Publications by authors named "Antonio Torrejón"

17 Publications

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Use of Social Media Apps by Nurses for Professional Purposes in Catalonia: Cross-Sectional Study.

Stud Health Technol Inform 2020 Jun;270:786-790

Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute and Universitat Pompeu Fabra, Barcelona, Spain.

Over the last few years, the use of social media mobile applications or apps (SMAs) has increased exponentially. The potential advantages of using these technologies by health professionals in clinical settings have been discussed many times. Considering that the nursing profession is the largest segment of the healthcare workforce in the majority of countries in the world, the impact of using these apps by these professionals is very relevant. The objectives of this study were, firstly, to determine if nurses were using SMAs professionally and the most frequent SMAs used and secondly, to find out if, among nurses, there is a need for training in the use of these mobile applications for professional purposes. The study is a descriptive cross-sectional study based on an Internet survey of 1,293 nurses in Catalonia (Spain). The average age of the respondents who had these apps installed on their mobile phones or tablets, was 43.12 (SD ± 11.32) years old. WhatsApp was the most frequent SMAs used by nurses for professional purposes, and 79.2 % of nurses mentioned they used it several times a day. WhatsApp was the preferred SMAs for communicating with colleagues (31.2% of nurses) followed by Facebook (18.4%) and Twitter (11.3%). In contrast, the use of the SMAs was much less frequent as a means of communication with patients (7.2% in the case of WhatsApp). Nurses expressed their need for specific training in the use of these apps for professional purposes, indicating the interest and potential impact of the introduction of these technologies in clinical environments. The use of SMAs is quite common among nurses at the moment of the survey, and WhatsApp was the most popular one to support their professional activity. Based on the results of the survey, the Nursing Association of Barcelona (COIB) will consider the design of specific training activities in the use of SMAs in clinical settings.
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http://dx.doi.org/10.3233/SHTI200268DOI Listing
June 2020

Correction: Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study.

JMIR Mhealth Uhealth 2020 04 30;8(4):e18516. Epub 2020 Apr 30.

Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain.

[This corrects the article DOI: 10.2196/15195.].
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http://dx.doi.org/10.2196/18516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226041PMC
April 2020

Use of Health Apps by Nurses for Professional Purposes: Web-Based Survey Study.

JMIR Mhealth Uhealth 2019 11 1;7(11):e15195. Epub 2019 Nov 1.

Col·legi Oficial d'Infermeres i Infermers de Barcelona, Barcelona, Spain.

Background: In the last few years, the number of mobile apps for health professionals has increased exponentially. Nevertheless, there is a lack of knowledge about the professional use, training requirements, and quality perception of these apps among health care professionals such as nurses. Considering that the nursing profession is the largest segment of health care workforce in many countries such as Spain, the impact of the use of health apps by these professionals can be critical to the future of modern health care.

Objective: The main objective of this study was to determine if nurses were using health apps professionally and what types of apps they were using. The secondary objectives were (1) to find out if, among nurses, there is a need for training in the use of health apps and (2) to explore nurses' perceptions of health professional apps, determining whether there is a need for a certification process for health apps and the type of institution or organization that should review and validate these apps for professional use.

Methods: After an initial piloting survey, all registered nurses at the Nursing Association of Barcelona were invited to participate in a 34-item online survey. Eventually, 1293 nurses participated in the survey; however, 52 did not complete the survey properly, omitting both age or gender information, and they were excluded from the analysis.

Results: About half of the respondents (600/1241, 48.35%) had health professional apps installed on their devices and were included for analysis. Most participants in the survey were women (474/600, 79.0%) and the remaining were men (126/600, 21.0%). The most popular types of apps used and installed among nurses were related to drug information, health calculators, and health guidelines. Overall, 97.0% (582/600) of nurses thought that the health apps should be certified, and 80.0% (480/600) agreed that the certification process should be carried out by professional or health institutions. Furthermore, 14.5% (87/600) of participants mentioned that they were asked by their patients to prescribe a health app and only 6.5% (28/430) recommended them often. Most nurses (354/433, 81.8%) who answered the question about the importance of receiving specific training on using and prescribing health apps considered this point a very relevant issue.

