Background Inflammatory bowel disease (IBD) can impact the quality of life and increase health care resource utilization. Nurses play an integral role in ensuring ease of access to care between scheduled office visits. Aims This study aimed to capture the utilization of Canadian IBD nursing telephone and e-mail services. Methods A descriptive cross-sectional study with an eight-item online survey was completed by nurses to assess the use of nurse-led telephone and e-mail services for IBD patients. Results Twenty-one IBD nurses participated, and 572 patients nurse encounters were reported. Patients with ulcerative (UC) contacted with disease flare when compared to Crohn’s disease (CD) (40% versus 24%, P < 0.001). Nursing services were primarily utilized for queries regarding medication (39.3%), disease exacerbations (29.6%), investigations (26%), and scheduling appointments (17.6%). Patients with CD had more telephone conversations (62.7%) and required more follow-up telephone calls (72.2%) compared to patients with UC (33%) and 25%, respectively. Nurse-managed interventions were provided independently for 61.4% of encounters, while 19% required a scheduled appointment in the IBD clinic. In the absence of telephone or e-mail assistance, older patients were more likely to call their family doctor (r = 0.18, P < 0.001), visit the emergency room (r = 0.18, P < 0.001), visit an urgent access clinic (r = 0.22, P < 0.001), or visit a walk-in clinic (r = 0.29, P < 0.001) than younger patients. Conclusions Nurse-managed IBD advice lines are proactive services that can address most patient disease-related concerns.

An ideal patient-controlled analgesia (PCA) opioid would have both a rapid onset and a long duration of action, attributes, which are not available in currently existing opioids including morphine, the most widely used agent. A mixture of rapid onset and long-acting opioids may potentially achieve both these qualities. In a randomized, double-blind study, we compared a fentanyl-morphine combination with morphine alone for PCA, in 54 patients undergoing bowel surgery. The combination solution was prepared according to a 1:75 fentanyl to morphine potency ratio. The mixture contained fentanyl 13.33 mug/mL and morphine 1 mg/mL. The morphine alone solution contained 2 mg/mL. Patients were randomly allocated to one of the regimens and were then evaluated 4 times during the first 48 hours following surgery. Time to effect, visual analog pain scores, opioid consumption, demands, deliveries, and side effects on an opioid-related symptom distress scale were recorded. Groups were well matched for age, weight, and sex. There were no significant differences between groups in time to effect, PCA usage, pain scores or side effects other than the occurrence of nausea, which was lower for the combination group in 1 visit. Further studies are needed to explore the potential of different potency ratios and opioid combinations to achieve rapid and long-lasting pain control.

Background: Discomfort in women with Crohn's disease is highly prevalent, even during remission. However, these women's lived experiences of discomfort are largely unknown. Aims: To explore the lived experiences of discomfort in women with Crohn's disease. Methods: Six women with Crohn's disease were recruited using purposive and snowball sampling. Semi-structured, audio-recorded interviews were conducted using Zoom and transcribed verbatim for analysis. van Manen's work guided the data analysis. Findings: Four phenomenological themes were identified: discomfort as an embodied experience, discomfort as a conscious experience, discomfort and social life, and discomfort as a way forward. Conclusion: Healthcare professionals and researchers can facilitate the recognition, impact and mitigating strategies of discomfort by acknowledging it as an essential phenomenon for women with Crohn's disease. Further research is recommended to understand better the experience of discomfort and its implications for women's quality of life and their social and therapeutic relationships.

Background: Inflammatory bowel disease (IBD) is a chronic, autoimmune gastrointestinal illness with a significant disease burden. The concept of discomfort in IBD lacks conceptual clarity. Aims: To analyse the concept of diagnostic and periprocedural discomfort in IBD and provide an understanding of its evolution, use in IBD research and implications for clinical practice through its attributes, antecedents, consequences and related terms. Methods: The Rodgers evolutionary concept analysis method guided this inductive approach. Findings: Seven journal articles, a dictionary, a thesaurus and one book were included in this analysis. The analysis yielded 12 surrogate terms, three attributes, five antecedents and one consequence. Diagnostic and periprocedural discomfort in IBD is an unpleasant, multidimensional and subjective experience, with biological, psychological or technical antecedents, which can occur independently of pain. Conclusion: Further research is required to enhance understanding of discomfort to improve the care of people living with IBD and their relationship with healthcare providers.

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