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Caring for people with Inflammatory Bowel Disease: learning from best practice

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It’s estimated that there are over half a million people living with Inflammatory Bowel Disease in the UK1. IBD is mainly used to describe ulcerative colitis and Crohn’s disease, two long-term conditions characterised by inflammation of the gut2.

Currently, there is unwarranted variation in the quality of IBD care across the UK, with waiting times for new patient appointments at gastroenterology clinics varying between one and 27 weeks3. A recent survey of 10,000 people living with IBD found that 26 per cent waited over a year for a diagnosis, and 41 per cent had visited accident and emergency at least once before being diagnosed4, which can prove costly for the NHS. At an estimated £900m annually5, lifetime medical costs associated with IBD care are comparable to diabetes and cancer care5.

Clearly, there’s a need for change on a national scale. The IBD community – including the IBD UK collaboration led by Crohn’s & Colitis UK – continues to achieve significant progress for people living with IBD, but tackling unwarranted variation requires further collaborative, national effort, with the support of government and NHS leaders.

As pandemic and economic pressures compound longstanding challenges to the NHS, addressing unwarranted variation in IBD care can feel daunting. But there are examples of best practice that demonstrate how even small changes can make a big difference to those living with IBD and the teams and services supporting them. “Levelling up care for people living with Inflammatory Bowel Disease (IBD)” a report initiated and funded by healthcare company Takeda UK, spotlights seven NHS best practice case studies across different parts of our IBD care pathway which other centres can learn from.

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This includes the “AWARE-IBD” project from the IBD Centre at Sheffield Teaching Hospitals Foundation Trust, in partnership with Crohn’s & Colitis UK. Funded by The Health Foundation as part of the “Common Ambition” programme, the project aims to improve service experience by making explicit the question “What matters to you?” – empowering those with IBD and enabling them to feel in control of their care. It aims to establish a process within the trust whereby change is driven through collaboration with people with IBD, and using systematic, embedded data collection. This has led to engagement with “less heard voices”, the development of personalised care plans and a toolkit to help people express what is important for them to their clinical team.

This is one example of good practice – but between trusts, the requirements of services may vary. Services can work with patients to further understand what “good care” means for them, embedding their voice into service development.

As we look for solutions to improve outcomes and experiences for people living with IBD, tackling unwarranted variation is key. While each trust has a role to play, we can’t tackle it alone. There’s a clear need for a national IBD strategy, drawing on the expertise of both patients and healthcare professionals, with NHS and government backing, to ensure everyone living with IBD can receive quality care.

C-ANPROM/GB/GI/0118 January 2023

References:

1Crohn’s & Colitis UK. New research shows over 1 in 123 people in UK living with Crohn’s or Colitis. March 2022. Available at: https://crohnsandcolitis.org.uk/news-stories/news-items/new-research-shows-over-1-in-123-people-in-uk-living-with-crohn-s-or-colitis Last accessed January 2023.

2NHS England. Inflammatory bowel disease. Available at: https://www.nhs.uk/conditions/inflammatory-bowel-disease/ Last accessed: January 2023.

3Oates B., Gastroenterology, Getting It Right First Time (GIRFT) Programme National Speciality Report. March 2021. Available at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/10/Gastroenterology-Oct21v.pdf Last accessed January 2023.

4IBD UK, “Crohn’s and Colitis Care in the UK: The Hidden Cost and a Vision for Change” April 2021. Last accessed January 2023. Available at: https://ibduk.org/reports/crohns-and-colitis-care-in-the-uk-the-hidden-cost-and-a-vision-for-change

5Crohn’s & Colitis UK, “New resources for Nurse and Healthcare Professionals”. February 2018. Available at: https://www.crohnsandcolitis.org.uk/news/new-resource-for-ibd-nurse-specialists Last accessed January 2023.

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Heads up – wood ticks are out and about in the Thompson-Okanagan – Vernon News – Castanet.net

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Tick season is back in the Okanagan.

