1
|
Neshatian L, Grant G, Fernandez-Becker N, Yuan Y, Garcia P, Becker L, Gurland B, Triadafilopoulos G. The association between vitamin-D deficiency and fecal incontinence. Neurogastroenterol Motil 2024; 36:e14753. [PMID: 38316640 DOI: 10.1111/nmo.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Vitamin-D is essential for musculoskeletal health. We aimed to determine whether patients with fecal incontinence (FI): (1) are more likely to have vitamin-D deficiency and, (2) have higher rates of comorbid medical conditions. METHODS We examined 18- to 90-year-old subjects who had 25-hydroxy vitamin-D levels, and no vitamin-D supplementation within 3 months of testing, in a large, single-institutional electronic health records dataset, between 2017 and 2022. Cox proportional hazards survival analysis was used to assess association of vitamin-D deficiency on FI. KEY RESULTS Of 100,111 unique individuals tested for serum 25-hydroxy vitamin-D, 1205 (1.2%) had an established diagnosis of FI. Most patients with FI were female (75.9% vs. 68.7%, p = 0.0255), Caucasian (66.3% vs. 52%, p = 0.0001), and older (64.2 vs. 53.8, p < 0.0001). Smoking (6.56% vs. 2.64%, p = 0.0001) and GI comorbidities, including constipation (44.9% vs. 9.17%, p = 0.0001), irritable bowel syndrome (20.91% vs. 3.72%, p = 0.0001), and diarrhea (28.55% vs. 5.2%, p = 0.0001) were more common among FI patients. Charlson Comorbidity Index score was significantly higher in patients with FI (5.5 vs. 2.7, p < 0.0001). Significantly higher proportions of patients with FI had vitamin-D deficiency (7.14% vs. 4.45%, p < 0.0001). Moreover, after propensity-score matching, rate of new FI diagnosis was higher in patients with vitamin-D deficiency; HR 1.9 (95% CI [1.14-3.15]), p = 0.0131. CONCLUSION & INFERENCES Patients with FI had higher rates of vitamin-D deficiency along with increased overall morbidity. Future research is needed to determine whether increased rate of FI in patients with vitamin-D deficiency is related to frailty associated with increased medical morbidities.
Collapse
Affiliation(s)
- Leila Neshatian
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Gabrielle Grant
- Clinical Observation and Medical Transcription Program, Stanford University School of Medicine, Stanford, California, USA
| | - Nielsen Fernandez-Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Ye Yuan
- Atropos Health, New York, New York, USA
| | - Patricia Garcia
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Laren Becker
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Brooke Gurland
- Department of Surgery, Stanford University, Stanford, California, USA
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Misseri R, Szymanski KM. Urinary and Fecal Incontinence During Sexual Activity Is Common and Bothersome Among Adults With Spina Bifida. Urology 2024; 186:54-60. [PMID: 38354913 DOI: 10.1016/j.urology.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for urinary fecal incontinence (UI, FI) during sexual activity (UIS, FIS) among adults with spina bifida (SB). METHODS An international online survey of adults with SB was administered through SB clinics and SB organizations via social media. Adults with a history of masturbation or partnered sexual activity were included. The primary outcome was ever experiencing UIS/FIS. Nonparametric tests and logistic regression were used for analysis. RESULTS A total of 341 adults met inclusion criteria (median age: 36years, 59% female, 52% shunted, 48% community ambulators). Baseline UI in the last 4weeks was reported by 50% and FI by 41%. Nineteen (5%) had a urostomy. Eight (2%) had a colostomy. Overall, 93% had a history of partnered genital contact. Among adults without a diversion, UIS was more common than FIS (70% vs 45%, P < .001). Among adults without a urostomy, UIS was more common among women (76% vs 62%, P = .01) and those with baseline UI (84% vs 50%, P < .001). UIS was not associated with age, shunt, ambulatory, or catheterization status (P >=.32). On bivariate analysis, female sex and baseline UI were independent predictors of UIS (P <=.001). Among adults without a colostomy, FIS was associated with female sex (50% vs 39%, P = .046), baseline FI (59% vs 32%, P < .001), community ambulation (52% vs 40%, P = .04), but not age, shunt, or MACE status (P >=.27). On multivariate analysis, baseline FI was independently associated with FIS (P < .001). Among adults with UIS/FIS, 29% experienced UIS "almost always" to "always," compared to 5% for FIS (P < .001). Virtually all adults found UIS/FIS bothersome (>=96% for each), even when incontinence occurred "almost never." UIS/FIS mostly occurred before and/or during orgasm than afterward (P < .001). UIS was reported by 53% of adults with a urostomy (100% bothersome). FIS was reported by 38% of adults with a colostomy (100% bothersome). CONCLUSION Incontinence during sexual activity is a common problem for men and women with SB. Baseline incontinence is an independent, but not absolute, predictor of both. While FIS is less frequent than UIS, both are virtually always bothersome.
