Ultrasound assessment of small bowel Crohn's disease: A mixed methods exploration of barriers and facilitators to implementation in adult NHS IBD services
Notice bibliographique
Résumé
Background: Crohn’s disease (CD) is a long-term condition which requires repeated disease monitoring via medical imaging, where repeated burdensome medical investigations negatively impact on patients quality of life. Small bowel ultrasound scanning (SBUS) has been shown to be similar in accuracy when compared to magnetic resonance enterography (MRE), has the potential to be quicker, less costly and improve patient experience of care, but it is not routinely used in NHS IBD care. \n \nObjectives: This thesis aims to provide insight on how best to support the implementation of SBUS in practice by collecting information about current national usage and appetite for SBUS uptake, stakeholder perceptions of the adoption of the intervention by health services and the potential impact of use of SBUS on care pathways in routine CD care. Findings from this work will contribute to the production of an implementation package to facilitate national uptake of SBUS in NHS IBD services. \n \nMethods: A scoping literature review and three research studies were undertaken throughout this programme of work. The scoping literature review was undertaken to explore clinical utility of SBUS in IBD settings. A national survey was undertaken to uncover current usage and appetite for use of SBUS in IBD settings. A qualitative semi structured interview study was undertaken to explore stakeholder perceptions of SBUS use and implementation of ultrasound in IBD settings. A care pathway analysis and cost implications analysis were undertaken to gauge the impact of the introduction of SBUS into an NHS IBD service. The quantitative data were analysed using descriptive statistics. Qualitative data were analysed using template analysis. \n \nResults: Ultrasound is reported as quicker, more acceptable to patients and safer when compared to MRE and has been shown to be similarly accurate in detecting presence and extent of small bowel CD. Ultrasound is used widely in central Europe and Canada but has not yet been embraced in the UK. Survey responses indicated that there is an appetite for the uptake of SBUS in NHS services. There is disparity in confidence levels when using ultrasound to make clinical decisions, compared to MRE. The interview study revealed that stakeholders believe that the introduction of SBUS into clinical services would be beneficial to patient experience, outcomes and cost reduction. There are concerns in relation to the availability of training for health care professionals and the belief that there are still concerns relating to accuracy of SBUS compared to MRE. Interview participants believed that the largest barriers to implementation of SBUS in the NHS were the existing practices, beliefs and behaviours of healthcare professionals which are likely to be difficult to amend. Care pathway and costs implications analysis’ showed that there are significant potential cost saving and waiting time reduction implications to the introduction of SBUS into NHS IBD services. \n \nConclusions: Recommendations from this work which will contribute to the generation of an implementation package for SBUS include the need for well-structured and supported training for health care professionals, tools for identifying and fostering leadership roles in promoting and sustaining change and mechanisms for reviewing and adapting SBUS over time to ensure it meets the needs of stakeholders and IBD services.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».