N. gonorrhoeae ), oral-anal sex, exclusively/majority receptive anal sex and having an increased number of sexual partners. Conclusion This review has highlighted some important demographic, biological and behavioural factors associated with E. histolytica in MSM which can inform future clinical guidelines and public health control strategies. PROSPERO registration number CRD42022366168. Data sharing not applicable to this article as no data sets were generated or analysed during the current study.","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"24 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140154922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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