Collapse
Affiliation(s)
- Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - John S Wiener
- Division of Pediatric Urology, Department of Urology, Duke University Medical Center, Durham, NC
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| |
Collapse
|
3
|
Weimer A, Hallock JL, Chen CCG. Primary care providers practice patterns regarding female pelvic floor disorders. Fam Med Community Health 2024; 12:e002448. [PMID: 38485284 PMCID: PMC10941109 DOI: 10.1136/fmch-2023-002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Pelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary care providers (PCPs) have a unique opportunity to increase treatment and provide appropriate referrals for these patients. METHODS An online survey was administered to PCPs to assess provider practices, knowledge, comfort managing and ease of referral for PFDs. Logistic regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest: discomfort with management and difficulty with referral of PFDs. RESULTS Of the 153 respondents to the survey, more felt comfortable managing stress urinary incontinence (SUI) and overactive bladder (OAB), compared with pelvic organ prolapse (POP) and faecal incontinence (FI) and were less likely to refer patients with urinary symptoms. Few providers elicited symptoms for POP and FI as compared with SUI and OAB. Provider variables that were significantly associated with discomfort with management varied by PFD, but tended to correlate with less exposure to PFDs (eg, those with fewer years of practice, and internal medicine and family physicians as compared with geriatricians); whereas the factors that were significantly associated with difficulty in referral, again varied by PFD, but were related to practice characteristics (eg, specialist network, type of practice, practice setting and quantity of patients). CONCLUSION These findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols, as well as collaboration with pelvic floor specialists to improve screening, treatment and referral for patients with PFDs.
Collapse
Affiliation(s)
- Anna Weimer
- Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | | | | |
Collapse
|
4
|
Meyer I, Iriondo-Perez J, Dyer KY, Sung V, Ackenbom MF, Florian-Rodriguez M, Kim E, Mazloomdoost D, Carper B, Gantz MG. Correlation Between Mobile-Application Electronic Bowel Diary and Validated Questionnaires in Women with Fecal Incontinence. Int Urogynecol J 2024; 35:545-551. [PMID: 38206340 PMCID: PMC11023758 DOI: 10.1007/s00192-023-05711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Despite growing interest in a mobile-app bowel diary to assess fecal incontinence (FI) symptoms, data are limited regarding the correlation between mobile-app diary and questionnaire-based outcomes. The primary aim is to determine whether percentage reduction in FI episodes (FIEs)/week recorded on a mobile-app diary correlates with changes in scores of validated FI-symptom measures from baseline to 12 weeks in women with FI undergoing percutaneous tibial nerve stimulation (PTNS) versus sham. METHODS This is a planned secondary analysis of a multicenter randomized trial in which women with FI underwent PTNS or sham. FIEs were collected using a mobile-app diary at baseline and after 12 weekly sessions. FI-symptom-validated measures included St. Mark's, Accidental Bowel Leakage Evaluation, FI Severity Index (FISI), Colorectal Anal Distress Inventory, Colorectal Anal Impact Questionnaire, FI Quality of Life, Patient Global Impression of Improvement (PGI-I), and Patient Global Symptom Control (PGSC) rating. Spearman's correlation coefficient (ρ) was computed between %-reduction in FIEs/week and change in questionnaire scores from baseline to 12 weeks. Significance was set at 0.005 to account for multiple comparisons. RESULTS Baseline characteristics of 163 women (109 PTNS, 54 sham) include mean age 63.4±11.6, 81% white, body mass index 29.4±6.6 kg/m2, 4% previous FI surgeries, 6.6±5.5 FIEs/week, and St. Mark's score 17.4±2.6. A significant correlation was demonstrated between %-reduction in FIEs/week and all questionnaires (p<0.005). A moderate-strength correlation (|ρ|>0.4) was observed for St. Mark's (ρ=0.48), FISI (ρ=0.46), PGI-I (ρ=0.51), and PGSC (ρ=-0.43). CONCLUSIONS In women with FI randomized to PTNS versus sham, a moderate correlation was noted between FIEs measured via mobile-app diary and FI-symptom-validated questionnaire scores.