Conclusions: About half of the nurses in Catalonia use health apps for professional purposes, and they believe that these types of tools should be validated and certified by health or professional institutions before using them in clinical environments. Although the prescription of health apps in clinical environments is infrequent among nurses, they would be willing to prescribe apps if they were certified by a health organization. Finally, among nurses, there is a need for training in using and prescribing health apps for health care purposes.
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http://dx.doi.org/10.2196/15195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858615PMC
November 2019

Delphi consensus statement: Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units.

J Crohns Colitis 2014 Mar 2;8(3):240-51. Epub 2013 Dec 2.

Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Spain; Servicio de Aparato Digestivo, Hospital Clínico "Lozano Blesa" de Zaragoza, Spain.

Background And Aims: While it is commonly accepted that Inflammatory bowel disease (IBD) Comprehensive Care Units (ICCUs) facilitate the delivery of quality care to Crohn's disease and ulcerative colitis patients, it remains unclear how an ICCU should be defined or evaluated. The aim of the present study was to develop a comprehensive set of Quality Indicators (QIs) of structure, process, and outcomes for defining and evaluating an ICCU.

Methods: A Delphi consensus-based approach with a standardized three-step process was used to identify a core set of QIs. The process included an exhaustive search using complementary approaches to identify potential QIs, and two Delphi voting rounds to select the QIs defining the core requirements for an ICCU.

Results: The consensus selected a core set of 56 QIs (12 structure, 20 process and 24 outcome). Structure and process QIs highlighted the need for multidisciplinary management and continuity of care. The minimal IBD team should include an IBD nurse, gastroenterologists, radiologists, surgeons, endoscopists and stoma management specialists. ICCUs should be able to provide both outpatient and inpatient care and admission should not break the continuity of care. Outcome QIs focused on the adequate prophylaxis of disease complication and drug adverse events, the need to monitor appropriateness of treatment and the need to reinforce patient autonomy by providing adequate information and facilitating the patients' participation in their own care.

Conclusions: The present Delphi consensus identified a set of core QIs that may be useful for evaluating and certifying ICCUs.
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http://dx.doi.org/10.1016/j.crohns.2013.10.010DOI Listing
March 2014

Inflammatory bowel disease patient's satisfaction with healthcare services received. Physicians' and nurses' perceptions.

Rev Esp Enferm Dig 2013 Aug;105(7):385-91

Background: patient satisfaction with healthcare services provided for inflammatory bowel diseases (IBD) is essential due to high resources use.

Objectives: the study aimed to describe patient satisfaction with healthcare services using the CACHE questionnaire and to assess gastroenterologist and nurse perception on patients' satisfaction.

Methods: observational multicentric prospective study in 35 Spanish hospitals. Patients included had Crohn's disease or ulcerative colitis. The study was approved by the Hospital Universitari Vall d'Hebron Ethics Committee. Scheduled study visits: baseline (patient sociodemographics and clinical data were collected), 2-4 and 6-months. Patient satisfaction with healthcare was assessed by CACHE questionnaire at each visit; it scores from 0-least satisfaction to 100-highest satisfaction.Gastroenterologists and nurses answered once an adapted questionnaire.

