Search

In the easternmost portion of the Gulf of Guinea, Bioko Island marks the beginning of an island chain that stretches NE–SW to the Equator, where São Tomé Island sits in the path of the Equatorial Undercurrent (EUC). In this study, we explore the meso-to-large-scale effects of local flow-topography interactions that escalate from the EUC encounter with the Gulf of Guinea islands. A mean shipboard ADCP section captures the EUC as a strong subsurface jet that ultimately hits São Tomé. Motivated by these observations, we ran two ocean general circulation model simulations that differ by the presence versus absence of the Gulf of Guinea islands. Diagnostics of salinity and potential vorticity (PV) from these simulations show that the EUC bifurcates at 6°E, triggering mesoscale activity that spreads the EUC waters. On both sides of São Tomé, the EUC branches roll up into eddies that propagate westward. These low-PV anticyclones carry high salinity through the tropical Atlantic, introducing PV anomalies along eddy corridors mirrored by the Equator. The formation of such eddies is affected by diapycnal and isopycnal mixing and friction, and their distribution between hemispheres is intrinsically related to the location of São Tomé. The eddies are modulated at both seasonal and interannual scales. A strong EUC generates numerous and stronger eddies, while seasonal equatorial upwelling indirectly hinders their formation. Convergence of the EUC upstream of São Tomé reveals intense downwelling and freshening, whereas divergence and upwelling are associated with the EUC negotiating the island. Key Points Velocity observations show that the EUC hits São Tomé Island at 6°E, forcing the jet to bifurcate earlier than if the island did not exist The EUC dynamics and the location of São Tomé impose an asymmetry to the bifurcation, affecting net zonal fluxes in the tropical Atlantic The EUC-island encounter triggers vertical advection and transformation of the EUC water via diapycnal a

Background: Patients with Crohn s disease can develop anal and perianal lesions, such as fistulas, ulcers, skin tags, perianal abscesses and strictures. Perianal Crohn s disease (PCD) is a condition that has a major impact on patients quality of life. The multidisciplinary team includes a nurse who manages the patient according to evidence-based medicine. Clinical practice and post-registration training are the way forward for nurses to acquire the skills needed to deliver quality care. Aims: This study explored the assessment of nurses knowledge of PCD. A cross-sectional survey was used to look at the nurses knowledge. Methods: The questionnaire was administered over 2 months, between September and October 2019. The questionnaire was anonymous, validated by a panel of experts in the field and consisted of 30 questions to assess knowledge and two questions to assess the need for training. It was directed to 120 clinical nurses in the departments of medicine and abdominal surgery. Results: There were 120 nurses enrolled, and 64.2% of nurses had cared for patients with PCD at least once. The survey showed a fairly low level of knowledge of the diagnostic and therapeutic care pathways for patients affected by PCD. On the other hand, a high need for training and in-depth study of the subject emerged. Conclusion: The nurse, an integral part of the multidisciplinary team, plays an important role in the education of these patients. Nurses present level of knowledge can certainly be improved thanks to their willingness to undertake training courses or to use information tools.

OBJECTIVE: Telemedicine (TM) has had a powerful impact in recent years, par-ticularly on managing chronic diseases such as inflammatory bowel disease (IBD). Knowing pa-tients' expectations and concerns is essential to increase their confidence in this mode of med-ical care. PATIENTS AND METHODS: We interviewed a large cohort of IBD patients enrolled at two Italian tertiary referral centers to investigate their trust in TM. RESULTS: A total of 376 patients complet-ed the survey and were included in the study: 293 (77.9%) considered TM valuable for manag-ing their disease, and 307 (85%) wanted to have TM service at their center. However, only 99 pa-tients (26.3%) believed that TM guarantees the same level of care as the in-person visit. Among the socio-demographic variables, those inde-pendently associated with trust in TM were the higher education qualification (p=0.02) and the level of competence in information and commu-nication technologies (ICT) (p=0.03). CONCLUSIONS: Our findings highlighted the importance of equipping IBD patients with ba-sic ICT skills to utilize TM services and increase their confidence in ICT with the help of caregiv-ers. Additionally, to improve the perceived val-ue of TM, it will be helpful to use additional tools such as telemonitoring of disease activity us-ing patients' reported outcomes or remote mea-surement of fecal calprotectin.