Collapse
Affiliation(s)
- Isuzu Meyer
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | | | - Vivian Sung
- Alpert Medical School of Brown University, University/Women & Infants Hospital, Providence, RI, USA
| | - Mary F Ackenbom
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Edward Kim
- Department of Obstetrics & Gynecology, Division of Urogynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Marie G Gantz
- RTI International, Research for the NICHD Pelvic Floor Disorders Network, Triangle Park, NC, USA
| |
Collapse
|
5
|
Whitlock AE, Arndt KR, Allar BG, Fakler MN, Cataldo TE, Crowell KT, Fabrizio AC, Messaris E. Mental health disorders as a risk factor in young patients with rectal prolapse. Langenbecks Arch Surg 2024; 409:72. [PMID: 38393458 DOI: 10.1007/s00423-024-03262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Rectal prolapse (RP) typically presents in the elderly, though it can present in younger patients lacking traditional risk factors. The current study compares medical and mental health history, presentation, and outcomes for young and older patients with RP. METHODS This is a single-center retrospective review of patients who underwent abdominal repair of RP between 2005 and 2019. Individuals were dichotomized into two groups based on age greater or less than 40 years. RESULTS Of 156 patients, 25 were < 40. Younger patients had higher rates of diagnosed mental health disorders (80% vs 41%, p < 0.001), more likely to take SSRIs (p = .02), SNRIs (p = .021), anxiolytics (p = 0.033), and antipsychotics (p < 0.001). Younger patients had lower preoperative incontinence but higher constipation. Both groups had low rates of recurrence (9.1% vs 11.6%, p = 0.73). CONCLUSIONS Young patients with RP present with higher concomitant mental health diagnoses and represent unique risk factors characterized by chronic straining compared to pelvic floor laxity.
Collapse
Affiliation(s)
- Ashlyn E Whitlock
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kevin R Arndt
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA.
| | - Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Michelle N Fakler
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Thomas E Cataldo
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kristen T Crowell
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Anne C Fabrizio
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| |
Collapse
|
6
|
Ullrich S, Denning NL, Holder M, Wittenberg R, Krebs K, Schwan A, Verderber A, Garrison AP, Rymeski B, Rosen N, Frischer JS. Does Length of Extended Resection Beyond Transition Zone Change Clinical Outcome for Hirschsprung Pull-Through? J Pediatr Surg 2024; 59:86-90. [PMID: 37865574 DOI: 10.1016/j.jpedsurg.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION A proximal resection margin greater than 5 cm from the intra-operative histologically determined transition zone has been deemed necessary to minimize the risk of transition zone pull-through. This extended resection may require the sacrifice of vascular supply and even further bowel resection. The impact of extended proximal resection margin on post-operative complications and functional outcomes is unclear. METHODS A retrospective chart review of patients who underwent primary pull-through for Hirschsprung disease at a single institution between January 2008 and December 2022 was performed. An adequate proximal margin was defined by a circumferential normally ganglionated ring and absence of hypertrophic nerves. The extended margin was defined as the total length of proximal colon with normal ganglion cells and without hypertrophic nerves. Fecal incontinence severity was assessed with the Pediatric Fecal Incontinence Severity Score (PFISS). RESULTS Eighty seven patients met criteria for inclusion. Median age at primary pull-through was 17 days (IQR 10-92 days), 55% (n = 48) of patients had an extended proximal margin (EPM) ≤ 5 cm, and 45% (n = 39) had an EPM > 5 cm. An EPM ≤5 cm was not associated with increased rates of Hirschsprung associated enterocolitis (≤5 cm 43%, >5 cm 39%, P = 0.701), diversion post pull-through (≤5 cm 10%, >5 cm 5%, P = 0.367) or reoperation for transition zone pull-through (≤5 cm 3%, >5 cm 0%, P = 0.112). EPM ≤5 cm had more frequent involuntary daytime bowel movements (P = 0.041) and more frequent voluntary bowel movements (P = 0.035). There were no differences in other measures of fecal incontinence severity. CONCLUSIONS Shorter proximal extended margins beyond the adequate ganglionated margin do not significantly impact post-operative complication rates and have an unclear effect on fecal incontinence. TYPE OF STUDY Case Control. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Sarah Ullrich
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA.