Results: participating 290 patients (54.2 % males, 41.3 years old), 62 gastroenterologists and 47 nurses. At baseline mean (SD) CACHE score was 81.7 (10.9); satisfaction with clinician care was the highest, patient information the lowest. Scores did not change across study. Gastroenterologist global score was 72.5 (9.8); Staff Care satisfaction was the highest, patient information the lowest. All scores were significantly lower than patients'. Nurses' global score was 82.2 (8.5), clinician care satisfaction was the highest, centre facilities the lowest. Scores on satisfaction with clinician care, centre facilities, and patient information scored statistically lower than patients'. No relationship was found between patients' satisfaction and patients characteristics. conclusions: IBD patients are satisfied with healthcare services provided, even though the information may be improved. Nurses' perception is similar to that of patients, physicians have a lower perception.
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http://dx.doi.org/10.4321/s1130-01082013000700003DOI Listing
August 2013

Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

Rev Esp Enferm Dig 2013 May-Jun;105(5):262-71

Background And Aims: nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards.

Methods: a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion.

Results: the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality).

Conclusion: the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.
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http://dx.doi.org/10.4321/s1130-01082013000500004DOI Listing
July 2015

Questionnaries for measuring fatigue and its impact on health perception in inflammatory bowel disease.

Rev Esp Enferm Dig 2013 Mar;105(3):144-53

Introduction: fatigue impacts perceived health, but its importance in inflammatory bowel disease is not known.

Objectives: to define the applicability of the fatigue measurement questionnaires and analyze it in patients with Crohn´s disease and ulcerative colitis.

Material And Methods: in a first phase, the psychometric properties of 3 fatigue measurement questionnaires were determined in 99 patients: Daily Fatigue Impact Scale, Fatigue Severity Scale, and Modified Fatigue Impact Scale. In a second phase, fatigue status and its relationship to disease and quality of life was determined in 127 patients and 69 healthy controls.

Results: the first part of the study showed the applicability of the questionnaires listed in inflammatory bowel disease, the Daily Fatigue Impact Scale (DFIS) having the best correlation with the quality of life and clinical activity. In the second phase, significantly higher levels of fatigue were observed in active disease than in disease in remission and healthy controls (p < 0,05). The severity of fatigue was significantly correlated with quality of life (r = -0.66 and -0.72 between IBDQ-9 and DFIS and in Crohn´s disease and ulcerative colitis, respectively) and with disease activity (r = 0.25 and Crohn´s disease and ulcerative colitis, respectively, p < 0.05).

Conclusions: in inflammatory bowel disease, fatigue measurement questionnaires have good properties and show that fatigue is an important manifestation of the disease, which has a significant impact on quality of life of patients.
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http://dx.doi.org/10.4321/s1130-01082013000300005DOI Listing
March 2013

Development and testing of a new instrument to measure patient satisfaction with health care in inflammatory bowel disease: the CACHE questionnaire.

Inflamm Bowel Dis 2013 Mar;19(3):559-68

Unitat Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebron, Ciberehd, Barcelona, Spain.

Background: Currently, there is no tool to evaluate satisfaction of patients with inflammatory bowel disease (IBD) with health care services. The objective of this study was to develop and test a new specific instrument to measure satisfaction with health care in patients with IBD.

Methods: The questionnaire was developed using a literature review, a focus group with clinical experts, and administration of a provisional version to 20 patients with IBD. The final version of the questionnaire was validated in a longitudinal multicenter study in adult patients with IBD. The instrument's underlying dimension structure was analyzed using factor analysis, and its feasibility, reliability, and validity were assessed.

Results: The final version of the CACHE questionnaire contains 31 items scored on a 5-point Likert-type scale. Scores were standardized to a range from 0 (minimum satisfaction) to 100 (maximum satisfaction). Factor analysis revealed 6 factors (staff care, clinician care, facilities, information, center accessibility, and support received), which explained 56% of variance. Overall, 91% of patients answered all items. Cronbach's alpha for the overall score was 0.93. There were no statistically significant correlations between the overall score and sociodemographic and clinical variables, but there was a statistically significant correlation between the time spent in the waiting room and the item measuring satisfaction with that aspect. There were no statistically significant changes in the overall score between the visits. The effect size was 0.016.