Colin Kennedy came across one of the blood-suckers while taking a walk with his dog.

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Kennedy was on the Test of Humanity Trail in Summerland last week and came home with an unwanted passenger – a wood tick.

“I just thought it would be good to report it so people start checking their dogs for ticks now that the weather is getting better,” Kennedy says.

Kennedy also reported the tick to eTick.

Anyone who has lived in the B.C. Interior for any length of time has likely had an encounter with a tick or knows someone who has.

They can be found year round, but are most likely to bite from March to June.

Ticks will lie in wait on a branch or tall grass, waiting for an unsuspecting person or animal to brush by. They then latch onto their victim and bury their heads under the skin.

Staying out of the woods is no guarantee you won’t encounter ticks.

Rob Higgins, an entomologist with the department of biological sciences at Thompson Rivers University in Kamloops, says the most common area to find ticks is on grasslands, but they can be found in urban environments as well.

“You can definitely pick them up in town, even when you think you’re walking in urban areas, because you’re brushing up against grasses on the side of the sidewalks,” he said.

If a tick has bitten you, Higgins says the best way to remove it is to take a pair of forceps or tweezers, slide them under the tick and pull backwards firmly – but not abruptly.

It will often take about 30 seconds of firm pressure to pull the tick out.

The variety most often found in B.C. is the Rocky Mountain wood tick.

Western black legged ticks, a species which Higgins said exists in low numbers in B.C., can carry Lyme disease. Each year, there are around a dozen Lyme cases discovered in the province, but about half those originate from outside the region.

Ticks can also carry other diseases, such as tick paralysis. According to Higgins, this disease mostly affects animals and he said vets and ranchers see cases each year.

Overall, it’s important to be careful, but most ticks in B.C. aren’t harmful.

“People don’t like ticks, fortunately here we don’t need to worry about them a great deal,” he said.

“You definitely want to remove them, you want to keep your eyes on your pets for symptoms of paralysis, but otherwise, we can consider the vast majority of them to be harmless.”

Have you had a close encounter of the insect kind? Email us a picture and we may feature it as Castanet’s Bug of the Week.

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'Pandora's Box': Doctors Warn of Rising Plant Fungus Infections in People After 'First of Its Kind' Case – VICE

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A man in India is the first human known to be infected by a fungus called Chondrostereum purpureum, a pathogen that is most well-known for causing a disease called silver leaf in plants, reports a new study. 

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The patient, who was 61 at the time of the diagnosis, made a full recovery and has not experienced any recurrence of the infection after two years of follow-up observations. However, this “first of its kind” case study exemplifies the risks that fungal pathogens pose for humans, especially now that climate change and other human activities like rampant urbanization, have opened a “Pandora’s Box for newer fungal diseases” by contributing to their spread, according to the study. 

Fungal pathogens are having a pop culture moment because they are the source of a fictional disease depicted in apocalyptic game The Last of Us, which was recently adapted into the acclaimed HBO series of the same name. But these microbes are also a real-life scourge that infect about 150 million people every year, resulting in about 1.7 million deaths. 

Though millions of fungal species exist, only a very small fraction of them are able to infect animals, including humans, because our bodies present challenges to these invaders such as high temperatures and sophisticated immune systems. 

Soma Dutta and Ujjwayini Ray, doctors at Apollo Multispecialty Hospitals in Kolkata, India, have now added one more fungus to that small list of human invaders with their unprecedented report of a C. purpureum infection. The patient, a plant mycologist, had suffered from cough, fatigue, anorexia, and a throat abscess for months before his hospital visit, and was probably exposed to the fungus as a result of his profession. 