| | | | - Monica Holder
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Randi Wittenberg
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Kevin Krebs
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Ava Schwan
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Abigail Verderber
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Aaron P Garrison
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Beth Rymeski
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Nelson Rosen
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Jason S Frischer
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| |
Collapse
|
7
|
Varma R, Feuerhak KJ, Mishra R, Chakraborty S, Oblizajek NR, Bailey KR, Bharucha AE. A randomized double-blind trial of clonidine and colesevelam for women with fecal incontinence. Neurogastroenterol Motil 2024; 36:e14697. [PMID: 37890049 PMCID: PMC10842236 DOI: 10.1111/nmo.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Diarrhea and rectal urgency are risk factors for fecal incontinence (FI). The effectiveness of bowel modifiers for improving FI is unclear. METHODS In this double-blind, parallel-group, randomized trial, women with urge FI were randomly assigned in a 1:1 ratio to a combination of oral clonidine (0.1 mg twice daily) with colesevelam (1875 mg twice daily) or two inert tablets for 4 weeks. The primary outcome was a ≥50% decrease in number of weekly FI episodes. KEY RESULTS Fifty-six participants were randomly assigned to clonidine-colesevelam (n = 24) or placebo (n = 32); 51 (91%) completed 4 weeks of treatment. At baseline, participants had a mean (SD) of 7.5 (8.2) FI episodes weekly. The primary outcome was met for 13 of 24 participants (54%) treated with clonidine-colesevelam versus 17 of 32 (53%) treated with placebo (p = 0.85). The Bristol stool form score decreased significantly, reflecting more formed stools with clonidine-colesevelam treatment (mean [SD], 4.5 [1.5] to 3.2 [1.5]; p = 0.02) but not with placebo (4.2 [1.9] to 4.1 [1.9]; p = 0.47). The proportion of FI episodes for semiformed stools decreased significantly from a mean (SD) of 76% (8%) to 61% (10%) in the clonidine-colesevelam group (p = 0.007) but not the placebo group (61% [8%] to 67% [8%]; p = 0.76). However, these treatment effects did not differ significantly between groups. Overall, clonidine-colesevelam was well tolerated. CONCLUSIONS AND INFERENCES Compared with placebo, clonidine-colesevelam did not significantly improve FI despite being associated with more formed stools and fewer FI episodes for semiformed stools.
Collapse
Affiliation(s)
- Revati Varma
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelly J Feuerhak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahul Mishra
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nicholas R Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Aydın ÖG, Baykara HB, Akın K, Kahveci S, Şeker G, Güler Y, Öztürk Y. Evaluation of functional gastrointestinal disorders in children aged 4-10 years with autism spectrum disorder. Turk J Pediatr 2024; 66:57-64. [PMID: 38523379 DOI: 10.24953/turkjped.2023.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Gastrointestinal system disorders are known to be prevalent among children with autism spectrum disorder (ASD). Some ASD-associated comorbidities are abdominal pain, constipation, diarrhea, gastroesophageal reflux, sleep disturbances, epilepsy, and psychiatric problems. Nonetheless, there is still limited information about the presence of functional GI disorders (FGIDs) among children with ASD, especially in Türkiye. Using the Rome criteria, we aimed to investigate FGIDs in children with ASD. METHODS The sample of the study consisted of 68 children aged 4-10 years, diagnosed with ASD according to the DSM-5 diagnostic criteria and had scores greater than 30 on the Childhood Autism Rating Scale (CARS-2) and an age-sex matched control group (n=78). The Rome III criteria were used to evaluate FGIDs. RESULTS The frequency of FGIDs in the ASD group was higher (76.5%) compared to the control group (p < 0.001). Compared to the control group, abdominal migraine frequency increased 10 times (p=0.012), functional constipation 7 times (p < 0.001), and fecal incontinence 6 times (p < 0.001) in the ASD group. Stool retention was not present in most children in the ASD group who were found to have fecal incontinence. CONCLUSION In this study, the most common FGIDs in the ASD group were abdominal migraine, functional constipation, and non-retentive fecal incontinence. The finding that most children with ASD who had fecal incontinence did not show stool retention implicated social, psychological, and behavioral factors as the causes of incontinence. Raising awareness of healthcare professionals about the frequency of FGIDs in children with ASD will improve many areas in the daily lives of these children.