Conclusions: The CACHE questionnaire covers aspects relevant to the assessment of health care quality in patients with IBD and has proved to be feasible, reliable, and valid.
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http://dx.doi.org/10.1097/MIB.0b013e31827febd1DOI Listing
March 2013

Satisfaction of health care professionals managing patients with inflammatory bowel disease.

J Crohns Colitis 2013 Aug 6;7(7):e249-55. Epub 2012 Nov 6.

Unitat Atenció Crohn-Colitis, University Hospital Vall d'Hebron, Pso. Vall d'Hebron 119, Barcelona, 08035, Spain.

Background And Aims: The aim of the present study was to analyze the satisfaction of health care professionals who attend patients with inflammatory bowel disease (IBD) and to determine the variables more related with satisfaction/dissatisfaction.

Methods: Cross-sectional, self-administered written 15-item questionnaire was evaluated using a Likert scale, completed by Spanish gastroenterologists and nurse practitioners specialized in IBD patient care.

Results: A total of 202 surveys, 133 physicians (65.8%) and 69 nurses (34.2%) were conducted. Global scoring of satisfaction was 54.0 for physicians and 64.2 for nurses (p<0.001). In both groups the highest scores were achieved in those items related to their professional careers and management of personal and professional lives as well as those that refer to their interdisciplinary relationship with other medical units, management of patients within the hospital setting and finally communication with the patient. The items that attained the lowest score included those related to the length and staff available for the medical consult, work environment and the balance among health care provider needs for contribution, recognition and fulfillment. With regard to the variables involved with satisfaction, the results show that those physicians that only took care of IBD patients achieved a higher degree of satisfaction. This could be related with the fulfillment of their own professional expectations.

Conclusions: The level of satisfaction of health care professionals that take care of IBD patients is low and may impact on patient care. Therefore, new strategies to increase the degree of satisfaction of IBD health care providers should be implemented.
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http://dx.doi.org/10.1016/j.crohns.2012.10.003DOI Listing
August 2013

Restoration of quality of life of patients with inflammatory bowel disease after one year with antiTNFα treatment.

J Crohns Colitis 2012 Oct 14;6(9):881-6. Epub 2012 Feb 14.

Unitat Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.

Background: Inflammatory bowel disease impairs patients' health related quality of life (HRQOL). AntiTNFα agents control disease activity effectively. An ambitious goal of treatment is to achieve the normalization of health. This can be assessed by using a cut-off scoring threshold of the IBDQ-36 questionnaire. It has not been established if antiTNFα treatment is able to restore to normal patients' HRQOL.

Aims: To determine whether patients with Crohn's disease (CD) and ulcerative colitis (UC) in clinical remission after one year treatment with antiTNFα agents achieve normalization of their HRQOL.

Methods: Observational and cross-sectional study in patients treated with antiTNFα for one year and in sustained clinical remission. Patients completed the specific questionnaire IBDQ-36. Complete restoration of health was considered achieved when global score of IBDQ-36 was higher than 209 points.

Results: 54 patients (43 with CD and 11 with UC) were included. Thirty patients received adalimumab and 24 infliximab. Median global score of the IBDQ-36 was 231, without differences between CD and UC (228 vs 235 respectively, p=ns). Normalization of HRQOL was achieved in all 11 UC patients and in 29 out of 43 CD patients (67%). In our sample population, restoration of health was significantly more frequent in UC than in CD (p<0.05).

Conclusions: One-year clinical remission induced by antiTNFα treatment restores perception of health to normal in most patients with IBD.
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http://dx.doi.org/10.1016/j.crohns.2012.01.019DOI Listing
October 2012

Nursing resources and responsibilities according to hospital organizational model for management of inflammatory bowel disease in Spain.

J Crohns Colitis 2011 Jun 11;5(3):211-7. Epub 2011 Feb 11.

Digestive System Service, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain.

Background: Nurses play an important role in the multidisciplinary management of inflammatory bowel disease (IBD), but little is known about this role and the associated resources.

