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Introduction: Patients with inflammatory bowel disease (IBD) require long-term secondary care with periodic specialist follow-up. This can be especially challenging for patients living in remote areas. One possible solution is the implementation of videoconference (VC) clinics as a distance-management tool. Here we assessed the use of VC clinics for IBD in terms of patient safety and economic benefit for patients with IBD living in rural areas in the Scottish Highlands and Islands., Methods: Eighty-eight patients participating in the IBD specialist nurses VC clinic administered via Raigmore Hospital, Inverness, Scotland, UK, between January 2016 and June 2017 were included in this study. A total of 229 appointments were assessed., Results: We found the use of a VC clinic to be safe and effective as only 0.9% of appointments required urgent medical assessment and 92% of the VC clinic appointments resulted in further VC clinic follow-up. A total travelling distance of 72,245.3 km and a total travelling time of 71,688 minutes were saved in this patient cohort. It was shown that an average of US$36.61 of potential travelling cost could be saved per appointment., Discussion: VC clinics represent a patient-centred participatory model of care for IBD patients living in remote areas with enormous time- and cost-saving potential while being safe and effective. Further investigations into patient satisfaction and the combination with other telemedicine tools such as telephone conferencing and mobile phone applications are needed to evaluate the full potential of the concept.

Purpose: This study reviews the presentation and management of juvenile onset chronic inflammatory bowel disease and identifies changes in incidence of the disease over a 20-year period., Methods: This was a retrospective study of all patients aged 16 and under with chronic inflammatory bowel disease diagnosed in 1 health region between 1980 and 1999. The patients were identified from computer records and the following variables studied: age, sex, mode of presentation, medical and surgical management, and length of follow-up., Results: One hundred seven patients were identified: 77 with Crohn's disease and 30 with ulcerative colitis. The incidence of ulcerative colitis and Crohn's disease has risen from 0.7 in 100,000 and 2.2 in 100,000, respectively, in the years 1980 through 1989 to 1.5 in 100,000 and 4.4 in 100,000 in the period 1990 through 1999. The median age at presentation was 10.1 years for ulcerative colitis and 10.8 years for Crohn's disease. The majority of disease was diagnosed within 1 year of the onset of symptoms, which were principally abdominal pain, diarrhea, and rectal bleeding. The average length of follow-up was 6.9 years. Analysis of the surgical management of Crohn's patients has shown a low rate of surgical intervention., Conclusions: This study has shown an increasing incidence of chronic inflammatory bowel disease in the Grampian region of Scotland coupled with a low rate of surgical intervention in Crohn's disease. These findings could be the result of early referral and diagnosis, with the disease being documented earlier in its course or more aggressive preemptive medical therapy.

Background: Trauma is the leading cause of death in children. Abdominal trauma is common, but there is little information on pancreatic injuries in UK children. The aim of this study was to investigate the clinical course of children suffering pancreatic trauma in Scotland., Methods: All children admitted to the three major Scottish paediatric surgery centres with evidence of pancreatic injury were identified. A retrospective case note review of these children was performed using a structured proforma., Results: 16 patients (11 males and 5 females), median age 7 years (range 1-11 years) were identified. The commonest mechanism of injury was the typical bicycle handlebar injury (10/16, 62%). Delays in definitive diagnosis were common due to subtle clinical signs. Increased serum amylase levels upon admission were not necessarily diagnostic for pancreatic injury. The diagnosis was confirmed by ultrasound scanning and/or computerised tomography in all patients. Ten patients (62%) developed pseudocysts and, in seven cases, they settled with non-operative management. There were no deaths and no long-term complications., Conclusion: Pancreatic injury in children is rare, and a high index of suspicion is required to make the diagnosis. The commonest mechanism of injury is a direct impact to the epigastrium, typically the bicycle handlebar injury. Presentation and diagnosis are frequently delayed. The incidence of pseudocysts is high, but most can be managed conservatively.