Collapse
Affiliation(s)
- Özlem Gülpınar Aydın
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Hüseyin Burak Baykara
- Department of Child and Adolescent Psychiatry School of Medicine, Dokuz Eylul University, İzmir
| | - Kardelen Akın
- Department of Pediatrics School of Medicine, Dokuz Eylul University, İzmir, Türkiye
| | - Sinem Kahveci
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Gül Şeker
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Yunus Güler
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Yeşim Öztürk
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| |
Collapse
|
9
|
Khamar J, Sachdeva A, McKechnie T, Lee Y, Tessier L, Hong D, Eskicioglu C. Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis. Tech Coloproctol 2023; 28:12. [PMID: 38091125 DOI: 10.1007/s10151-023-02886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/21/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano. METHODS MEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates. RESULTS After screening 661 citations, 29 studies were included. Overall, 1513 patients undergoing CS (18.8% female, mean age: 43.1 years) were included. Patients with CS had a 6% (95% CI: 3-12%) risk of recurrence and a 16% (95% CI: 5-38%) risk of incontinence at 6 months. CS patients had an average healing time of 14.6 weeks (95% CI: 10-19 weeks) with 73% (95% CI: 48-89%) of patients achieving complete healing at 6 months postoperatively. There was no difference in recurrence between CS and fistulotomy, advancement flap, two-stage seton fistulotomy, or draining seton. CONCLUSIONS Overall, this analysis shows that CS has comparable recurrence and incontinence rates to other modalities. However, this may be at the expense of more postoperative pain and extended healing time. Further comparative studies between CS and other modalities are warranted.
Collapse
Affiliation(s)
- J Khamar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - A Sachdeva
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - T McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Y Lee
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - L Tessier
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - D Hong
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - C Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
| |
Collapse
|
10
|
Gilbertson KE, Liu T, Wiener JS, Walker WO, Smith K, Castillo J, Castillo H, Wilson P, Peterson P, Clayton GH, Valdez R. Age-Specific Probability of 4 Major Health Outcomes in Children with Spina Bifida. J Dev Behav Pediatr 2023; 44:e633-e641. [PMID: 37816172 PMCID: PMC10926062 DOI: 10.1097/dbp.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE This study aimed to estimate the age-specific probability of 4 health outcomes in a large registry of individuals with spina bifida (SB). METHODS The association between age and 4 health outcomes was examined in individuals with myelomeningocele (MMC, n = 5627) and non-myelomeningocele (NMMC, n = 1442) from the National Spina Bifida Patient Registry. Sixteen age categories were created, 1 for each year between the ages of 5 and 19 years and 1 for those aged 20 years or older. Generalized linear models were used to calculate the adjusted probability and 95% prediction intervals of each outcome for each age category, adjusting for sex and race/ethnicity. RESULTS For the MMC and NMMC groups, the adjusted coefficients for the correlation between age and the probability of each outcome were -0.933 and -0.657 for bladder incontinence, -0.922 and -0.773 for bowel incontinence, 0.942 and 0.382 for skin breakdown, and 0.809 and 0.619 for lack of ambulation, respectively. CONCLUSION In individuals with SB, age is inversely associated with the probability of bladder and bowel incontinence and directly associated with the probability of skin breakdown and lack of ambulation. The estimated age-specific probabilities of each outcome can help SB clinicians estimate the expected proportion of patients with the outcome at specific ages and explain the probability of the occurrence of these outcomes to patients and their families.
