Browsing by Author "Hansen, Tawnya"
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Item Open Access Geographic Differences in the Risk of Surgery in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis(2021-11-15) Hansen, Tawnya; Kaplan, Gilaad; Ma, Christopher; Novak, KerriCrohn’s disease (CD) and ulcerative colitis (UC), collectively known as the inflammatory bowel diseases (IBD), are chronic immune mediated conditions. The pathophysiology of these disease is not well understood but genetic predisposition, dietary and microbiome-related factors, and environment exposures have been previously implicated. These diseases have traditionally been thought of as diseases of Caucasians living in the Western world: North America, Europe, and Oceania. However, the incidence of these diseases has been increasing in newly industrialized countries in Asia, Africa, and Latin America. In the Western world, a large proportion of healthcare spending related to IBD management has been on biologic agents.These biologic agents are very costly and are thought to decrease the risk of surgery. The risks of surgery among patients with IBD in the Western world is well described. However, the risks of IBD surgery in Asian countries has not been well assessed. Therefore, the aim of this thesis is to determine the risk of IBD surgery among persons in Asia compared to persons living in Western countries.A systematic review was conducted to identify all population-based studies reportingrisk of IBD surgery for Crohn’s disease or ulcerative colitis among inception cohorts diagnosed in the year 1999 or later. A meta-analysis was performed to pool the risk of surgery for Western and Asian countries. Choropleth maps were generated to highlight regional differences in surgery risk (https://arcg.is/5r48K).Item Open Access Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid(2021-07-30) Williams, Astrid-Jane; Karimi, Neda; Chari, Radha; Connor, Susan; De Vera, Mary A.; Dieleman, Levinus A.; Hansen, Tawnya; Ismond, Kathleen; Khurana, Rshmi; Kingston, Dawn; O’Connor, Katie; Sadowski, Daniel C.; Fang-Hwa, Flora; Wine, Eytan; Leung, Yvette; Huang, VivianAbstract Background Research has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased “voluntary childlessness”. Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD. Methods The International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility. Results Issues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received. Conclusions The novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.