Explore the vast range of titles available.

This biography of the noted children's author explores the life and career of Dr. Seuss.

Objectives:Anastomotic reconstruction following intestinal resection in Crohn's disease (CD) may employ side-to-side anastomosis (STSA; anti-peristaltic orientation) or end-to-end anastomosis (ETEA). Our aim was to determine the impact of these two anastomotic techniques on long-term clinical status in postoperative CD patients.Methods:We performed a comparative effectiveness study of prospectively collected observational data from consented CD patients undergoing their first or second ileocolonic bowel resection and re-anastomosis between 2008 and 2012, in order to assess the association between anastomosis type and 2-year postoperative quality of life (QoL), healthcare utilization, disease clinical or endoscopic recurrence, use of medications, and need for repeat resection.Results:One hundred and twenty eight postoperative CD patients (60 STSA and 68 ETEA) were evaluated. At 2 years postoperatively, STSA patients had higher rates of emergency department visits (33.3% vs. 14.7%; P=0.01), hospitalizations (30% vs. 11.8%; P=0.01), and abdominal computed tomography scans (50% vs. 13.2%; P<0.001) with lower QoL (mean short inflammatory bowel disease questionnaire 47.9 vs. 53.4; P=0.007). There was no difference among the two groups in the 30 day surgical complications and 2-year patterns of disease activity, CD medication requirement, endoscopic recurrence, and need for new surgical management (all P > 0.05).Conclusions:At 2 years postoperatively, CD patients with ETEA demonstrated better QoL and less healthcare utilization compared with STSA, despite having similar patterns of disease recurrence and CD treatment. These findings suggest that surgical reconstruction of the bowel as an intact tube (ETEA) contribute to improved functional and clinical status in patients with CD.

Background Community awareness of the harms of overdiagnosis remains low. Objective To evaluate community responses to a public health campaign designed for health service waiting rooms that focuses on the harms of unnecessary diagnostic imaging for low back pain. Methods We conducted two focus groups of 19 community members with or without low back pain in Sydney, Australia. This study formed the fourth and final stage of the development process of a public health campaign: (a) initial design, (b) expert review and revision, (c) online experiment and (d) community views & revision. We evaluated reactions to components of the campaign that included digital posters and an information leaflet using strong imagery and messaging about the risk of overdiagnosis. We conducted a qualitative thematic analysis to identify main themes. Results Community members reacted with surprise, initial mistrust, and occasionally anger towards imagery and messaging that suggested diagnostic imaging tests could be unnecessary and harmful. With further reflection and discussion, and after reading longer format information about overdiagnosis, the participants found some of the messages informative and useful. Participants appeared to gain a better understanding of the concept of overdiagnosis and the importance of not rushing to imaging. Conclusions Public health campaigns including posters and leaflets displayed in waiting rooms could raise awareness about overuse of diagnostic imaging and the harms of overdiagnosis more broadly. However, negative reactions are possible and must be managed carefully. Patient or Public Contribution We involved a community participation manager who provided advice on the focus group discussion guide, participant recruitment and manuscript presentation.

Background Demands are increasingly being made for clinical trialists to actively share individual participant data (IPD) collected from clinical trials using responsible methods that protect the confidentiality and privacy of clinical trial participants. Clinical trialists, particularly those receiving public funding, are often concerned about the additional time and money that data-sharing activities will require, but few published empirical data are available to help inform these decisions. We sought to evaluate the activity and resources required to prepare anonymised IPD from a clinical trial in anticipation of a future data-sharing request. Methods Data from two UK publicly funded clinical trials were used for this exercise: 2437 participants with epilepsy recruited from 90 hospital outpatient clinics in the SANAD trial and 146 children with neuro-developmental problems recruited from 18 hospitals in the MENDS trial. We calculated the time and resources required to prepare each anonymised dataset and assemble a data pack ready for sharing. Results The older SANAD trial (published 2007) required 50 hours of staff time with a total estimated associated cost of £3185 whilst the more recently completed MENDS trial (published 2012) required 39.5 hours of staff time with total estimated associated cost of £2540. Conclusions Clinical trial researchers, funders and sponsors should consider appropriate resourcing and allow reasonable time for preparing IPD ready for subsequent sharing. This process would be most efficient if prospectively built into the standard operational design and conduct of a clinical trial. Further empirical examples exploring the resource requirements in other settings is recommended. Trial registration SANAD: International Standard Randomised Controlled Trials Registry: ISRCTN38354748 . Registered on 25 April 2003. MENDS: EU Clinical Trials Register Eudract 2006-004025-28 . Registered on 16 May 2007. International Standard Randomised Controlled Trials Registry: ISRCTN05534585 /MREC 07/MRE08/43. Registered on 26 January 2007.