Collapse
Grants
- U01DD001279 ACL HHS
- U01 DD001268 NCBDD CDC HHS
- U01 DD001279 NCBDD CDC HHS
- U01DD001093 ACL HHS
- U01DD001062 ACL HHS
- U01 DD001057 NCBDD CDC HHS
- U01 DD001275 NCBDD CDC HHS
- DD000738, DD000740, DD000743, DD000774, DD001057, DD001062, DD001065, DD001093, DD001235, DD001237, DD001240, DD001262, DD001265, DD001266, DD001268, DD001270, DD001272, DD001274, DD001275, DD001278, DD001279, and DD001280. CDC HHS
- U01 DD001237 NCBDD CDC HHS
- U01DD001057 ACL HHS
- U01 DD000738 NCBDD CDC HHS
- U01DD001065 ACL HHS
- U01 DD001280 NCBDD CDC HHS
- U01DD001235 ACL HHS
- U01 DD001235 NCBDD CDC HHS
- U01DD001268 ACL HHS
- U01DD001275 ACL HHS
- U01 DD001093 NCBDD CDC HHS
- U01DD001240 ACL HHS
- U01DD001262 ACL HHS
- U01 DD001278 NCBDD CDC HHS
- U01DD001270 ACL HHS
- U01DD001274 ACL HHS
- U01 DD000740 NCBDD CDC HHS
- U01DD001266 ACL HHS
- U01 DD000774 NCBDD CDC HHS
- CC999999 Intramural CDC HHS
- U01 DD001265 NCBDD CDC HHS
- U01 DD001062 NCBDD CDC HHS
- U01 DD001240 NCBDD CDC HHS
- U01 DD001274 NCBDD CDC HHS
- U01DD001280 ACL HHS
- U01 DD001262 NCBDD CDC HHS
- U01 DD001270 NCBDD CDC HHS
- U01 DD001065 NCBDD CDC HHS
- U01 DD000743 NCBDD CDC HHS
- U01DD001237 ACL HHS
- U01DD001272 ACL HHS
- U01DD001265 ACL HHS
- U01 DD001266 NCBDD CDC HHS
- U01 DD001272 NCBDD CDC HHS
- U01DD001278 ACL HHS
Collapse
Affiliation(s)
- Kendra E. Gilbertson
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
| | - Tiebin Liu
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
| | - John S. Wiener
- Division of Pediatric Urology, Department of Urology, Duke University School of Medicine, Durham, NC
| | - William O. Walker
- Department of Pediatrics, Division of Developmental Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA
| | - Kathryn Smith
- Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX
| | - Pamela Wilson
- Department of Rehabilitation and Therapy, Children’s Hospital Colorado, Aurora, CO
| | - Paula Peterson
- Brain and Spine Center, Primary Children’s Hospital, Salt Lake City, UT
| | - Gerald H. Clayton
- Department of Rehabilitation and Therapy, Children’s Hospital Colorado, Aurora, CO
| | - Rodolfo Valdez
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Chamblee, GA
| |
Collapse
|
11
|
Chaichanavichkij P, Vollebregt PF, Keshishian K, Knowles CH, Scott SM. The Clinical Impact of Obesity in Patients With Disorders of Defecation: A Cross-Sectional Study of 1,155 Patients. Am J Gastroenterol 2023; 118:2247-2257. [PMID: 37417793 DOI: 10.14309/ajg.0000000000002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Obesity is a global epidemic. Its clinical impact on symptoms of fecal incontinence (FI) and/or constipation and underlying anorectal pathophysiology remains uncertain. METHODS This is a cross-sectional study of consecutive patients meeting Rome IV criteria for FI and/or functional constipation, with data on body mass index (BMI), attending a tertiary center for investigation between 2017 and 2021. Clinical history, symptoms, and anorectal physiologic test results were analyzed according to BMI categories. RESULTS A total of 1,155 patients (84% female) were included in the analysis (33.5% normal BMI; 34.8% overweight; and 31.7% obese). Obese patients had higher odds of FI to liquid stools (69.9 vs 47.8%, odds ratio [OR] 1.96 [confidence interval: 1.43-2.70]), use of containment products (54.6% vs 32.6%, OR 1.81 [1.31-2.51]), fecal urgency (74.6% vs 60.7%, OR 1.54 [1.11-2.14]), urge FI (63.4% vs 47.3%, OR 1.68 [1.23-2.29]), and vaginal digitation (18.0% vs 9.7%, OR 2.18 [1.26-3.86]). A higher proportion of obese patients had Rome criteria-based FI or coexistent FI and functional constipation (37.3%, 50.3%) compared with overweight patients (33.8%, 44.8%) and patients with normal BMI (28.9%, 41.1%). There was a positive linear association between BMI and anal resting pressure (β 0.45, R 2 0.25, P = 0.0003), although the odds of anal hypertension were not significantly higher after Benjamini-Hochberg correction. Obese patients more often had a large clinically significant rectocele (34.4% vs 20.6%, OR 2.62 [1.51-4.55]) compared with patients with normal BMI. DISCUSSION Obesity affects specific defecatory (mainly FI) and prolapse symptoms and pathophysiologic findings (higher anal resting pressure and significant rectocele). Prospective studies are required to determine whether obesity is a modifiable risk factor of FI and constipation.
