The effects of a designer music intervention on patients' anxiety, pain, and experience of colonoscopy: a short report on a pilot study.

There is a controversy on whether listening to music before or during colonoscopy reduces anxiety and pain and improves satisfaction and compliance with the procedure. This study aimed to establish whether specifically designed music significantly affects anxiety, pain, and experience associated with colonoscopy. In this semirandomized controlled study, 34 patients undergoing a colonoscopy were provided with either muted headphones (n = 17) or headphones playing the investigator-selected music (n = 17) for 10 minutes before and during colonoscopy. Anxiety, pain, sedation dose, and overall experience were measured using quantitative measures and scales. Participants' state anxiety decreased over time (P < .001). However, music did not significantly reduce anxiety (P = .441), pain scores (P = .313), or midazolam (P = .327) or fentanyl doses (P = .295). Despite these findings, 100% of the music group indicated that they would want music if they were to repeat the procedure, as compared with only 50% of those in the nonmusic group wanting to wear muted headphones. Although no significant effects of music on pain, anxiety, and sedation were found, a clear preference for music was expressed, therefore warranting further research on this subject.

The experience of anxiety in colonoscopy outpatients: a mixed-method study.

Colonoscopy is commonly used to investigate gastrointestinal symptoms such as pain or changes in bowel habits and may either induce patient anxiety or assist in patient reassurance. Currently, 2 studies investigating negative colonoscopy, reassurance, and anxiety came to conflicting conclusions on this issue. Furthermore, it is possible that differences in coping styles may influence patient anxiety. A mixed-methods study was conducted with 26 precolonoscopy and 24 postcolonoscopy patients to address the conflicting, limited literature regarding colonoscopy, coping, and anxiety. Participants completed postal surveys and interviews were conducted with 16 participants. There was no significant difference between pre- and postcolonoscopy groups on any anxiety measures; however, this was possibly because of individual differences. Significant positive correlations were found between maladaptive coping and state anxiety indicating that healthcare professionals should consider screening for maladaptive coping in patients needing invasive procedures. Neither problem- nor emotion-focused coping showed any significant relationship with state anxiety. Interviews revealed that clinicians and endoscopy nurses should be aware that some patients are not absorbing correct information about colonoscopy, specifically that they may be conscious or experience pain during the procedure. Because of this, clinicians should ensure that patients understand standard practice at their hospital. In addition, interview data suggested that more attention should be given to pain management as it currently may not be adequate during conscious sedation.

'Just to get it off my chest': Patients' views on psychotherapy in inflammatory bowel disease

Objective: This study aimed to explore patients' experiences and views on psychotherapy in relation to inflammatory bowel disease (IBD), and Crohn's disease (CD) in particular. Method: This descriptive survey study used semi-structured in-depth interviews with open-ended questions and a qualitative content analysis to summarise responses of 12 CD patients with mental health problems undergoing treatment with antidepressants. Results: Of 12 interviewed CD sufferers, only four received any form of psychotherapy. Two psychotherapy users considered it useful and beneficial. Patients who used psychotherapy with good results reported it improved their disease course, most likely due to improving patients' skills in reducing stress and thus, delaying relapse of the disease. Conclusion: Psychotherapy seems to be under used in IBD patients with mental health problems. Psychotherapy may act as a preventer of disease relapse in some patients and this observation needs to be tested with further quantitative studies. Online therapies may be the answer to limited psychotherapeutic resources in gastroenterology clinics.

Uncertain diagnostic language affects further studies, endoscopies, and repeat consultations for patients with��functional gastrointestinal disorders.

BACKGROUND & AIMS: Although guidelines state that functional gastrointestinal disorders (FGIDs) can be diagnosed with minimal investigation, consultations and investigations still have high costs. We investigated whether these are due to specific behaviors of specialist clinicians by examining differences in clinician approaches to organic gastrointestinal diseases vs FGIDs. METHODS: We performed a retrospective review of 207 outpatient department letters written from the gastroenterology unit at a tertiary hospital after patient consultations from 2008 through 2011. We collected data from diagnostic letters and case notes relating to patients with organic (n��=��108) or functional GI disorders (n��= 119). We analyzed the content of each letter by using content analysis and reviewed case files to determine which investigations were subsequently performed. Our primary outcome was the type of diagnostic language used and other aspects of the clinical approach. RESULTS: We found gastroenterologists to use 2 distinct types of language, clear vs qualified, which was consistent with their level of certainty (or lack thereof), for example, "the patient is diagnosed with���." vs "it is possible that this patient might have���.". Qualified diagnostic language was used in a significantly higher proportion of letters about patients with FGIDs (63%) than organic gastrointestinal diseases (13%) (P < .001). In addition, a higher proportion of patients with FGIDs underwent endoscopic evaluation than patients with organic gastrointestinal diseases (79% vs 63%; P < .05). CONCLUSIONS: In an analysis of diagnoses of patients with FGIDs vs organic disorders, we found that gastroenterologists used more qualified (uncertain) language in diagnosing patients with FGIDs. This may contribute to patient discard of diagnoses and lead to additional, unwarranted endoscopic investigations.

