NURSING MANAGEMENT OF IBS--IMPROVING OUTCOMES

描述(改编自申请者摘要)：在美国， 据估计，17%-30%的人经历了相容的症状 患有肠易激综合征(IBS)。肠易激综合征是一种功能性状况 以大便模式改变为特征的(如便秘、腹泻)， 腹痛和腹胀。它影响的女性比男性更多，导致 明显的症状痛苦，干扰功能活动和 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，以及通过药物治疗调节运动。这个 这些疗法单独或联合使用的有效性保证 额外的调查，因为1)使用了不同种类的样本 关于主要的肠道症状，心理特征，和 IBS的持续时间/慢性；2)使用回溯性措施记录 干预前后的症状描述，以及3)未能 以症状谱为主的月经周期变化的控制 女性样本。也很少有全面的后续数据，包括 症状轨迹和保健服务利用情况的描述 干预文献中出现了由患者进行干预的情况。该计划的目的是 目前的研究是比较简短的、1次会议、 自我管理干预到全面，8周，自我管理 干预措施以减轻经医学诊断为IBS的妇女的症状。一个 第三组患有IBS的女性将不接受治疗，并担任 对照组。除了测量症状的变化外，指标 功能能力和卫生保健利用率将被测量为12 在干预之后的几个月里。第三个目标是探索 心理和生理指标对变化的贡献 IBS症状。对其中每一个的贡献有进一步的了解 潜在的因果机制将为开发 治疗建议。 年龄在20岁到45岁之间的女性，通过 医疗保健提供者也将从医疗中心诊所招聘 作为大型HMO(团体健康)的胃肠病和初级保健诊所 合作)。受试者将被跟踪一个月经周期，每天使用 然后将症状日记随机分配到3组中的一组(最少或 全面自我管理或控制组)。在8次会议之后 (或同等时间)，并在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.