Collapse
Affiliation(s)
- Pam Chaichanavichkij
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Paul F Vollebregt
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - Karekin Keshishian
- Department of Colorectal Surgery, The Royal London Hospital, Whitechapel Road, London, United Kingdom
| | - Charles H Knowles
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| | - S Mark Scott
- National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Neuroscience, Surgery & Trauma, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
12
|
Wang Y, Li N, Zhou Q, Wang P. Fecal incontinence was associated with depression of any severity: insights from a large cross-sectional study. Int J Colorectal Dis 2023; 38:271. [PMID: 37991579 DOI: 10.1007/s00384-023-04563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Current studies on the association between fecal incontinence (FI) and depression are very limited, and most of them are restricted to women or elderly patients. This study aims to evaluate in detail the association between FI and depression among US adults. METHODS 13,480 adults aged 20 years and older were selected from the National Health and Nutrition Examination Survey 2005-2010. Monthly loss of solid, liquid, or mucous stool was defined as FI. Clinical depression and depression severity were assessed by the validated Patient Health Questionnaide-9 (PHQ-9). Models of multivariate logistic regression were used to calculate adjusted odds ratios (ORs). A subgroup analysis was carried out to ensure that the results were stable. RESULTS After adjusting for covariates such as demographics, risk behaviors and associated comorbidities, the PHQ-9 score and clinical depression were both significantly associated with FI, with ORs and 95%CIs of 1.11 (1.10-1.13) and 3.01 (2.53-3.57). Depression of all severities was also significantly associated with FI. The ORs and 95%CIs of FI with mild depression, moderate depression, and moderately severe to severe depression were 2.29 (1.96-2.68), 3.44 (2.77-4.27) and 4.65 (3.61-6.00), respectively. Subgroup analyses showed no statistically significant interactions (P > 0.05). CONCLUSIONS In conclusion, FI significantly associated with depression of any severity. Like the elderly or female patients with FI, young and middle-aged or men with FI are also at high risk of depression and should also be the focus of depression screening and early intervention.
Collapse
Affiliation(s)
- Yan Wang
- Department of Oncology, China Academy of Chinese Medical Sciences Guang' anmen Hospital, 100053, Beijing, China
| | - Na Li
- Department of Anesthesiology, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Qiang Zhou
- Department of Orthopedic Surgery, Hekou District People's Hospital, 257200, Dongying City, Shandong Province, China
| | - Pengfei Wang
- Department of Anorectal surgery, China Academy of Chinese Medical Sciences Xiyuan Hospital, 100091, Beijing, China.
| |
Collapse
|
13
|
Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health 2023; 23:2005. [PMID: 37838661 PMCID: PMC10576367 DOI: 10.1186/s12889-023-16901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions. OBJECTIVE Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women. MATERIAL AND METHODS This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated. RESULTS One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia. CONCLUSIONS The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.
Collapse
Affiliation(s)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real, Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real, Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaen, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| |
Collapse
|
14
|
Kohta M, Koyanagi H, Inagaki Y, Nishikawa K, Kobayashi N, Tamura S, Ishikawa M, Banno Y, Takekoshi K, Mano K, Sugama J. Selective detection of urease-producing bacteria on the genital skin surface in patients with incontinence-associated dermatitis. Int Wound J 2023; 20:3289-3297. [PMID: 37095598 PMCID: PMC10502248 DOI: 10.1111/iwj.14209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023] Open
Abstract
We aimed to investigate the association between the presence of cutaneous urease-producing bacteria and the development of incontinence-associated dermatitis (IAD) using an original urea agar medium as a step toward developing advanced preventive measures. In previous clinical assessments, we developed an original urea agar medium to detect urease-producing bacteria via the medium's colour changes. In a cross-sectional study, specimens were collected via the swabbing technique at genital skin sites in 52 stroke patients hospitalised in a university hospital. The primary objective was to compare the presence of urease-producing bacteria between the IAD and no-IAD groups. Determining the bacterial count was the secondary objective. The prevalence of IAD was 48%. A significantly higher detection rate of urease-producing bacteria was observed in the IAD group than in the no-IAD group (P = .002) despite the total number of bacteria being equivalent between them. In conclusion, we discovered that there was a significant association between the presence of urease-producing bacteria and IAD development in hospitalised stroke patients.
