Anti-TNF therapy for Crohn's disease: where are we in 2011
The use of anti-tumour necrosis factor for patients with Crohn's disease is now common place but remains far from straightforward. Getting it right for the patient requires both doctors and nurses to have a wide range of skills. Making the best clinical judgement based on a balance of benefit and risk (while being mindful of the constraints of cost) and presenting this to the patient and sharing the decision, is a tough task. Good judgements require a sound understanding of the evidence. This short summary of that evidence, and the recommendations of National Institute for Health and Clinical Excellence, is just what the busy gastroenterologist needs to make the best judgements.
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Establishing a biologics service for patients with inflammatory bowel disease
I have long believed that making decisions about treatment should not be affected or constrained by the prospect of having to make complicated arrangements to deliver the treatment. Most treatments we prescribe do not require much more effort than writing a prescription and dictating a letter. Prescribing biologics is different. Patients need careful counselling, they need screening before treatment can start and the majority still require intravenous infusions. Being well organised and having all of this on automatic pilot not only makes life for the prescriber easier, it also creates a much more efficient, patient centred and safe service. When patients are processed in a systematic way, using carefully thought through and properly resourced pathways, there is much less room for error. The Leeds biologics service is an exemplar of this approach and there is …