"It's a tube up your bottom; it makes people nervous": the experience of anxiety in initial colonoscopy patients.

This study aimed to prospectively consider the effect of colonoscopy on patients' experiences of anxiety at 4 time points related to an initial colonoscopy, using a qualitative approach. The study involved a sample of 13 patients undergoing an initial colonoscopy at a public hospital and followed for 12 months. Four exploratory interviews were conducted with each participant: before the procedure, 1 week, 2 weeks, and 12 months after the procedure. Thematic analysis was conducted to summarize patients' responses. In these participants, colonoscopy was associated with stigma. The discussion of the procedure was perceived as stressful and embarrassing and led to anxiety. Irrational expectations regarding the procedure were also contributing to anxiety, as was a doctor-patient relationship based on unequal powers and lack of control. Before the procedure, fear of a serious diagnosis contributed to anxiety; however, postprocedure, an unclear or functional diagnosis also appeared to increase anxiety. Anticipating the preparation for the procedure was also reported as an important factor in preprocedure anxiety. A shift toward a biopsychosocial approach to healthcare, such as providing patients with a greater sense of control by participating in decision making, should be recommended as it may reduce anxiety.

An integrated model of care for inflammatory bowel disease sufferers in Australia: development and the effects of its implementation.

BACKGROUND: Psychological comorbidities are associated with poor outcome and increased healthcare utilization in patients with inflammatory bowel disease (IBD). However, a model of care addressing the biopsychosocial dimension of disease is not routinely applied in IBD. This review describes the development of such a model and the effects of its implementation in a hospital-based cohort of patients with IBD. METHODS: Three different approaches were used: 1) collecting baseline epidemiological data on mental health comorbidities; 2) raising awareness of and targeting mental health problems; 3) examining the effects of the model implementation. RESULTS: High rates of anxiety and depressive symptoms (36% and 13%, respectively) that are maintained over time were identified in IBD patients presenting at a metropolitan teaching hospital. Patients with documented psychological comorbidities were more likely to be hospitalized than those without (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.25, 13.61). Improvements in disease activity, anxiety, depression, quality of life, and coping have been noted when cognitive-behavioral therapy (CBT) was provided to patients. A drop in the use of opiates (P = 0.037) and hospitalization rates (from 48% to 30%) in IBD patients has been noted as a result of introduction of the changed model of care. In addition, the mean total cost of inpatient care was lower for IBD patients than controls (US$12,857.48 [US$15,236.79] vs. US$ 30,467.78 [US$ 53,760.20], P = 0.005). CONCLUSION: Our data to date suggest that an integrated model of care for patients with IBD may yield superior long-term outcomes in terms of medication use and hospitalization rates and reduce healthcare costs.

What do participants of the Crohn's and Colitis UK (CCUK) Annual York Walk think of their Inflammatory bowel disease care? A short report on a survey

There has been a growing interest in a patient-centered model of care in inflammatory bowel disease; however, no relevant study using a mixed methodology has been conducted to date. Thus, our multidisciplinary group aimed to explore the issue of patient involvement in care among the inflammatory bowel disease community. A mixed-methods anonymous survey was conducted during the Crohn's and Colitis UK annual event. Summary statistics were used to describe the sample, and a simple thematic analysis identified key themes in qualitative responses. There were 64 survey respondents, representing 73% of the total family/friend groups participating (N = 87). Overall, 75% of respondents answered that they had the opportunity to discuss their care with their inflammatory bowel disease practitioner and 81% felt their opinions were taken on board and valued. A clear majority (84%) had at some point been treated by a gastroenterologist. In contrast, less than half (44%) had the opportunity for a dietician consultation and only 28% had the opportunity for a psychologist/counselor consultation. Although satisfaction with inflammatory bowel disease care was high, access to specialty services was concerning. Efforts should be made to provide access to mental health practitioners for those with clinically significant anxiety and/or depression.