Objective: To improve knowledge of resource availability for health care activities and the different organizational models in managing IBD in Spain.

Methods: Cross-sectional study with data obtained by questionnaire directed at Spanish Gastroenterology Services (GS). Five GS models were identified according to whether they have: no specific service for IBD management (Model A); IBD outpatient office for physician consultations (Model B); general outpatient office for nurse consultations (Model C); both, Model B and Model C (Model D); and IBD Unit (Model E) when the hospital has a Comprehensive Care Unit for IBD with telephone helpline, computer, including a Model B. Available resources and activities performed were compared according to GS model (chi-square test and test for linear trend).

Results: Responses were received from 107 GS: 33 Model A (31%), 38 Model B (36%), 4 Model C (4%), 16 Model D (15%) and 16 Model E (15%). The model in which nurses have the most resources and responsibilities is the Model E. The more complete the organizational model, the more frequent the availability of nursing resources (educational material, databases, office, and specialized software) and responsibilities (management of walk-in appointments, provision of emotional support, health education, follow-up of drug treatment and treatment adherence) (p<0.05).

Conclusions: Nurses have more resources and responsibilities the more complete is the organizational model for IBD management. Development of these areas may improve patient outcomes.
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http://dx.doi.org/10.1016/j.crohns.2011.01.001DOI Listing
June 2011

Enterotypes of the human gut microbiome.

Nature 2011 May 20;473(7346):174-80. Epub 2011 Apr 20.

European Molecular Biology Laboratory, Meyerhofstrasse 1, 69117 Heidelberg, Germany.

Our knowledge of species and functional composition of the human gut microbiome is rapidly increasing, but it is still based on very few cohorts and little is known about variation across the world. By combining 22 newly sequenced faecal metagenomes of individuals from four countries with previously published data sets, here we identify three robust clusters (referred to as enterotypes hereafter) that are not nation or continent specific. We also confirmed the enterotypes in two published, larger cohorts, indicating that intestinal microbiota variation is generally stratified, not continuous. This indicates further the existence of a limited number of well-balanced host-microbial symbiotic states that might respond differently to diet and drug intake. The enterotypes are mostly driven by species composition, but abundant molecular functions are not necessarily provided by abundant species, highlighting the importance of a functional analysis to understand microbial communities. Although individual host properties such as body mass index, age, or gender cannot explain the observed enterotypes, data-driven marker genes or functional modules can be identified for each of these host properties. For example, twelve genes significantly correlate with age and three functional modules with the body mass index, hinting at a diagnostic potential of microbial markers.
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http://dx.doi.org/10.1038/nature09944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728647PMC
May 2011

Contribution of nurses to the quality of care in management of inflammatory bowel disease: a synthesis of the evidence.

J Crohns Colitis 2010 Dec 17;4(6):611-22. Epub 2010 Sep 17.

Digestive System Service, Gregorio Marañón University Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain.

Background: The purpose of quality of care programs is to improve patient outcomes. In programs targeting patients with inflammatory bowel disease (IBD), nurses play a key role.

Aim: To know the available scientific evidence on the quality of care in IBD management, at the levels of structure, process and outcome, in relation to nurses.

Methods: Systematic search in MEDLINE, EMBASE, Índice Médico Español, Cochrane Library, and grey literature. Inclusion criteria were: 1) documents referring IBD; 2) documents providing relevant information on nurses' involvement in the management of IBD; and 3) an original article.

Results: A total of 284 documents were identified, 15 of which were included: 8 related with structure, 12 with process, and 6 with outcomes. Some documents treated more than one level. At the level of structure, services should incorporate specialist nurses as part of the multidisciplinary team, as well as resources to facilitate patient access to nursing care. Notable at the process level, organizational aspects and nurses' competencies and skills in the management of IBD have been described. Among the outcomes mentioned are clinical outcomes, quality of life, and patient satisfaction attributable to nursing staff. No evidence was found about the association between structure or process issues with patient outcomes. Most of the studies reviewed have methodological limitations.

