Medical alert card: a valuable tool in the management of Hirschsprung's-associated enterocolitis from parental perspective

Hirschsprung-associated Enterocolitis Action Plan: A Pictographic Tool for Caregivers of Children With Hirschsprung Disease

BACKGROUND

Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of Hirschsprung disease (HD), with significant morbidity and mortality rates. Early diagnosis and treatment are critical, and caregivers play a key role in detecting HAEC, performing colonic irrigations, and seeking timely medical care. This study validates an HAEC action plan designed to assist caregivers in managing HAEC at home.

METHODS

A caregiver-focused HAEC Action Plan was developed following the National Institute of Health (NIH) 5-step "Clear & Simple" approach. It included patient-specific information, symptom pictographs, and a stepwise HAEC management protocol. Previously validated pictograms were used with the permission of the original institution. Additionally, 6 unvalidated pictograms were used. Readability was assessed using multiple formulas. Caregivers and the community evaluated the newly used pictograms' validity and action plan's comprehension, quality, and usefulness using the Consumer Information Rating Form (CIRF). Understandability and actionability were evaluated by librarians using the Patient Education Materials Assessment Tool. Clinicians validated its suitability using the modified Suitability Assessment of Materials (SAM) instrument.

RESULTS

The 6 new pictograms were validated. Readability was acceptably below the 6th-grade level. Overall CIRF score reached 91.5 % (superior). Understandability, actionability, and suitability were rated at 91 %, 91 %, and 82.5 %, respectively. Suggested improvements included using clearer pictograms, unit adjustments, additional details on irrigation duration, improved text visibility, and translation of the tool into other languages.

CONCLUSIONS

The HAEC Action Plan is a clear, user-friendly tool for guiding caregivers in the early recognition and management of HAEC. Once employed in clinical practice, it has the potential to reduce HAEC-associated morbidity and mortality in children with HD.

LEVEL OF EVIDENCE

N/A.

Medical Alert Cards for patients with an anorectal malformation: a useful tool to increase awareness

PURPOSE

Anorectal malformations (ARMs) are rare congenital anomalies causing altered anatomy and frequent hospitalizations. Parental awareness and clear communication are crucial in family-centered care. This study assesses the impact of patient-held ARM Medical Alert Cards on healthcare providers and caregivers.

METHODS

Caregivers of children with ARMs, including cloacal anomalies, received Medical Alert Cards with (1) contact details; (2) disease-related information; and (3) patient-specific data. A survey evaluated these cards' effectiveness in enhancing ARM awareness among healthcare professionals and caregivers.

RESULTS

Among 33 respondents, 29 (88%) found the cards helpful in increasing ARM awareness. Both caregivers and providers found the content coherent, with a median readability score of 9 (IQR 8-10). The card layout was well-received by 30 out of 32 respondents (94%), and all noted the clarity of the contact details, facilitating patient referrals to specialized care. Most caregivers (13 out of 14, 93%) expressed willingness to use these cards in medical settings. Suggestions for improvement included adding more patient-specific information, enhancing readability, and providing visual anatomy diagram.

CONCLUSION

Medical Alert Cards for patients with ARMs can enhance understanding of ARMs among caregivers and healthcare providers, serving as a vital tool in patient-centered management strategies tailored to individual needs.

Medical Alert Cards for Pediatric Patients With Antegrade Continence Enemas to Enhance Awareness

INTRODUCTION

The antegrade continence enema (ACE) is a surgical technique that establishes a route for colonic irrigation, necessitating a detailed comprehension of the procedural methodology, including the conduit construction, the catheters selection, and the administration of irrigation solutions. It is critical to disseminate comprehensive information regarding ACE procedures to health-care professionals and caregivers to enhance their understanding and support management of patients undergoing this intervention. This study aims to evaluate the efficacy of a novel educational tool designed to augment the knowledge base of physicians and caregivers regarding ACE procedures.

METHODS

Medical alert cards were conceptualized for patients managed with ACEs via an appendicostomy, neoappendicostomy, or cecostomy. These cards included essential information such as (1) contact details of the health-care team, (2) specifics of the surgical procedure, (3) criteria for emergency department referral, and (4) bespoke patient-specific information. A single-institution survey was conducted to assess the cards' role in improving awareness of ACE procedures among health-care providers and caregivers and guiding management of patients with ACEs. The study adhered to Consensus-Based Checklist for Reporting of Survey Studies guidelines.

RESULTS

Twenty-seven responses were collected from 18 health-care providers and nine caregivers. A significant majority (n = 24, 88%) affirmed the cards' effectiveness in providing detailed information about individual patients. The design and layout of the card were well-received by 93% (n = 25) of respondents, with a median readability score of 8 (interquartile range 7-10). Additionally, some providers (n = 3, 17%) highlighted the card's utility in facilitating patient referrals to specialized care centers. Suggestions for improvement included adding information about different types of tubes, enhancing readability, and optimizing the visual representation of the conduit.

CONCLUSIONS

Medical alert cards demonstrated a significant potential to improve understanding of ACEs among health-care providers and caregivers. The cards aid in informing stakeholders about the ACE procedure, guiding the child's management, and referring the patients to specialized care facilities when necessary.

Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management

BACKGROUND

Pull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development.

METHODS

A single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018-July 2022. Endpoints included post-pull-through HAEC incidence, recurrence at an 18-month follow-up, time to the first HAEC episode, NICU length of stay (LOS), and HAEC-related LOS.

RESULTS

Twenty-four neonates were included. Eighteen were discharged from the NICU with home irrigations. Of these, 3 (28%) developed enterocolitis preoperatively, 12 (67%) underwent a delayed pull-through. NICU LOS in the delayed cohort was 3 times shorter than in the neonatal (6 vs. 18 days, p < 0.01). The incidence of enterocolitis (82% vs. 80%), time to the first episode (43 vs. 57 days), and HAEC-related LOS (median of 3 days) were similar.

CONCLUSIONS

Delayed HD pull-through is a viable neonatal reconstruction alternative that reduces NICU stay without increasing the risk of postoperative HAEC development.

TYPE OF STUDY

Original Research Article.

LEVEL OF EVIDENCE

III.

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.