Trastornos gastrointestinales funcionales en menores de dos a��os: prevalencia y factores asociados en una IPS Bogot�� 2015 - 2016

Antecedentes: Los trastornos gastrointestinales funcionales de la infancia (TGFI) son manifestaciones gastrointestinales cr��nicas en cualquier parte del tubo digestivo sin da��o estructural o bioqu��mico los cuales se pueden clasificar seg��n los criterios de ROMA III. Se desconoce su prevalencia en ni��os latinoamericanos menores de 4 a��os. Objetivos: Estimar la prevalencia de los TGFI y cada una de sus entidades en menores de 2 a��os y explorar sus factores asociados. Metodolog��a: Estudio corte trasversal con muestra aleatoria (n=323) tomada de la poblaci��n de una instituci��n de salud en la ciudad de Bogot��, realizando mediante encuesta diligenciada por los padres. El an��lisis se realiz�� por medio del software SPSS�� utilizando estad��stica descriptiva y an��lisis bivariado, como medida de asociaci��n se calcul�� las Razones de Disparidad (RD) con IC95%. Resultados: Se encontr�� una prevalencia de TGFI de 22.1%, diarrea funcional 14.6%, disquecia 12%, regurgitaci��n 9.2%, estre��imiento 3.3%, v��mito c��clico 2%, c��lico infantil 1.6% y rumiaci��n 0%. La administraci��n de tetero durante la estancia hospitalaria neonatal se asocia con v��mito c��clico RD= 6 IC 95% (1.076 ��� 33.447) p=0.021. La administraci��n de formula infantil durante los primeros 6 meses de vida se asocia con diarrea funcional RD= 0.348 IC 95% (0.149 ��� 0.813) p=0.012 Conclusi��nes: Los TGFI son una causa frecuente de molestias en los menores de 2 a��os de edad. Sugerimos realizar la validaci��n del cuestionario ���questionnaire on infant/toddler gastrointestinal symptoms rome version III��� con el fin de mejorar la validez y precisi��n de los hallazgos en estudios futuros.

Eficacia de terapias biol��gicas de tipo anti-angiog��nico en el c��ncer colorrectal metast��sico revisi��n sistem��tica de la literatura

Introducci��n: El c��ncer colorrectal (CCR) se encuentra entre los 5 tipos de c��ncer con mayor incidencia a nivel mundial. Alrededor del 20% de los casos son diagnosticados en estadios metast��sico, donde el tratamiento inicialmente era quimioterapia con una supervivencia global a 5 a��os de 12 a 14 meses. Es as�� que se investiga el papel de la angiog��nesis tumoral, orientado al desarrollo de terapias, implementando su uso en estadios avanzados. Metodolog��a: Se realiz�� una b��squeda sistem��tica en las bases de datos Embase, PubMed, SciELO y LILIACS con t��rminos estandarizados a trav��s de la herramienta MeSH y DECS bajo los lineamientos establecidos en las gu��as de revisiones sistem��ticas y meta-an��lisis (Manual Cochrane). Se tomaron estudios cl��nicos aleatorizados controlados con pacientes con CCR metast��sico, que hayan recibido quimioterapia sola o combinada con terapias antiangiog��nicas, publicados en ingl��s y espa��ol entre el 2003 y 2013. Resultados: 6 art��culos cumplieron con criterios de inclusi��n. Estos reportaron 15.8 meses en promedio de supervivencia global en el tratamiento de quimioterapia asociada a terapias biol��gicas frente a 14.4 meses con solo quimioterapia. Los eventos adversos de tipo vascular aumentaron m��s en el grupo de antiangiog��nicos, reportando muertes debidas a perforaciones intestinales. Conclusiones: Los reg��menes de quimioterapia asociadas a terapias antiangiog��nicas brindan una mayor supervivencia global y libre de progresi��n, al igual que mayor n��mero de tasas de respuesta. Son terapias con eventos adversos importantes pero que deber�� seleccionarse bien al paciente para disminuir su riesgo de eventos. Palabras claves: C��ncer colorrectal metast��sico, terapia anti-angiog��nica, quimioterapia en segunda l��nea, receptor del factor de crecimiento de endotelio vascular, supervivencia global.

