Impact of Care in an Interdisciplinary Inflammatory Bowel Disease Specialty Clinic on Outcomes in Patients Insured with Medicaid

BACKGROUND

Inflammatory bowel disease (IBD) patients are known to benefit from care delivered in a specialized, interdisciplinary setting. We aimed to evaluate the impact of this model on health outcomes, quality metrics, and health care resource utilization (HRU) in IBD patients insured with Medicaid.

MATERIALS AND METHODS

In July 2017, IBD patients at our tertiary hospital were transitioned from a fellows' general gastroenterology (GI) clinic to a fellows' interdisciplinary IBD clinic. IBD patients were included if they were insured with Medicaid, had at least 1 visit in the general GI clinic between July 1, 2016 and June 30, 2017, and at least 1 visit between July 1, 2017 and June 30, 2018 in the IBD clinic. Characteristics related to patients' IBD course, overall health care maintenance, and HRU were compared.

RESULTS

A total of 170 patients (51% male, mean age 39 y) were included. After the transition to the IBD clinic, use of corticosteroids (37% vs. 25%; P =0.004) and combination therapy were significantly lower (55% vs. 38%; P =0.0004), although use of high-dose biologics numerically increased (58.5% vs. 67%; P =0.05). Posttransition, patients showed significantly lower levels of mean C-reactive protein ( P =0.04). After the transition, patients attended significantly fewer outpatient GI visits ( P =0.0008) but were more often seen by other health care specialists ( P =0.0003), and experienced a numeric decrease in HRU with fewer emergency department visits, hospitalizations, and surgeries.

CONCLUSIONS

Care in an interdisciplinary, IBD specialty setting is associated with significantly decreased corticosteroid use, decreased C-reactive protein levels, and improved access to ancillary services in Medicaid patients.

Exchange bias driven by Dzyaloshinskii-Moriya interactions

The exchange bias effect in a compensated IrMn3/Co(111) system is studied using multiscale modeling from ab initio to atomistic spin model calculations. We evaluate numerically the out-of-plane hysteresis loops of the bilayer for different thicknesses of the ferromagnetic layer. The results show the existence of a perpendicular exchange bias and an enhancement of the coercivity of the system. To identify the origin of the exchange bias, we analyze the hysteresis loops of a selected bilayer by tuning the different contributions to the exchange interaction across the interface. Our results indicate that the exchange bias is primarily induced by Dzyaloshinskii-Moriya interactions, while the coercivity is increased mainly due to a spin-flop mechanism.

[Pyeloplasty without intrarenal stent in pediatric patients]

PURPOSE

In spite of advances in minimally invasive endoscopic surgery, open dismembered pyeloplasty continues to be used in many pediatric centers, especially in small children. The purpose of this work is to present our experience in the performance of this technique using a minimally invasive open pyeloplasty without intrarenal stents.

MATERIAL AND METHODS

A retrospective review was made of patients between July 1992 and July 2009. During this time, 348 patients underwent open dismembered pyeloplasty. A total of 310 patients (89%), 223 boys and 87 girls, underwent open pyeloplasty without intrarenal stent. The incision was from 2 to 2.5 cm in the flank. An extrarenal drain (3-5 days) and a bladder catheter (< 24 hs) were placed in all patients.

RESULTS

A total of 319 pyeloplasties were performed without intrarenal catheter in our Service. Of these, 174 (54.5%) were on the left side, 127 (39.8%) on the right side and 9 (5.6%) were bilateral. Age interval was 14 days to 18 years, 58% of the children being younger than 12 months at the time of surgery. With a mean follow-up of 6.7 years (17 years to 11 months), 312 pyeloplasties (97.8%) were successful, with persistence of the obstructive patient in 7 patients who required a new open pyeloplasty (2.2%). Other complications were: prolonged drainage (6), wound infection (1), and urinary infection (2). Mean stay was 22 hours.

CONCLUSIONS

Open dismembered pyeloplasty is a safe and effective treatment choice for pyeloureteral stenosis in children and can be done without intrarenal stents with no detriment to its success.

Field induced vortex dynamics in magnetic Ni nanotriangles

The magnetization states in Ni triangular dots under an applied magnetic field have been studied using variable-field magnetic force microscopy (VF-MFM) imaging. In order to understand their dynamics we performed micromagnetic simulations which are in remarkable agreement with the experimental MFM results. The nanostructures present magnetic vortices as ground states which move under an external magnetic field. The combination of micromagnetic simulations and MFM imaging allows us to identify correctly the vortex chiralities and polarizations. The triangular geometry produces an improved contrast of the vortex core. Additionally, the vortices of different chiralities present clearly different MFM images under an applied field.