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Introduction: Biologics are effective for the treatment of inflammatory bowel disease (IBD). However, unwarranted variation in processes and outcomes has been reported in the treatment of IBD. A care pathway for the treatment of IBD has the potential to reduce practice variation and improve outcomes. This study aims to compare the effect of a uniform care pathway for the treatment of patients with IBD with biologics to the current situation.
Methods And Analysis: IBD Value is a longitudinal multicentre non-randomised parallel cluster trial with a baseline period. The study takes place in eight centres in the Netherlands. The baseline period will run for 12 months, after which the care pathway will be implemented in 6 of the 8 participating hospitals during the implementation phase of 3 months. Hereafter, the effect of the care pathway will be assessed for 12 months. Total study period is 27 months. The primary outcome is the effect of the care pathway on disease control (IBD-Control questionnaire). Secondary outcomes are the effect of the care pathway on the other outcomes of the International Consortium of Health Outcomes Measurement IBD standard set, health-related generic quality of life, patient experiences and degree of variation; cost effectiveness of the care pathway; and the variation between hospitals in the aforementioned outcomes in the baseline period. Outcomes will be measured every 6 months. The study started on 1 December 2020 and a minimum of 200 patients will be included.
Ethics And Dissemination: The study was deemed not to be subject to Dutch law (WMO; Medical Research Involving Human Subjects Act) by the Medical Ethics Committee of the Erasmus MC, the Netherlands (registration number: MEC-2020-075) and a waiver was provided. Results will be disseminated through peer-reviewed journals and presented at (inter)national conferences.
Trial Registration Number: NL8276.
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http://dx.doi.org/10.1136/bmjopen-2021-050539 | DOI Listing |
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Univ. of Pennsylvania, Medicine, Philadelphia, Pennsylvania, United States.
Lymphangioleiomyomatosis (LAM) is a rare lung disease caused by hyperactivation of the mechanistic/mammalian target of rapamycin 1 (mTORC1) growth pathway in a subset of mesenchymal lung cells. Histopathologically, LAM lesions have been described as immature smooth muscle-like cells positive for the immature melanocytic marker HMB45/PMEL/gp100 and phosphorylated ribosomal protein S6 (pS6). Advances in single cell sequencing (scRNA-seq) technology allowed us to group LAM cells according to their expression of cancer stem cell (CSC) genes and identify three clusters: a high CSC-like state (SLS), an intermediate state, and a low CSC-like inflammatory state (IS).
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University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada.
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View Article and Find Full Text PDFProc Natl Acad Sci U S A
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Australian Antarctic Division, Kingston, TAS 7050, Australia.
Antarctic krill () is the central prey species in the Southern Ocean food web, supporting the largest and fastest-growing fishery in the region, managed by the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR). Climate change is threatening krill populations and their predators, while current catch limits do not take into account climate variability or krill population dynamics. In 2024, CCAMLR was unable to renew its spatial catch limits, highlighting the urgent need for improved management of the krill fishery to prevent any harm to the Southern Ocean ecosystem.
View Article and Find Full Text PDFAm J Physiol Lung Cell Mol Physiol
September 2025
Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH.
Cystic Fibrosis (CF) is characterized by impaired mucociliary clearance and pulmonary infections. Accumulating evidence suggests that fundamentally abnormal inflammatory responses also contribute to CF pathology. TGFβ, a pleiotropic cytokine, is a modifier of CF lung disease; its mechanism of action in CF is unclear.
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