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Yamamoto A, Kessoku T, Ogata T, Jono T, Takahashi K, Tanaka K, Suzuki K, Takeda Y, Ozaki A, Kasai Y, Okubo N, Iwaki M, Kobayashi T, Misawa N, Yoshihara T, Suzuki A, Fuyuki A, Hasegawa S, Imajo K, Kobayashi N, Matsumoto M, Tamai N, Sanada H, Oyamada S, Ichikawa Y, Nakajima A. A Handheld Ultrasound Device Can Predict Constipation with Rectal Fecal Retention in a Palliative Care Setting. Diagnostics (Basel) 2024; 14:1626. [PMID: 39125503 PMCID: PMC11311552 DOI: 10.3390/diagnostics14151626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/14/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs' usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.
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Affiliation(s)
- Atsushi Yamamoto
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Gastroenterology, Fujisawa Syonandai Hospital, Fujisawa 252-0802, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Palliative Medicine, International University Health and Welfare, Narita Hospital, Narita 286-8520, Japan
- Department of Gastroenterology, International University Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Tomoki Ogata
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Tsumugi Jono
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Kota Takahashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Gastroenterology, Yokosuka General Hospital Uwamachi, Yokosuka 238-0017, Japan
| | - Kosuke Tanaka
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Palliative Medicine, International University Health and Welfare, Narita Hospital, Narita 286-8520, Japan
- Department of Gastroenterology, International University Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Ko Suzuki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Yuma Takeda
- Department of Palliative Medicine, Yokohama City University, Yokohama 236-0004, Japan; (Y.T.); (Y.I.)
| | - Anna Ozaki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Yuki Kasai
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Naoki Okubo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Oncology, Yokohama City University, Yokohama 236-0004, Japan;
| | - Michihiro Iwaki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Takashi Kobayashi
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Tsutomu Yoshihara
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Akihiro Suzuki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Oncology, Yokohama City University, Yokohama 236-0004, Japan;
| | - Akiko Fuyuki
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Palliative Care, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
| | - Sho Hasegawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
| | - Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
- Department of Gastroenterology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
| | | | - Masaru Matsumoto
- School of Nursing, Ishikawa Prefectural Nursing University, Kahoku 929-1210, Japan; (M.M.); (H.S.)
| | - Nao Tamai
- Department of Nursing, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan;
| | - Hiromi Sanada
- School of Nursing, Ishikawa Prefectural Nursing University, Kahoku 929-1210, Japan; (M.M.); (H.S.)
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, Tokyo 116-0013, Japan;
| | - Yasushi Ichikawa
- Department of Palliative Medicine, Yokohama City University, Yokohama 236-0004, Japan; (Y.T.); (Y.I.)
- Department of Oncology, Yokohama City University, Yokohama 236-0004, Japan;
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan; (A.Y.); (T.O.); (T.J.); (K.T.); (K.T.); (K.S.); (A.O.); (Y.K.); (N.O.); (M.I.); (T.K.); (N.M.); (T.Y.); (A.S.); (A.F.); (S.H.); (K.I.); (A.N.)
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Grant MP, Cardin A, O'Connor N, Eastman P. Examining Clinical Utility of Imaging for Inpatient Palliative Care. Am J Hosp Palliat Care 2016; 34:632-636. [PMID: 27006392 DOI: 10.1177/1049909116640524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Medicine in the final months of life is increasingly interventional, both in the manner by which life may be prolonged and symptoms may be reduced. Radiology is frequently utilized to provide diagnostic clarity and improve symptom control. As with any intervention, examining the benefit and potential harms of a procedure is required to establish its role in ongoing clinical care. METHODS This retrospective cohort study involved patients admitted to an inpatient palliative care unit between October 2013 and September 2014. Data were collected using clinical databases manually searched by the researchers. RESULTS Of 388 admissions, there were a total of 154 imaging events completed in 85 patients. Patients who had imaging performed had longer mean length of stays, more likely to be discharged home, and male. Very few imaging events (4%) occurred in the 3 days prior to death and none on the day of death. In total, 43% of imaging confirmed the clinical suspicion and management changed 42% of times. Limbs X-rays and computed tomography brain had low rates of confirming clinical suspicion (21% and 17%) and changing management (21% and 33%). There were a total of 7 complications resulting from imaging, the majority due to interventional procedures. CONCLUSION The use of imaging in inpatient palliative care seems to be of substantive utility, prompting alterations in management in >40% of instances. The majority of imaging occurred prior to the terminal phase of the disease and with few complications.