Revisi��n sistem��tica utilidad de asa y calcio con o sin vitamina d en la prevenci��n de c��ncer colorrectal y la recurrencia de p��lipos adenomatosos en paciente con riesgo de padecer esta patolog��a

Introducci��n: El c��ncer colorrectal es una patolog��a con alto impacto en la salud p��blica, debido a su prevalencia, incidencia, severidad, costo e impacto en la salud mental y f��sica del individuo y la familia. Ensayos cl��nicos realizados en pacientes con antecedente de infarto al miocardio que consum��an ��cido acetil salic��lico (asa), calcio con y sin vitamina D, mostraron asociaci��n entre el consumo de estos medicamentos y disminuci��n en la incidencia en c��ncer colorrectal y p��lipos adenomatosos. Objetivo: Evaluar la literatura sobre el uso de asa, calcio con y sin vitamina D con relaci��n a su impacto en la prevenci��n del c��ncer colorrectal y p��lipos adenomatosos. M��todos: Se realiz�� revisi��n sistem��tica buscando ensayos cl��nicos realizados en pacientes con factores de riesgo para c��ncer colorrectal y p��lipos adenomatosos que usaron asa, calcio con y sin vitamina D fueron incluidos. Resultados: se escogieron 105 para la revisi��n sistem��tica. Conclusiones: Es necesario desarrollar m��s estudios que lleven a evaluar el efecto protector de la aspirina, calcio y vitamina D. En los art��culos revisados la aspirina a dosis de 81 a 325 mg d��a se correlaciona con reducci��n de riesgo de aparici��n de CRC aunque la dosis ideal, el tiempo de inicio y la duraci��n de la ingesta continua no son claros. Hacen falta estudios que comparen poblaciones con ingesta de asa a diferentes dosis.

Estado de las enfermedades raras que cursan con discapacidad intelectual en Colombia

Las enfermedades raras o hu��rfano son una problem��tica que ha tomado mucha importancia en el contexto mundial del presente siglo, estas se han definido como cr��nicas, de dif��cil tratamiento de sus s��ntomas y con baja prevalencia en la poblaci��n; muchas de estas enfermedades cursan con varios tipos de discapacidad, siendo el objetivo del presente trabajo el enfocarse en aquellas enfermedades raras que cursan con discapacidad intelectual. Para poder profundizar en estas enfermedades se realiz�� una revisi��n te��rica sobre las enfermedades raras, as�� como de la discapacidad ps��quica y su importancia a nivel mundial y nacional. A partir de estas definiciones, se revisaron en profundidad 3 enfermedades raras que cursan con discapacidad intelectual en el contexto colombiano, como son: el s��ndrome de Rett, el s��ndrome de Prader-Willi y el s��ndrome de X fr��gil. En cada una de estas enfermedades adem��s se explicaron los tipos de diagn��stico, intervenci��n, prevenci��n, grupos de apoyo y tipos de evaluaci��n que m��s se usan en el contexto nacional

Gu��a de pr��ctica cl��nica para la enfermedad hep��tica grasa no alcoh��lica

Objetivo: Brindar una gu��a de pr��ctica cl��nica basada con la evidencia m��s reciente para el diagn��stico y tratamiento de la Enfermedad Hep��tica Grasa No alcoh��lica teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atenci��n en Colombia. Materiales y m��todos: Esta gu��a fue desarrollada por un equipo multidisciplinario con apoyo de la Asociaci��n Colombiana de Gastroenterolog��a, el Grupo Cochrane ITS y el Instituto de Investigaciones Cl��nicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas cl��nicas relevantes y se realiz�� la b��squeda de gu��as nacionales e internacionales en bases de datos especializadas. Las gu��as existentes fueron evaluadas en t��rminos de calidad y aplicabilidad. Una gu��a cumpli�� los criterios de adaptaci��n, por lo que se decidi�� adaptar 3 preguntas cl��nicas. El Grupo Cochrane realiz�� la b��squeda sistem��tica de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base a la metodolog��a GRADE. Las recomendaciones de la gu��a fueron socializadas en una reuni��n de expertos con entes gubernamentales y pacientes. Resultados: Se desarroll�� una gu��a de pr��ctica cl��nica basada en la evidencia para el diagn��stico y tratamiento de la Enfermedad Hep��tica Grasa No alcoh��lica en Colombia Conclusiones: El diagn��stico y manejo oportuno de la Enfermedad Hep��tica Grasa No alcoh��lica contribuir�� a disminuir la carga de la enfermedad en Colombia y las enfermedades asociadas