Background: During the COVID-19 pandemic, many inflammatory bowel disease (IBD) centres had to reorganise their work, and multidisciplinary teams, including IBD nurses, have had to try to deliver services to patients as safely as possible. Aims: This survey aimed to assess the thoughts, opinions and feelings of IBD patients on biologics regarding the efforts of IBD nurses to organise care during the COVID-19 pandemic. Methods: An evaluation survey based on an anonymous questionnaire was distributed to IBD nurses in five Italian IBD centres, in parallel. Findings: Of 306 participants, 55.6% had Crohn’s disease and 44.4% had ulcerative colitis. Most (79.1%) were aware of the specialist IBD nurse role, and 75.8% could distinguish it from generalist nurses. Of patients, 99.7% felt IBD nurses were competent to care for their condition and 91.2% felt that IBD nurses could provide valid scientific information. Meanwhile, 81.4% had a good or excellent relationship with their IBD nurse. Patients reported that most nurses wore personal protective equipment (94.4%), promoted self-care (91.8%), asked about presence of fever or cough (84.3%), asked about patient health status (83.7%) and covered pandemic safety and social distancing rules (69.3%), but fewer spoke about patient mood (44.4%) or relevant benefits, rules and exemptions (26.8%). Most participants (77.8%) faced pandemic-related issues for infusions. Nearly all (97.4%) knew immunosuppressed people were vulnerable to COVID-19, but only 42.8% spoke to their nurse about it. Some 61.8% of patients were concerned about COVID-19, but only 39.2% raised this with the IBD nurse. However, many more patients spoke to a nurse about concerns regarding biologics (41.8%) and worsening IBD symptoms (46.4%) in the pandemic than the actual number experiencing these issues (13.7% and 4.3%, respectively). Conclusion: The results show that IBD patients appreciate the role of the specialist nurse in their care.

OBJECTIVE: The role of nurses has great educational-scientific potential in COVID-19 vaccination. The aim of this work is to clarify whether the educational role of IBD nurses in vaccination is perceived by IBD patients. MATERIALS AND METHODS: A cross-sectional study was carried out, through a questionnaire, to evaluate how many IBD patients received health education about vaccinations from the dedicated nurses (IBD nurses). RESULTS: There were four hundred questionnaires, 310 patients (77.5%) answered all questions. The nurse does not appear to help educate patients on influenza vaccination (66.1%) or pneumococcal vaccination (81.6%). Disclosed patients have many doubts about the new COVID-19 vaccination (74.4%) and many seek information (74.8%) and think that the nurse can provide the necessary information (70%). CONCLUSIONS: IBD nurses do not seem very active in the vaccination education role, and they do not meet patients’ expectations, which are conversely very high.

Objective: The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center. Patients and Methods: Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed. Results: Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions. Conclusions: Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

The coronavirus disease 2019 (COVID-19) pandemic is having a major clinical as well as organisational impact on the national health-care system in Italy, particularly in high-volume hospitals which are usually active for many essential clinical needs, including inflammatory bowel disease (IBD). Here, we report major clinical and organisational challenges at a high-volume Italian IBD centre one month after the start of the Italian government’s restrictions due to the COVID-19 pandemic. All routine follow-up IBD visits of patients in remission were cancelled or rescheduled for 8–12 weeks’ time. However, access to the hospital for therapy or for unstable/relapsing patients was not considered postponable. Everyone attending the centre (e.g. physicians, nurses, administrative personnel and patients) were advised to respect the general recommended rules for hand hygiene and social distancing, to disclose if they had a fever or cough or flu-like symptoms and to wear a surgical mask and gloves. At the entrance of the therapy area, a control station was set up in order to double-check all patients with a clinical interview and conduct thermal scanning. A total of 1451 IBD patients under biotechnological or experimental therapy actively followed in the CEMAD IBD centre were included in the study. About 65% of patients maintained their appointment schedules without major problems, while in 20% of cases planned infusions were delayed because of the patient’s decision or practical issues. About 10% of patients receiving subcutaneous therapy were allowed to collect their medicine without a follow-up visit. Finally, 10% of patients living outside the Lazio region requested access to their therapy at a local centre closer to their home. At present, five patients have been found to be positive for SARS-CoV-2 infection but with minimal symptoms, 22 are in ‘quarantine’ for contact considered to be ‘at risk’ for the infection. Up to now, none of them has experienced significant symptom

