University of Macau / Institute of Chinese Medical Sciences

Background: Ulcerative colitis (UC) occurs in remissions and relapses and requires frequent outpatient follow-ups for management by specialists. These visits may not always coincide with the need for attention leading to unnecessary outpatient visits, nonattendances, inadequate monitoring, patient dissatisfaction and increased costs. Self management and shared decision making with health professionals may help overcome such challenges. Use of printed patient education interventions as a self management technique in UC has been discussed in this review. Objectives: To determine the impacts and implications of printed patient education interventions on patient empowerment, improved patient care, decreased healthcare use without burden on primary care and its impact on saving costs. The applicability of such an intervention in context of Hong Kong will also be discussed. Methods: PubMed and ProQuest Health and Medicine Databases, and Google scholar search engine were searched for original studies reporting results of randomized controlled trials (RCTs) of use of printed patient education interventions in management of inflammatory bowel disease and ulcerative colitis. There was no limit put on publication dates. Results: Four RCTs were finalized for review. The studies named primary and secondary outcomes, some of which were common to more than one study, and included process evaluations. Knowledge of UC was evaluated as an outcome in two studies, quality of life in four, health related anxiety and depression in two, patient satisfaction in two, medication adherence in one, relapses experienced in one and healthcare use in three. Knowledge and patient satisfaction was found to significantly improve in two studies. Statistically significant reduction was found in healthcare use in 2 RCTs with one also reporting fewer visits to outpatient department and primary care. Results were statistically insignificant for quality of life, medication adherence, relapse length, reporting of relapses and health related anxiety and depression in different studies though further study of their long-term effects is warranted to be better demonstrate their potential benefits. Conclusion: The presently proposed printed materials used in the studies appear to produce modest benefits in self management of UC. As the idea of self management evolves with time, we would need to define the optimal format of printed intervention and ways for continuous reinforcement in patients, as, currently, UC management is a lifelong process. / published_or_final_version / Public Health / Master / Master of Public Health

Thesis (MSocSc)--University of South Australia, 1997

Thesis (doctoral)--Lund University, 1993. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1993. / Added t.p. with thesis statement inserted.

目的：通過收集潰傷性結腸炎（ Ulcerative colitis, UC ）的相關研究文獻，認識本病的發病機制、病名源流、流行病學及相關中醫藥治療情況，了解2006-2016 年間UC 的中藥口服治療現狀和用藥規律，對本病的常用藥和證治規律做統計分析，為臨床治療和研究該病提供有價值的參考依據。方法：檢索〈中國期刊全文數據庫〉’搜集2006-2016 年間有關中醫藥治療潰傷性結腸炎的研究文獻，按照合理的納入和排除標準’選出符合要求的文章，用Microsoft Office Excel2013 軟件建立UC 中藥口服用藥規律數據庫，對文章中涉及的中藥進行用藥頻率、藥物性味歸經及藥物類型的統計分析，以認識UC 常用內服中藥的情況，分析其用藥和證治規律。結果： (1 ）按照文獻的納入和排除標準進行篩選，總共選出符合要求的文章137 篇，涉及口服治療潰、屬性結腸炎的中藥141 種，總藥物使用次數1623 次，常用藥物依次為：白術、甘草、黃連、白苟、木香、夜苓、黨參、白頭翁、當歸、黃良、憲政仁、陳皮、黃琴、敗醬草、地輸、黃柏、枳殼等。藥物分類以清熱藥和補虛藥為主，清熱藥中使用頻率最高的是清熱燥濕藥與清熱解毒藥，補虛藥中使用頻率最高的是補氣藥，藥性寒、溫頻率相仿，藥味以甘苦辛為主，用藥歸經多為肝經、脾經、胃經和肺經。結論： (1 ）常用口服治佇潰傷性結腸炎的藥物以清濕熱藥和補氣藥為主，排名前十的依次為：白術、甘草、黃連、白苟、木香、夜苓、黨參、白頭翁、當歸、黃皮。（ 2 ）潰傷性結腸炎證型特點：虛實互存、寒熱錯雜，本虛標實，脾虛為本、濕熱為標，實證者以濕熱窒滯、濁毒絡腸為主，而虛證多見氣血虧虛、脾胃虛弱。(3 ）治療應辨清寒熱、虛實、標本，實者清熱燥濕、解毒通絡，虛者調補氣血，健脾理究，並酌情配伍止血收澀等藥。關鍵詢：潰傷性結腸炎﹔中藥﹔規律﹔性味歸經