Background: Chronic stomach regurgitation associated with eating disorders (EDs) poses a high risk for tooth erosion. This study investigated oral health conditions, behavioral patterns, and tooth erosion in women with EDs. Methods: 16 ED and 13 healthy women were enrolled; 14 ED and 10 healthy control subjects completed the study. Subjects completed demographic, medical, oral, and behavioral health history questionnaires. Dental caries status was recorded as Decayed, Missing and Filled Teeth (DMFT)index and the severity of tooth erosion as Basic Erosive Wear Examination (BEWE) scores. Saliva was collected for flow rate, pH, and buffering capacity analysis. Results: The ED group had a lower stimulated saliva flow rate and higher DMFT index but no significant difference in BEWE scores compared to the controls (t-test, significance level 0.05). Five of the fourteen ED subjects exhibited extensive tooth erosion, which may have been exacerbated by their tooth-brushing behavior. Conclusions: Although some ED subjects showed extensive tooth erosion in this pilot study, the average BEWE score of the ED group was not significantly different from the controls. Extensive tooth erosion in ED may relate to the low stimulated salivary flow. A larger-scale clinical study is necessary to validate these results.

Abstract Background Almost half of patients with Crohn’s disease (CD) require bowel surgeries in their lifetime. Due to the high risk of postoperative disease recurrence and high rate of previous antitumor necrosis factor (anti-TNF) failure, often alternative therapy options such as ustekinumab (UST) and vedolizumab (VDZ) are used. We aimed to evaluate the efficacy of UST and VDZ among postoperative CD patients as postoperative prophylaxis and rescue therapy. Methods Consented CD patients who underwent initial ileocecal resection and were treated with UST and VDZ were included in this study. Demographics, clinical characteristics, health care utilization, endoscopy scores, and surgery outcomes were collected. Postoperative early CD recurrence was defined as a Rutgeerts endoscopic score ≥i2 within the first 2 years. The rescue therapy group was defined as patients who received either UST or VDZ after having Rutgeerts endoscopic score ≥i2 postoperatively. Results During 2009 to 2019, 98 CD patients were treated with UST or VDZ postoperatively. Postoperative early recurrence rates were 5% (n = 1 out of 20) and 6% (1 out of 15) for the UST and VDZ groups, respectively. Two patients from the UST group and 1 patient from the VDZ group required bowel surgery during follow-up with median drug exposure of 51 (95% confidence interval [CI], 29-61) and 30 (95% CI, 14-63) months, respectively; 55% and 69% of patients had at least 1 point of improvement on postoperative endoscopic Rutgeerts score, respectively, for UST and VDZ. Only 3 out of 40 and 1 out of 23 patients required bowel surgery during follow-up while receiving UST and VDZ as rescue therapy. Conclusions Both UST and VDZ were effective as postoperative therapies either as prophylaxis or rescue therapy. Lay Summary This retrospective 11-year data examines the efficacy of ustekinumab and vedolizumab among postoperative Crohn’s disease patients. When utilizing postoperative Rutgeerts score, this study confirms that both ustekinumab and vedolizumab were effective as postoperative therapies either as prophylaxis or rescue therapy.

We sought to characterize the effects of diabetes mellitus on the natural history of inflammatory bowel disease. From a large cohort of inflammatory bowel disease patients, we found that although patients suffering from comorbid diabetes mellitus demonstrated evidence of increased disease severity, they may be undertreated with immunomodulator and/or biologic agents.AbstractBackgroundGiven the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM.MethodsData of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment.ResultsOut of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn’s disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P < 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P < 0.001, gastroenterology clinic visits P < 0.001, and median annual charges P < 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations.ConclusionsThis study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.Video Abstract 10.1093/ibd/izz305_video1Video Abstractizz305_video16123115852001

