Monthly Archives: June 2014

Reply to Drs. Walmsley and Casey letter.






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Reply to Drs. Walmsley and Casey letter.
J Crohns Colitis. 2013 Dec 1;7(11):932
Authors: Bennebroek Evertsz’ F, Nieuwkerk PT, Stokkers PC, Ponsioen CY, Bockting CL, Sanderman R, Sprangers MA
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Development of the patient Harvey Bradshaw index and a comparison with a clinician-based Harvey Bradshaw index assessment of Crohn’s disease activity.






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Development of the patient Harvey Bradshaw index and a comparison with a clinician-based Harvey Bradshaw index assessment of Crohn’s disease activity.

J Clin Gastroenterol. 2013 Nov-Dec;47(10):850-6

Authors: Evertsz’ FB, Hoeks CC, Nieuwkerk PT, Stokkers PC, Ponsioen CY, Bockting CL, Sanderman R, Sprangers MA

Abstract
GOALS AND BACKGROUND: The objective is to develop a patient-based Harvey Bradshaw Index (P-HBI) of Crohn’s Disease (CD) activity and to compare it with the clinician-based HBI of CD activity in CD outpatients.
STUDY: Consecutive patients with CD randomly completed the P-HBI either before or after the consultation. The gastroenterologist assessed patient’s CD activity on the same day. Overall agreement between HBI and P-HBI was calculated with Spearman’s ρ and Mann-Whitney U test. Agreement regarding active disease versus remission and agreement at item level was calculated by percent agreement and Cohen’s κ.
RESULTS: One hundred eighty-one (response rate 88.3%) CD patients participated. P-HBI and HBI showed a large correlation (rs=0.82). The medians (interquartile range) of the total HBI (2; 0 to 4) and P-HBI (4; 1 to 7) were statistically significantly different (z=-8.411; P<0.001). Fortunately, in 82.6% of the cases this difference between clinicians and patients was not clinically significant (<3.2). The percentage agreement between clinician and patient, judging CD as active or as in remission, was 77%, rs=0.56, κ=0.52, indicating a moderate agreement. P-HBI and HBI on frequent extraintestinal manifestations in CD varied from less than chance (κ=-0.02) to a perfect agreement (κ=1). Patients tended to report more symptoms while completing the patient-based questionnaire compared to what they reported to the clinician during consultation.
CONCLUSIONS: The P-HBI is the first step in developing a potential promising tool given its adequate agreement with the original HBI and its feasibility, especially in patients with low scores. Future research is necessary to develop a validated patient-based version studied in several patient populations.

PMID: 23632348 [PubMed – indexed for MEDLINE]

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The patient simple clinical colitis activity index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: a comparison of the P-SCCAI with clinician-based SCCAI and biological markers.






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The patient simple clinical colitis activity index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: a comparison of the P-SCCAI with clinician-based SCCAI and biological markers.

J Crohns Colitis. 2013 Dec 1;7(11):890-900

Authors: Bennebroek Evertsz’ F, Nieuwkerk PT, Stokkers PC, Ponsioen CY, Bockting CL, Sanderman R, Sprangers MA

Abstract
AIM: To develop a patient-based Simple Clinical Colitis Activity Index (P-SCCAI) of ulcerative colitis (UC) activity and to compare it with the clinician-based SCCAI, C-reactive protein (CRP) and Physician’s Global Assessment (PGA) of UC activity. Monitoring UC activity may give patients disease control and prevent unnecessary examinations.
METHODS: Consecutive UC patients randomly completed the P-SCCAI either before or after consultation. Gastroenterologists assessed patients’ UC activity on the same day. Overall agreement between SCCAI and P-SCCAI was calculated with Spearman’s Rho and Mann-Whitney U test. Agreement regarding active disease versus remission and agreement at domain level were calculated by percent agreement and kappa (κ).
RESULTS: 149 (response rate 84.7%) UC patients participated. P-SCCAI and SCCAI showed a large correlation (rs=0.79). The medians (IQR) of the P-SCCAI (3.78;0-15) tended to be higher than those of the SCCAI (2.86;0-13), although this difference did not reach statistical significance (z=1.71| p=0.088). In 77% of the cases the difference between clinicians’ and patients’ scores was not clinically different (i.e.≤2). Percentage agreement between clinicians and patients, judging UC as active or in remission, was 87%, rs=0.66, κ=0.66, indicating a substantial agreement. In general patients tended to report more physical symptoms than clinicians. C-Reactive protein (CRP) was found to have a significant association with both P-SCCAI and SCCAI (κ=0.32, κ=0.39 respectively) as was PGA (κ=0.73 for both indices).
CONCLUSIONS: The P-SCCAI is a promising tool given its substantial agreement with the SCCAI and its feasibility. Therefore, P-SCCAI can complement SCCAI in clinical care and research.

PMID: 23269224 [PubMed – indexed for MEDLINE]

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