BACKGROUND: La malattia infiammatoria intestinale (IBD) è una condizione cronica caratteriz- zata da recidive acute che hanno un impatto importante sulla qualità della vita dei pazienti, sia fisi- camente che psicologicamente. Nella cura personalizzata dei pazienti IBD, un ruolo chiave è rico- perto dall'infermiere IBD, che fornisce supporto psicologico ed educativo, nonché una fonte di contatto per tutti i pazienti. OBIETTIVO: lo scopo del presente studio era valutare la percezione dei pazienti con IBD sui ruoli, le competenze e le abilità degli infermieri IBD in un centro specializzato. Questa è la base per ulte- riori programmi volti a migliorare la qualità dell'assistenza. METODI: un questionario composto da 15 dichiarazioni riguardanti il ruolo dell'infermiere IBD nel loro trattamento è stato offerto a tutti i pazienti che frequentano questo centro IBD per un periodo di 3 mesi. I risultati sono stati mostrati confrontando quelli dei pazienti attualmente in trattamento con una terapia biologica con quelli che ricevono una terapia non biologica. RISULTATI: i pazienti in questo centro hanno una scarsa consapevolezza del ruolo infermieristico IBD, in particolare quelli che non ricevono cure biologiche. Sebbene la maggior parte dei pazienti sia consapevole di poter utilizzare l'infermiere IBD come punto di contatto, la maggior parte non è a conoscenza delle qualifiche dell'infermiere IBD per discutere le proprie opzioni di trattamento e fornire supporto psicologico. CONCLUSIONI: l’indagine mostra che la figura dell'infermiere IBD è ancora poco riconosciuta dai pazienti, con una probabile conseguente sottoutilizzazione dei servizi di un professionista alta- mente qualificato e istruito. Diverse questioni chiave per il miglioramento del servizio infermieri- stico IBD sono state sollevate da questo studio e richiedono indagini simili in altri centri., BACKGROUND: Inflammatory Bowel Disease (IBD) is a chronic condition characterized by acute relapses which have an important impact on the quality of life of patients, both physically and psychologically. In the personalized care of IBD patients, a key role is covered by the IBD nurse, who provides psychological and educational support, as well as a source of contact for all patients. AIM: Aim of the present study was to assess the perception of IBD patients about roles, competences and abilities of the IBD nurses in a specialized center. This is the base for further programs aiming to improve quality of care. METHODS: A questionnaire composed of 15 statements regarding the role of the IBD nurse in their treatment was offered to all patients attending this IBD center over a 3-month period. Results were showed comparing those of patients currently receiving treatment with a biologic therapy to those receiving non-biologic therapy. RESULTS: Patients in this center have a poor awareness of the IBD nurse role, particularly those not receiving biologic treatment. Although most patients are aware that they can use the IBD nurse as a point of contact, the majority are not aware of the qualifications of the IBD nurse to discuss their treatment options and provide psychological support. CONCLUSION: Our survey shows that the figure of the IBD nurse is still poorly recognised by patients, with a likely resultant underutilisation of the services of a highly skilled and educated professional. Several key issues for improvement for the IBD nurse service have been raised by this study and warrant similar investigation in other centres.