Abstract Background Approximately half of Crohn’s disease (CD) patients experience recurrence and need for repeat resections, highlighting need for prognostic biomarkers. Presence of epithelioid granuloma on surgical tissue and high Rutgeerts endoscopic score are associated with postoperative CD clinical recurrence. We sought to evaluate presence of epithelioid granuloma at first surgery and Rutgeerts score as a combined risk assessment for CD surgical recurrence. Methods Our study included consented CD patients who underwent initial ileocecal resection and were prospectively followed postoperatively. From 2009 to 2019, 418 CD patients underwent initial ileocecal resection with >4 years of follow-up, including postoperative endoscopic assessment (Rutgeerts score). Results Postoperative CD patients were grouped based on granuloma presence (30.6%; n = 128) or absence (69.4%; n = 290). Endoscopic recurrence (defined as Rutgeerts score ≥i2) was similar between the granuloma (26%) and no granuloma (25%) groups, respectively (P = .82). Patients with granuloma and CD endoscopic recurrence at first postoperative endoscopy had higher number of bowel surgeries compared with all other groups (no granuloma or CD endoscopic recurrence, P = .007; no granuloma but CD endoscopic recurrence present, P = .04; granuloma present and no CD endoscopic recurrence, P = .04). Epithelioid granuloma presence was associated with 1.65 times higher risk of subsequent surgery independently from first postoperative endoscopic recurrence Rutgeerts score. Conclusions Granuloma presence on initial surgical histology is immediately available and identifies high-risk CD patients who may benefit from early postoperative treatment, and these precision intervention trials are warranted. Lay Summary This study shows the presence of epithelioid granuloma as a risk factor for repeat Crohn’s disease–related surgery, which is independent of first postoperative Rugteerts score. These 11-year observational data provide a risk factor that is immediately available after surgery and identifies high-risk CD patients who may benefit from early postoperative treatment.

To determine if text message–based behavioral interventions could increase response rates to a patient-reported outcomes survey in the emergency department (ED). We conducted a study within a trial (SWAT), within the NUDG-ED trial. The NUDG-ED trial aimed to reduce low-value care for patients with back pain presenting to eight EDs in Sydney, Australia. This SWAT was a 3-arm randomized controlled trial (RCT) nested within the NUDG-ED trial. After discharge from the ED, patients were randomized to receive one of the three text message invitations to complete a follow-up patient-reported outcome survey: a standard control message, or one of two behaviorally informed messages including either a prize draw incentive or prosocial framing. Our primary outcome measure was the response rate in each study group. We performed a linear mixed-effects model controlling for hospital heterogeneity and patient characteristics to estimate the mean difference (MD) in proportions with 95% CI, to determine the effectiveness of the behavioral interventions. A total of 1494 patients were randomized between May 15, 2024 and January 29, 2025. Of these, 52% were women, the median age was 46 years (IQR 35, 62), 43% were from disadvantaged areas and 51% were triaged with a clinically urgent condition. Baseline characteristics were balanced across all groups. Our primary analysis found that compared to the control, the prize draw incentive increased response rates (n = 997 patients, MD = 6.9%, 95% CI: 1.8% to 11.9%, P = .007). Our adjusted mixed-effects model also found a significant increase in response rates (n = 979 patients, MD = 6.4%, 95% CI 1.3% to 11.4%, P = .013). Compared to the control, the prosocial framing message may have slightly increased response rates, but the results were not statistically significant (n = 996 patients, 17.2% vs 21.1%, MD = 3.9%, 95% CI: −1.1% to 8.9%). In this randomized trial, a prize draw incentive modestly improved response rates to a patient-reported outcomes survey in routine emergency care settings. Prosocial framing may have slightly increased response rates, but the effect was uncertain. Both behavioral approaches warrant further testing in routine care settings. Patient-reported outcomes, such as surveys about how people feel and recover after care, are important for understanding what matters most to patients. However, response rates to these surveys are often very low, especially in real clinical settings. This makes it difficult to draw strong conclusions about whether treatments are helping patients. So, researchers and health services need to find ways to improve response rates. This study looked at whether simple text message strategies could encourage more patients to complete follow-up surveys after visiting the ED for low back pain. We conducted a RCT involving 1494 patients in Sydney. After being discharged from the ED, patients were randomly assigned to receive one of the three text message invitations to complete a survey: a standard message, a message offering entry into a prize draw, or a message using prosocial wording (emphasizing how their response could help others). We found that patients who received the prize draw message were more likely to complete the survey. About 24% responded to this message, compared to 17% who received the standard message, an increase of around 7%. We are uncertain whether the prosocial message was effective. These findings suggest that adding a prize draw incentive to a text message-based study invitation can modestly increase survey participation in routine health-care settings. Improving response rates helps ensure that patient perspectives are more accurately represented in research and health-care improvement efforts. Further studies are needed to confirm these results and explore other effective ways to increase participation. [Display omitted] Key findings•Response rates to patient-reported outcome surveys are typically low.•Text message based behavioral strategies increased response rates in emergency care patients. What this adds to what is known?•This study shows that behavioral strategies are feasible and effective in clinical settings. What is the implication and what should change now?•Such strategies could enhance data quality and facilitate patient-centred evaluations of care.