When conventional techniques failed to diagnose the disease, the pathogen was sent to a World Health Organization center based in India where it was finally identified using DNA sequencing. The case “highlights the potential of environmental plant fungi to cause disease in humans and stresses the importance of molecular techniques to identify the causative fungal species,” according to their recent study in the journal Medical Mycology Case Reports

“This is a first of its kind of a case wherein this plant fungus caused disease in a human,” Dutta and Ray said in the study. “This case report demonstrates the crossover of plant pathogens into humans when working in close contact with plant fungi. The cross-kingdom pathogenicity demands much work to be done in order to explore insights of the mechanisms involved, thus leading to possible recommendations to control and contain these infections.”

C. purpureum can infect a variety of different plants with silver leaf disease, an often fatal condition that is named after the color that the pathogen induces on the leaves on the hosts. It is the latest in a growing number of fungal pathogens that have infected humans, which are buoyed on in part by human activities, such as urbanization, travel, and commerce. 

Human-driven climate change is also accelerating the spread of infectious diseases, including fungal pathogens, by allowing microbes to adapt to higher temperatures (like those in mammal bodies), expand their range, and interact with new hosts in the aftermath of extreme weather events. And though fungal diseases have maintained a lower profile in epidemiology compared to other pathogens, they may be more dangerous than viruses or bacteria in some contexts.

“While viral and bacterial diseases receive most attention as the potential cause of plagues and pandemics, fungi can arguably pose equal or even greater threats,” according to a 2021 study in PLoS Pathogens. “There are no vaccines available yet for fungal pathogens, the arsenal of antifungal agents is extremely limited, and fungi can live saprotrophically, producing large quantities of infectious spores and do not require host-to-host contact to establish infection. Indeed, fungi seem to be uniquely capable of causing complete host extinction.”

In addition to avoiding the spread of new fungal pathogens that can directly infect humans, researchers also point to the damage these diseases can deal to crops and ecosystems that people depend on. For this reason, Dutta and Ray recommend more research into the nature of these infections and strategies to mitigate their spread.

“Cross-kingdom human pathogens, and their potential plant reservoirs, have important implications for the emergence of infectious diseases,” Dutta and Ray said. “Fungi are also responsible for various infections in plants that cause destruction of millions of plants and crops” and “produce toxins that contaminate food and cause acute toxicity.”

“Over the past several decades multiple new pathogenic fungi have emerged,” they concluded. “A notable emergence of the multidrug resistant fungus Candida auris has spread all over the world and has become a significant threat. The worsening of global warming and other civilization activities opens Pandora’s Box for newer fungal diseases.”

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Staff reassigned to children’s ICU in Winnipeg, some surgeries postponed: Shared Health – Global News

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An influx of kids sick with respiratory illness at the children’s pediatric intensive care unit (PICU) in Winnipeg has forced a staff shakeup that may result in the postponement of some non-urgent surgeries, health officials say.

Shared Health says roughly 10 staff — including some from pediatric surgical and recovery units — are being temporarily reassigned to help at Health Sciences Centre Children’s ICU.

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Children’s ER seeing ‘unprecedented’ patient levels in Winnipeg as feds secure more pain medications

Officials say a resurgence in respiratory illness circulating in the province is to blame for an uptick in kids ending up in the hospital’s ICU.

There were 17 kids receiving intensive care in the PICU as of Thursday morning. The PICU’s normal baseline capacity is nine.


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“A significant number of these patients were experiencing medically complex cases that were further complicated by respiratory illness, including infants and young children,” Shared Health said in an online statement.

There were 51 patients in the hospital’s neonatal ICU Thursday morning. The normal baseline capacity there is 50.

Meanwhile, Shared Health says the number of kids visiting the ER with influenza-like symptoms has increased from a low of 22 on March 18 to 47 on Wednesday.

Read more:

Children’s ER seeing ‘unprecedented’ patient levels in Winnipeg as feds secure more pain medications

Shared Health didn’t say how long it expects the latest staff reassignments will be in place.

While all urgent and life-threatening surgeries will continue to be performed, Shared Health said some non-urgent procedures will be postponed.

Families of affected patients will be contacted, officials said.


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&copy 2023 Global News, a division of Corus Entertainment Inc.

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