Experiencia y porcentaje de complicaciones de las derivaciones portosist��micas intrahep��ticas transyugulares en la Fundaci��n Cardioinfantil

La derivaci��n portosist��mica intrahep��tica transyugular (TIPS) es una t��cnica importante en el manejo de las complicaciones de la hipertensi��n portal, en especial en aquellos pacientes candidatos a trasplante hep��tico. Se trata de un estudio observacional anal��tico, sin riesgo, en el cual se emplearon t��cnicas y m��todos de investigaci��n documental retrospectivo, y no se realiz�� ning��n tipo de intervenci��n sobre las variables fisiol��gicas, psicol��gicas y sociales de la poblaci��n incluida. Se realiz�� la descripci��n demogr��fica de los pacientes, caracter��sticas cl��nicas, hallazgos imageneol��gicos y aspectos t��cnicos asociados al procedimiento de los pacientes con hipertensi��n portal que han sido manejados con TIPS en la Fundaci��n CardioInfantil desde Enero 1 de 2007 hasta Junio 30 de 2016. Se incluyeron 54 pacientes de los cuales el 66,7% no presentaron complicaciones inmediatas, tenidas en cuenta desde la terminaci��n del procedimiento y hasta las siguientes 24 horas; sin embargo, 16,9% debutaron con encefalopat��a durante este periodo. De las complicaciones tard��as, la m��s frecuente fue la ascitis con un 66,7%, con una mortalidad de 20,4% de los cuales, el 45% de estos fue por shock s��ptico y falla org��nica secundaria. Aunque el porcentaje de complicaciones asociadas al procedimiento fue alto en nuestros pacientes, se encuentra dentro de los valores reportados en la literatura. Los resultados presentados son un punto de partida para la evaluaci��n del procedimiento en nuestra poblaci��n y permiten implementar estrategias de mejora que conlleven a incidir de manera positiva en el porcentaje de complicaciones y mortalidad derivadas del procedimiento.

Diverticulosis y relaci��n con el consumo de fibra en pacientes del Hospital Universitario de la Samaritana

Introducci��n: La diverticulosis es la condici��n m��s frecuentemente encontrada en la colonoscopia, condici��n asintom��tica, con un alto costo para el sistema de salud. Diversos factores han demostrado estar en relaci��n con la aparici��n de la enfermedad. En nuestra poblaci��n, esta informaci��n se desconoce; el objetivo del estudio es la caracterizaci��n de la poblaci��n con diverticulosis y su relaci��n con la frecuencia de la ingesta de fibra. Materiales y M��todos: Estudio observacional prospectivo de corte transversal con componente anal��tico. Realizado a todas las personas que asistieron al HUS a realizaci��n de colonoscopia entre Noviembre de 2015 y Abril de 2016. Se recolectaron datos de la frecuencia de fibra ingerida a trav��s de entrevistas basadas. Resultados: Se estudiaron 278 personas, 55.7% mujeres. La prevalencia de diverticulosis fue de 21.58%, siendo m��s frecuente en mujeres ( 66,7%), 31% entre los 71-80 a��os, 2,16% ten��an antecedente familiar de diverticulosis; principal sitio de afectaci��n fue colon sigmoide en las mujeres y el colon descendente en los hombres. En las personas con diverticulosis el consumo de harina de trigo fue mayor (91,67% vs 86,7%), mientras el consumo de frutas fue mayor en las personas que no presentaron diverticulosis (83,49% vs 78,33%). Conclusiones: La prevalencia de diverticulosis es similar a lo reportado en la literatura. As�� mismo se encontr�� un mayor consumo de fibra en la poblaci��n sin divert��culos lo que hace pensar que a pesar de que esta condici��n es multifactorial , el consumo de mayores cantidades de fibra puede prevenir la aparici��n de la misma

Intususcepci��n

Paciente masculino de 91 a��os con antecedente de hipertensi��n arterial en manejo farmacol��gico; que ingresa con cuadro de 3 meses de deposiciones diarreicas con episodios de hematoquecia ocasional, asociado a dolor abdominal difuso intermitente.