Conclusions: The available evidence provide useful information for the design of standards of structure and process relating to nurses' management of IBD. The IBD nurses' challenge is to provide evidence that these standards help improve health outcomes in patients.
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http://dx.doi.org/10.1016/j.crohns.2010.08.009DOI Listing
December 2010

Validation of the Spanish version of a questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease (QUOTE-IBD).

Inflamm Bowel Dis 2010 Jun;16(6):982-92

Hospital Universitari Vall d'Hebron, Crohn-Colitis Care Unit, CIBER-EHD, Barcelona, Spain.

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunoinflammatory diseases that place a considerable burden on patients, their families, and society. Quality of care plays an important role for patients. A questionnaire to measure quality of care through the eyes of patients with inflammatory bowel disease (QUOTE-IBD) has been designed and validated specifically for the English language and culture. The objective was to translate the QUOTE-IBD into Spanish and to determine its validity in patients with IBD.

Methods: This is a prospective study in 2 phases: first, translation and validation of the Spanish QUOTE-IBD. Translation was based on the validated QUOTE-IBD. Second, once the complete translation was finished, comprehension of the items was assessed with a specific questionnaire in a reduced number of patients. Criterion validity was assessed with the Pearson's correlation coefficient between scores of the QUOTE-IBD and visual analog scales (VAS). In order to analyze the reproducibility of the Spanish QUOTE-IBD, the questionnaire was completed by stable patients twice, with a span of time of at least 4 weeks.

Results: A total of 103 patients (CD: 61, UC: 42) were included in the study. Pearson's correlation coefficient between total care Spanish QUOTE-IBD and VAS of health care items was 0.34 (P < 0.001). Correlations among all 6 care dimensions score of Spanish QUOTE-IBD and VAS were statistically significant (P < 0.01). Results of first and second administration of total care and dimensional care scores of Spanish QUOTE-IBD in 46 stable patients were not different.

Conclusions: The Spanish QUOTE-IBD has proved to be a valid instrument to measure the quality of health care for patients with CD and UC.
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http://dx.doi.org/10.1002/ibd.21156DOI Listing
June 2010

Unstable composition of the fecal microbiota in ulcerative colitis during clinical remission.

Am J Gastroenterol 2008 Mar;103(3):643-8

Digestive Disease Research Unit, University Hospital Vall d'Hebron, Ciberehd, Barcelona, Spain.

Background And Aim: Studies have identified abnormal characteristics of the gut microbiota in patients with active IBD, but whether the changes are causal or secondary to inflammation remains uncertain. We investigated dynamics of fecal microbiota in ulcerative colitis (UC) during remission by genomic technology.

Patients And Methods: Patients in clinical remission and on stable maintenance mesalazine therapy were recruited (N = 33). Fecal samples were collected at regular intervals over a period of 1 yr. Sixteen patients who remained in remission and eight healthy controls were included in the analysis. Variable V6 to V8 regions of the 16S rRNA gene in DNA extracts from fecal samples were amplified by polymerase chain reaction. Amplicons were separated by denaturant gradient gel electrophoresis, band profiles were compared by software, and similarity indices were calculated from densitometric curves.

Results: Band profiles showed unique patterns with low similarity index between individuals, suggesting host specificity in the predominant microbiota. Within the same individual, profiles were stable in controls but varied notably over time in patients. In controls, the similarity index was remarkably stable (78 +/- 8% mean +/- SD) over a period of 24 months. However, patients showed a steady decline in similarity index versus the initial profile, dropping down to 42 +/- 24% at month 3 of follow-up and to 23 +/- 19% at month 12 (P < 0.001). Biodiversity of the dominant microbiota, as estimated by number of bands, was lower in patients (17 +/- 4) than controls (23 +/- 4, P < 0.01).

