Rectal nitric oxide as biomarker in the treatment of inflammatory bowel disease: Responders versus nonresponders

AIM： To explore rectal nitric oxide （NO） as biomarker of treatment response in ulcerative colitis （UC） and Crohn＇s disease （CD）, and examine relationships between rectal NO, mucosal expression of NO synthases （NOS）, and pro-inflammatory cytokines. METHODS： Twenty-two patients with UC and 24 with CD were monitored during steroid treatment. Rectal NO levels were measured and clinical activities were assessed on days 1, 3, 7 and 28. Mucosal presence of NOS and pro-inflammatory cytokines were analyzed by immunohistochemistry and RT-PCR. RESULTS： Active UC and CD displayed markedly increased rectal NO levels （10950 ± 7610 and 5 040 ± 1 280 parts per billion （ppb）, respectively） as compared with the controls （154 ± 71 ppb, P 〈 0.001）. Rectal NO correlated weakly with disease activity in both UC and CD （r = 0.34 for UC and r = 0.48 for CD, P 〈 0.01）. In 12 patients, a steroid-refractory course led to colectomy. These patients had only slightly increased NO levels （UC： 620 ± 270 ppb; CD： 1260 ± 550 ppb） compared to those with a therapeutic response （UC： 18860 ± 530 ppb, P 〈 0.001, CD： 10060 ± 3200 ppb, P 〈 0.05）. CONCLUSION： Rectal NO level is a useful biomarker of treatment response in IBD as low NO levels predicts a poor clinical response to steroid treatment.

Person-centered endoscopy safety checklist: development,implementation,and evaluation

AIM To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a "checklist intervention".METHODS The checklist,based on previously published safety checklists,was developed and locally adapted,taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team's performance were conducted before and after the introduction of the checklist. In addition,questionnaires focusing on patient participation,collaboration climate,and patient safety issues were collected from patients and staff. RESULTS A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted(from 0% at baseline to 87% after 10 mo,P < 0.001),and remained high among nurses(93% at baseline vs 96% after 10 mo,P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist,but compliance was suboptimal: All items in the observed nurse-led "summaries" were included in 56% of these interactions,and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff,items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist,but this did not result in statistical significance(P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist;hence,no statistical difference was noted.CONCLUSION The intervention led to increased patient identity verification by physicians-a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.