NURSING MANAGEMENT OF IBS--IMPROVING OUTCOMES

描述（改编自申请人的摘要）：在美国， 据估计，17-30%的人口经历了与 肠易激综合征（IBS） IBS是一种功能性疾病 其特征在于肠道模式的改变，（例如，便秘、腹泻）， 腹痛和腹胀。 它影响更多的女性比男性，造成 严重的症状困扰，干扰功能活动， 提高卫生保健利用率。 目前推荐的治疗方法包括 饮食控制（增加纤维，排除饮食），自我管理， 心理治疗和通过药物治疗的运动调节。 的 这些疗法单独或组合的有效性保证了 由于1）使用了异质样本而进行的额外调查 关于主要肠道症状、心理特征，以及 IBS的持续时间/慢性化，2）使用回顾性措施记录 干预前后的症状特征，以及3）未能 控制月经周期的变化，主要是在症状特征 女性样本 也很少有全面的随访数据，包括 症状轨迹和卫生保健服务利用的描述 发生在干预文献中。 的目的 本研究是比较一个简短的，1次会议， 自我管理干预以全面、8周、自我管理为主 在医学诊断为IBS的女性中进行干预以减轻症状。 一 第三组患有IBS的女性将不接受治疗， 对照组 除了测量症状的变化外， 功能能力和医疗保健利用将被测量为12 干预后的几个月。 第三个目标是探索 心理和生理指标的变化的贡献 IBS症状 进一步了解每个人的贡献， 潜在的因果机制将提供有用的信息， 治疗建议。 年龄在20至45岁之间，并通过 还将从医疗中心诊所招募医疗保健提供者 作为大型HMO（Group Health）的胃肠病学和初级保健诊所， 合作）。 受试者将接受一个月经周期的随访，每天使用 然后将症状日记随机分配至3组之一（最小或 综合自我管理组或对照组）。 在8次会议之后 (or在6个月和12个月时，进行干预后评估 会发生在一个月经周期。

DESCRIPTION (Adapted from the Applicant's Abstract): In the United States, it is estimated that 17-30% of the population experience symptoms compatible with Irritable Bowel Syndrome (IBS). IBS is a functional condition characterized by change in bowel patterns, (e.g., constipation, diarrhea), abdominal pain and bloating. It affects more women than men, causing significant symptom distress, interfering with functional activities and increasing health care utilization. Current recommended therapies include diet manipulation (increased fiber, exclusion diets), self-management, psychotherapy, and motility modulation via pharmacological therapy. The effectiveness of these therapies either singly or in combination warrant additional investigation because of the 1) use of a heterogeneous sample with respect to predominant bowel symptoms, psychological profile, and duration/chronicity of IBS, 2) use of retrospective measures to document the symptom profile prior to and following the intervention, and 3) failure to control for menstrual cycle variations in symptom profiles in predominantly female samples. Also rarely is comprehensive follow-up data including descriptions of symptom trajectory and utilization of health care services by patients occur in the intervention literature. The purpose of the present study is to compare the effectiveness of a brief, 1 session, self-management intervention to a comprehensive, 8 week, self-management intervention in reducing symptoms in women with medically diagnosed IBS. A third group of women with IBS will receive no treatment and serve as the control group. In addition to measuring changes in symptoms, indicators of functional ability and health care utilization will be measured for 12 months following the intervention. The third aim is to explore the contribution of psychological and physiological indicators to a change in IBS symptoms. A further understanding of the contribution of each of these potentially causal mechanisms will provide useful information for developing treatment recommendations. Women who are between 20 and 45 years of age and diagnosed with IBS by a health care provider will be recruited from a medical center clinic as well as gastroenterology and primary care clinics of a large HMO (Group Health Cooperative). Subjects will be followed for one menstrual cycle using daily symptom diaries then randomized to one of the 3 groups (minimal or comprehensive self-management or control group). Following the 8 sessions (or equivalent time) and at 6 and 12 months, a post intervention assessment will occur across one menstrual cycle.