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

A dextran sulphate (DS) model of ulcerative colitis was used to examine the effects of macronutrient restriction with (MR+PRO) and without (MR) probiotic supplementation (VSL#3RTM) on protein metabolism and growth. MR and MR+PRO decreased weight and chest circumference gain, but had no effect on linear growth of piglets. MR decreased the protein fractional synthesis rate (FSR) of liver, masseter, longissimus dorsi, colon, as well as plasma albumin, measured by stable isotope tracer L-[ring-2H 5]phenylalanine. MR+PRO increased the FSR of hepatic proteins by greater than 70% and increased both the FSR and absolute synthesis rate (ASR) of the total plasma protein pool, albumin and fibrinogen. Over 11 days, MR+PRO piglets showed a smaller decrease in plasma total protein concentrations than WN piglets, and maintained higher albumin levels than either WN or MR piglets. These findings highlight the importance of adequate nutrition during gastrointestinal inflammation and show that when food intake is decreased, probiotics stimulate liver protein synthesis and increase the acute phase protein response, similar to the well-nourished state.

No description available.

Both ulcerative colitis and Crohn's disease are chronic disorders of unknown aetiology. The purpose of this study was to map the incidence and current natural history of both diseases so that this knowledge might assist in the better management of patients. The study is of a cohort of 723 patients with inflammatory bowel disease diagnosed in Wolverhampton, Salisbury and Swindon between 1977-86 and followed up prospectively until 31st December 1993. The incidence, mortality, survival and short-term prognosis in relation to age, sex, length of history, severity and extent of disease were analysed. The long-term prognosis was examined in relation to the course, relapses, recurrence, surgical treatment, remote complications and cancer risk. No increase in the incidence of ulcerative colitis and Crohn's disease was found. The age distribution of both diseases showed a bimodal pattern with peaks at 20-39 and 50-69. The incidence of ulcerative colitis was highest in Wolverhampton as was the incidence of Crohn's disease in Swindon. It was similar between men and women. The Standardised Mortality Ratio (~MR) of ulcerative colitis and Crohn's disease was similar to the general population, except that it was significantly higher in Swindon. The excess death was not from ulcerative colitis. Ulcerative colitis: Rank correlation analysis showed length of history, extent and severity of disease were strongly associated with prognosis of first attack. There was also a strong inter-relationship between these factors. 80% of patients were in remission at any time but at 15 years 72% had experienced at least one relapse and 15% of patients had undergone colectomy. The severity and extent of disease at first attack was found to be predictive of colectomy. The prognosis was different in Wolverhampton. More patients underwent surgery and colectomy. When the influence of race was considered South Asian patients presented with more severe and extensive colitis and they were younger than white patients. The relapse and colectomy rate were greater in South Asians during follow up. The racial differences in incidence, course and prognosis of ulcerative colitis needs further investigations. The lower incidence in Swindon, less common extensive colitis both at presentation and during follow up, and lower colectomy rate might suggest a milder form of ulcerative colitis. Crohn's disease: Rank correlation analysis showed age, site of disease and length of history were not associated with short term prognosis. Almost 80% of patients were in remission at any time and 84% experienced at least one relapse in 14 years which required treatment. The relapse rate in Swindon was higher but were mostly treated medically.47% of patients had undergone some form of intestinal resection in 14 years, 33% required a second operation within 10 years. This study failed to show any relationship between the first recurrence and age at diagnosis, length of history or initial site of involvement. The prognosis was different in Wolverhampton; more patients underwent intestinal resection. In Wolverhampton there were significantly more patients with anal Crohn's and 38% of these patients who underwent surgery did so because of anal Crohn's. There was a improvement in the prognosis of VC and CD in the present study in comparison to the studies in the last few decades. The apparent improvement of outcome may result from changing criteria and speed of diagnosis, the introduction of new treatments and their rapid application. The need exists for new and improved treatment for those patients who do not currently respond adequately. Outcome measurements suggest that most, but not all patients, with ulcerative colitis and Crohn's disease lead a relatively normal social and working life. The results may be of value for reassessing the life insurance risk of patients with inflammatory bowel disease. The results suggest there is a need for further reallocation of resources for both research and health care delivery to these patients.