BackgroundInflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient’s quality of life (QOL) through an application like HealthPROMISE.ObjectiveThe objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients.MethodsParticipants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views).ResultsEnrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints.ConclusionsHealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. U...
S362Poster presentations the time of initial seton placement), intermediate-term (<12 months from the time of initial seton placement), and long-term (>12 months from the time of initial seton placement) outcomes were analyzed. Results: The study cohort included 41 patients. Indication for placement of draining seton alone rather than definitive surgical fistula repair was presence of anal ulceration, stenosis and/or proctitis (n=30; 73%), complex fistulae not amenable to surgical repair (n=8; 26%) or patient preference (n=3; 7%). Concomitant medical therapy using biologics, immunomodulators, and/or steroids was used in 28 (68%), 14 (34%) and 13 (32%) patients, respectively. Median length of follow-up after seton placement was 35 months (range, 8-69). Over the short-term, 16/41 (39%) patients required additional seton placement for new or persistent fistula after median follow-up time of 2.2 months (range, 0.2-5.5 months). Over the intermediateterm, 6/37 (16%) more patients required additional seton placement for new or persistent fistula after a median follow-up time of 7.7 months (range, 7-11.4 months). Over the long-term, 7/35 (20%) more patients required additional seton placement for new or persistent fistula after a median follow-up time of 16.8 months (range, 14.5-29.5 months). Overall, 29 (71%) patients required additional seton placement for new or persistent fistula after a median time of 7 months (range, 0.2-29.5 months) after initial seton placement (Figure 1). The majority of patients requiring additional seton placement also had concomitant medical therapy with a biologic agent (19/29; 66%). Patients who had a family history of CD had a significantly lower incidence of additional seton placement (50%) compared to patients who did not have a family history of CD (90%) (p=0.04). All other clinical factors including concomitant medical therapy were not associated with additional seton placement. Conclusions: Almost 75% of patients with planned long-term seton drainage for PFCD required additional setons. These data suggest that draining setons in PFCD, even in combination with biologic agents, may not have as promising results as previously believed. Progression of PFCD remains high despite biologic therapy and seton drainage. P554 Icahn School of Medicine at Mount Sinai, Department of Medicine, New York City, United StatesBackground: Patients with IBD are ideal candidates for home-based remote monitoring care that is centered on enhanced symptom tracking and improved communication with care teams. The objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes quality of care [QOC] and quality of life [QOL] as compared to a patient education app. Methods: Participants were randomized to either interventional (HealthPROMISE) or control (education app). All patients completed intake questionnaires assessing health literacy, disease severity, general health status, and demographic information. Patients in the HealthPROMISE arm were ...
Background: Disease extent varies in UC from proctitis (E1) to left-sided colitis (E2) and pancolitis (E3). When the extent of UC is limited there is a sharp demarcation between macroscopically involved and uninvolved areas, which remains unexplained. As 25% of limited UC patients extend over time, we assessed molecularly the mechanisms defining the anatomic delineation between affected and unaffected colon. Methods: We performed RNA-seq analysis on biopsies from UC patients and characterised inflammation at and proximal to the endoscopic demarcation of disease. We collected biopsies from endoscopically involved rectum (37), sigmoid (12) and left colon (9) of UC patients. Uninvolved areas, either directly adjacent to the inflamed site or more proximal were also sampled. The resulting 148 paired biopsies were then "ordered" by inflammation status and gut location and a "distance" from inflammation was assigned for each biopsy. The distance from the first adjacent region to the inflamed biopsy was defined as D = 1, for example, inflamed rectum and uninflamed sigmoid. A D = 2 was assigned if the adjacent biopsy was two regions away from the inflamed biopsy up to D = 5. Expression changes were modelled over all the distances from inflammation. Results: Two striking patterns of expression were observed. One included genes progressively changing expression as the distance from the site of inflammation increased ("slope geneset"). The second included genes abruptly changing expression at the first adjacent region to the inflamed biopsy and then not changing further ("wall geneset"). Slope genes decreasing in expression were inflammatory (IFNg, IL6 and Oncostatin-M), suggesting that the reach of inflammation was further than observed by endoscopy. However, a subset of inflammatory genes as well as integrins and adhesion molecules had sharply decreased expression at the adjacent uninflamed region (wall genes: IL23A, IL22, TNF, and IL10), suggesting that these may be important for modulating progression of disease. Upregulated slope genes included solute carrier and homeobox genes while upregulated wall genes included glucoronidation and fatty acid binding proteins, suggesting altered gut function. Conclusions: A complex molecular pattern exists at the "visible" line of disease demarcation. This may help to understand its origin and potentially provide biomarkers of UC extension. Background: The single-nucleotoide polymorphisms (SNP) rs1893217, located in the gene locus encoding protein tyrosine phosphatase non-receptor type 2 (PTPN2), is associated with inflammatory disorders, including inflammatory bowel disease (IBD), rheumatic arthritis, and type 1 diabetes. We have demonstrated that PTPN2 plays a crucial role in maintaining intestinal homeostasis. The polyamine spermidine, which is a potent activator of PTPN2 enzymatic activity, limits IFNg-induced pro-inflammatory signalling events via activation of PTPN2. Of note, spermidine treatment promotes intestinal barrier function and reduces intestinal inflammation in a mou...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.