Conclusion: Molecular analysis of fecal bacteria in patients with inactive UC shows low biodiversity and temporal instability.
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http://dx.doi.org/10.1111/j.1572-0241.2007.01592.xDOI Listing
March 2008

Fecal excretion of deoxyribonucleic acid in long-term follow-up of patients with inactive ulcerative colitis.

Inflamm Bowel Dis 2007 Apr;13(4):386-90

Digestive System Research Unit, Unitat d'Atenció Crohn-Colitis, Barcelona, Spain.

Background: We have developed a technique for measuring fecal excretion of human DNA by assuming that luminal desquamation of epithelial and inflammatory cells increases in damaged colonic mucosa. However, the clinical usefulness of this technique in the follow-up of patients with ulcerative colitis has not been established. The aim of this study was to determine the stability of fecal DNA in inactive ulcerative colitis and its potential value as an indicator of relapse.

Methods: The 54 patients with clinically quiescent ulcerative colitis in this prospective study were followed for 12 months or until clinical relapse (clinical activity index > 7). Fecal calprotectin concentration was determined by ELISA, and fecal DNA concentration was determined by quantitative PCR.

Results: During the year of follow-up, 23 of the 54 patients relapsed, with a median increase in the colitis activity index from 1.0 to 8.0 (P < 0.01). Median fecal DNA remained unchanged in patients with stable, inactive colitis, ranging from 6.8 copies/microg at inclusion to 1.7 copies/microg at the end of follow-up. Fecal calprotectin level also was unchanged, ranging from 414.0 microg/g at inclusion to 128.9 microg/g at the end of follow-up. In contrast, fecal DNA concentration increased significantly in patients who relapsed (259.0 versus 3.9 copies/microg at entry; P < 0.01). Similar increases in relapsing patients were also observed with fecal calprotectin. ROC curve analysis to assess the accuracy of fecal DNA and calprotectin in detecting relapses during follow-up yielded similar results.

Conclusions: Fecal DNA concentration remained stable in patients with inactive ulcerative colitis but increased significantly with relapses. Determining fecal DNA concentration may be a new objective instrument to use in the follow-up of patients.
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http://dx.doi.org/10.1002/ibd.20042DOI Listing
April 2007

Remission on thiopurinic immunomodulators normalizes quality of life and psychological status in patients with Crohn's disease.

Inflamm Bowel Dis 2006 Aug;12(8):692-6

Unitat de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.

Background: Thiopurinic immunomodulators are effective for maintaining symptom remission in Crohn's disease. Little is known, however, about their effect on patients' quality of life or psychological well-being. The present study aimed to determine whether remission induced by thiopurinic immunomodulators returns levels of quality of life and psychological well-being to normal.

Materials And Methods: A case-control study was performed. Cases were 33 patients with Crohn's disease treated with azathioprine or 6-mercaptopurine and in stable remission for at least 6 months. Sixty-six healthy individuals matched 2:1 by age and sex and 14 patients with active Crohn's disease were included as control groups. Quality of life was evaluated with the Short Form (SF-36) questionnaire, and the respective Hamilton rating scales were used for anxiety and depression. ANOVA with Bonferroni's correction was used for multiple comparisons.

Results: SF-36 global scores were 85 in the study group, 85 in healthy controls (P = 1), and 58.6 in patients with active disease (P < 0.001 for the comparison with the other 2 groups). The differences between values were 0 (95% CI -4-4), 26.4 (95% CI 20-32), and 26.4 (95% CI 19-33), respectively. The respective anxiety and depression scores were 6.5, 5.5, and 16.2 and 3.7, 3.3, and 10.9. No significant differences were observed in any of the SF-36 domains between case and control groups, whereas in patients with active disease, all domains were significantly worse.

Conclusions: Thiopurinic immunomodulator-induced remission restores normal levels of quality of life and psychological well-being in Crohn's disease patients.
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http://dx.doi.org/10.1097/00054725-200608000-00004DOI Listing
August 2006