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Affiliation(s)
- Matthew Paul Grant
- 1 Department of Medicine, Monash University, Clayton, Victoria, Australia.,2 Department of Palliative Medicine, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Anthony Cardin
- 3 Department of Palliative Medicine and Radiology, Barwon Health, Geelong, Victoria, Australia
| | - Niamh O'Connor
- 4 Department of Palliative Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Peter Eastman
- 3 Department of Palliative Medicine and Radiology, Barwon Health, Geelong, Victoria, Australia
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Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P. Laxatives for the management of constipation in people receiving palliative care. Cochrane Database Syst Rev 2015; 2015:CD003448. [PMID: 25967924 PMCID: PMC6956627 DOI: 10.1002/14651858.cd003448.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This article describes the second update of a Cochrane review on the effectiveness of laxatives for the management of constipation in people receiving palliative care. Previous versions were published in 2006 and 2010 where we also evaluated trials of methylnaltrexone; these trials have been removed as they are included in another review in press. In these earlier versions, we drew no conclusions on individual effectiveness of different laxatives because of the limited number of evaluations. This is despite constipation being common in palliative care, generating considerable suffering due to the unpleasant physical symptoms and the availability of a wide range of laxatives with known differences in effect in other populations. OBJECTIVES To determine the effectiveness and differential efficacy of laxatives used to manage constipation in people receiving palliative care. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science (SCI & CPCI-S) for trials to September 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating laxatives for constipation in people receiving palliative care. DATA COLLECTION AND ANALYSIS Two authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity. MAIN RESULTS We identified five studies involving the laxatives lactulose, senna, co-danthramer, misrakasneham, docusate and magnesium hydroxide with liquid paraffin. Overall, the study findings were at an unclear risk of bias. As all five studies compared different laxatives or combinations of laxatives, it was not possible to perform a meta-analysis. There was no evidence on whether individual laxatives were more effective than others or caused fewer adverse effects. AUTHORS' CONCLUSIONS This second update found that laxatives were of similar effectiveness but the evidence remains limited due to insufficient data from a few small RCTs. None of the studies evaluated polyethylene glycol or any intervention given rectally. There is a need for more trials to evaluate the effectiveness of laxatives in palliative care populations. Extrapolating findings on the effectiveness of laxatives evaluated in other populations should proceed with caution. This is because of the differences inherent in people receiving palliative care that may impact, in a likely negative way, on the effect of a laxative.
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Affiliation(s)
- Bridget Candy
- University College LondonMarie Curie Palliative Care Research Department, Division of Psychiatry6th Floor, Maple House149 Tottenham Court RoadLondonUKW1T 7NF
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryCharles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
| | - Philip J Larkin
- UCD College of Health SciencesUCD School of Nursing, Midwifery and Health Systems and Our Lady's Hospice and Care ServicesDublinIreland
| | - Victoria Vickerstaff
- University College LondonMarie Curie Palliative Care Research Department, Division of Psychiatry6th Floor, Maple House149 Tottenham Court RoadLondonUKW1T 7NF
| | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, UCL Division of PsychiatryDivision of PsychiatryRoom 119, First Floor, Charles Bell House67‐73 Riding House StreetLondonUKW1W 7EJ
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Erichsén E, Milberg A, Jaarsma T, Friedrichsen MJ. Constipation in Specialized Palliative Care: Prevalence, Definition, and Patient-Perceived Symptom Distress. J Palliat Med 2015; 18:585-92. [PMID: 25874474 DOI: 10.1089/jpm.2014.0414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevalence of constipation among patients in palliative care has varied in prior research, from 18% to 90%, depending on study factors. OBJECTIVES The aim of this study was to describe and explore the prevalence and symptom distress of constipation, using different definitions of constipation, in patients admitted to specialized palliative care settings. METHODS Data was collected in a cross-sectional survey from 485 patients in 38 palliative care units in Sweden. Variables were analyzed using logistic regression and summarized as odds ratio (OR). RESULTS The prevalence of constipation varied between 7% and 43%, depending on the definition used. Two constipation groups were found: (1) medical constipation group (MCG): ≤3 defecations/week, n=114 (23%) and (2) perceived constipation group (PCG): patients with a perception of being constipated in the last two weeks, n=171 (35%). Three subgroups emerged: patients with (1) only medical constipation (7%), (2) only perceived constipation (19%), and (3) both medical and perceived constipation (16%). There were no differences in symptom severity between groups; 71% of all constipated patients had severe constipation. CONCLUSIONS The prevalence of constipation may differ, depending on the definition used and how constipation is assessed. In this study we found two main groups and three subgroups, analyzed from the definitions of frequency of bowel movements and experience of being constipated. To be able to identify constipation, the patients' definition has to be further explored and assessed.
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Affiliation(s)
- Eva Erichsén
- 1 Department of Social and Welfare Studies, Linköping University , Norrköping, Sweden .,2 Department of Advanced Home Care, Linköping University , Norrköping, Sweden .,3 Palliative Education and Research Centre, Linköping University , Norrköping, Sweden
| | - Anna Milberg
- 1 Department of Social and Welfare Studies, Linköping University , Norrköping, Sweden .,2 Department of Advanced Home Care, Linköping University , Norrköping, Sweden .,3 Palliative Education and Research Centre, Linköping University , Norrköping, Sweden
| | - Tiny Jaarsma
- 1 Department of Social and Welfare Studies, Linköping University , Norrköping, Sweden
| | - Maria J Friedrichsen
- 1 Department of Social and Welfare Studies, Linköping University , Norrköping, Sweden .,2 Department of Advanced Home Care, Linköping University , Norrköping, Sweden .,3 Palliative Education and Research Centre, Linköping University , Norrköping, Sweden
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