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Introduction: Southampton General Hospital provides inflammatory bowel disease (IBD) services for a population of 650 000. Biological agents have impacted hugely on IBD but are costly drugs requiring careful supervision. These challenges led us to develop a specialist nurseled biologics service to improve patient care. Method: A 2010 case note audit highlighted areas for improvement in monitoring biologics and follow-up. A business case was developed to establish an IBD nurse to ensure identification and appropriate screening, education and review of biologics patients. A gain share was agreed with the local Care Commissioning Group (CCG) and £60 000 invested. Outcomes were reaudited in 2014. Results: Biologic use has grown rapidly from 90 patients in 2011 to 330 in 2014. All records are now kept in a centralised database. Infection screening improved from 79% to 100%. In 2014, 96% of patients had follow-up =4 months post-induction to assess response, but two patients were seen at 7 months. 80% were followed up again at 9-12 months (100% at 9-14 months), all with treatment decisions. The initial investment was recouped via commissioners funding 368 additional outpatient appointments and 35 colonoscopies. Savings represented 15% total yearly biologic costs. Conclusions: The introduction of the IBD biologics nurse-led service resulted in significant gains in care quality and costs. The need for improved follow-up of patients on biologics reflects increased pressures on clinic resources across the country. With continued biologics expansion, the introduction of a biologics nurse has provided invaluable support to patients and the IBD team at Southampton General Hospital. [ABSTRACT FROM AUTHOR]

The follow-up of inflammatory bowel disease (IBD) patients is challenging due to the relapsing remitting nature of the diseases, the wide spectrum of severity and complexity as well as the need for monitoring of long-term complications and drug treatments. Conventional outpatient follow-up lacks flexibility for patients and there are competing pressures for clinic time. Alternative follow-up pathways include telephone clinics, self management programmes or discharging patients. The IBD virtual clinic (VC) is a further option. Patients with an established diagnosis for >2 years, who have been stable for >1 year, do not have primary sclerosing cholangitis and who give their consent, are entered into the VC system. Two months before their annual follow up is due patients are sent blood test forms and a simple questionnaire with an information sheet. If they meet any of the criteria on the questionnaire, they are asked to contact the IBD specialist nursing team to discuss their situation. The blood test results and the patient's database entry are reviewed to ensure that they are not due surveillance investigations. The patients and their GPs then receive a letter informing them of their management plan. We currently follow-up 20% of the Southampton IBD cohort using the VC. The VC system is an innovative, effi cient and patient-responsive method for following up mild to moderate IBD. It is well liked by patients but is dependent on a well-maintained database with good integration of IT systems and requires both clerical and IBD nurse specialist support. [ABSTRACT FROM AUTHOR]

Introduction Percutaneous Coronary Intervention (PCI) is widely used in the emergency and elective setting. If drug-eluting stents are deployed, dual antiplatelet therapy must continue for 12 months. Antiplatelet agents are a recognised cause of overt and occult gastrointestinal (GI) bleeding. The aim of this study was to determine the rate of GI complications following PCI in a tertiary cardiothoracic centre. Methods A cohort of 604 patients, who underwent coronary stenting in a 6-month period, was identified from cardiology records. 369 patients were tertiary referrals and so excluded from analysis as follow-up data was unavailable. The electronic notes of 235 patients were reviewed to identify GI complications in the year after PCI. These were classified as overt GI bleeding, anaemia or dyspeptic symptoms. Results The patients were aged 39-73 years (median 64 years). 78% were male and 97% were Caucasian. 80% of patients were on aspirin and clopidogrel for at least 12 months after PCI. 14% of patients were anaemic prior to PCI, defined by a local laboratory reference range of haemoglobin (Hb) <125g/L. It was not standard practice to monitor Hb in the year after PCI, but 97% of patients had Hb tested for another reason, 33% of whom had microcytosis. In the year post-PCI, 45 (19%) patients were anaemic on at least one test, with no obvious cause, such as surgery. Of these, only 16% were tested for iron deficiency anaemia (IDA). 5 of 7 patients tested had definite IDA. Prior to PCI, only 3% of the cohort were anaemic to a degree that would have prompted referral for investigation, based on Department of Health guidelines for suspected lower GI cancer (Hb <11g/dL in men, Hb <10g/dL in postmenopausal women). During treatment with aspirin and clopidogrel, this proportion rose significantly to 10% (p=0.006) Within 12 months of PCI, 10 patients had a gastroscopy, 2 patients had upper and lower GI endoscopy, and 3 had lower GI endoscopy only. The indications in these 15 patients included overt bleeding (5 patients), IDA (4 patients) and GI symptoms (4 patients). 7 of 12 patients had endoscopic signs of upper GI inflammation, with findings of oesophagitis, gastritis or duodenitis. 4 OGDs were normal and another identified Barrett's oesophagus. Significant lower GI diagnoses included rectal cancer, a sigmoid ischaemic ulcer and diverticular disease. Conclusion These results suggest dual antiplatelet therapy increases the prevalence of anaemia, which may be due to iron deficiency. Hb and iron status are not routinely monitored in the year post-PCI. Iron deficiency can cause significant symptoms of fatigue, even in the absence of anaemia and IDA may herald a more sinister underlying pathology. We suggest a review of practice post-PCI, as identification of iron deficiency may prompt timely treatment and investigation. [ABSTRACT FROM PUBLISHER]