Collapse
Affiliation(s)
- Masushi Kohta
- Research Center for Implementation Nursing Science InitiativeFujita Health UniversityToyoakeJapan
| | - Hiroe Koyanagi
- Research Center for Implementation Nursing Science InitiativeFujita Health UniversityToyoakeJapan
| | | | - Keiji Nishikawa
- Department of NursingFujita Health University Nanakuri Memorial HospitalTsuJapan
| | - Nanako Kobayashi
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Shigeru Tamura
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Miyuki Ishikawa
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Yumi Banno
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Kanako Takekoshi
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Keiko Mano
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Junko Sugama
- Research Center for Implementation Nursing Science InitiativeFujita Health UniversityToyoakeJapan
| |
Collapse
|
15
|
Emile SH, Khan SM, Garoufalia Z, Silva-Alvarenga E, Gefen R, Horesh N, Freund MR, Wexner SD. A network meta-analysis of surgical treatments of complete rectal prolapse. Tech Coloproctol 2023; 27:787-797. [PMID: 37150800 DOI: 10.1007/s10151-023-02813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI). METHODS A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI. RESULTS Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant. CONCLUSIONS Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
Collapse
Affiliation(s)
- S H Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - S M Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Z Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - E Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
| | - R Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - M R Freund
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Florida, Weston, FL, 33331, USA.
| |
Collapse
|
16
|
Yüceler Kaçmaz H, Kaplan Ö, Kaplan A, Şahin MG, Cetinkaya A, Avci A. Incontinence-Associated Dermatitis: Prevalence in Intensive Care Units and Knowledge, Attitudes, and Practices of Nurses. J Nurs Care Qual 2023; 38:354-360. [PMID: 36947830 DOI: 10.1097/ncq.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs). PURPOSE To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting. METHODS A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data. RESULTS The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices. CONCLUSIONS Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.
Collapse
Affiliation(s)
- Hatice Yüceler Kaçmaz
- Department of Nursing, Health Science Faculty, Erciyes University, Kayseri, Turkey (Drs Yüceler Kaçmaz and Özlem Kaplan); First and Emergency Aid Program, İncesu Ayşe and Saffet Arslan Health Services Vocational School, University of Kayseri, Kayseri, Turkey (Dr Ali Kaplan); Department of Women's Health Nursing, Erciyes University, Kayseri, Turkey (Ms Şahin); Ministry of Health, Kayseri City Hospital, Kayseri, Turkey (Ms Şahin); and Departments of Internal Medicine (Mr Cetinkaya) and Dermatology (Mr Avci), Health Science University Kayseri City Hospital, Kayseri, Turkey
| | | | | | | | | | | |
Collapse
|
17
|
Cano-Valderrama Ó, Miguel TF, Bonito AC, Muriel JS, Fernández FJM, Ros EP, Cabrera AMG, Cerdán-Santacruz C. Surgical treatment trends and outcomes for anal fistula: fistulotomy is still accurate and safe. Results from a nationwide observational study. Tech Coloproctol 2023; 27:909-919. [PMID: 37460829 DOI: 10.1007/s10151-023-02842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE The aim of the present study was to analyse current surgical treatment preferences for anal fistula (AF) and its subtypes and nationwide results in terms of success and complications. METHODS A retrospective multicentre observational cohort study was conducted. The study period was 1 year (2019), with a follow-up period of at least 1 year. A descriptive analysis of patient characteristics and trends regarding technical options was performed. Univariate and multivariate Cox regression models were used to analyse factors associated with healing and faecal incontinence (FI). RESULTS Fifty-one hospitals were involved, providing data on 1628 patients with AF. At a median follow-up of 18.3 (9.9-28.3) months, 1231 (75.9%) patients achieved healing, while 390 (24.1%) did not; failure was catalogued as persistence in 279 (17.2.0%) patients and as recurrence in 111 (6.8%). On multivariate analysis, factors associated with healing were fistulotomy (OR 5.5; 95% CI 3.8-7.9; p < 0.001), simple fistula (OR 2.1; 95% CI 1.5-2.8; p < 0.001), single tract (HR 1.9; 95% CI 1.3-2.8; p < 0.001) and number of preparatory surgeries (none vs. 3; HR 1.8; 95% CI 1.2-2.8; p = 0.006). Regarding de novo FI, in the multivariate analysis previous anal surgery (OR 1.5, 95% CI 1.0-2.4, p = 0.037), age (OR 1.02, 95% CI 1.00-1.04, p = 0.002) and being female (OR 1.7, 95% CI 1.1-2.5, p = 0.008) were statistically related. CONCLUSIONS Anal fistulotomy is the most used procedure for AF, especially for simple AF, with a favourable overall balance between healing and continence impairment. Sphincter-sparing or minimally invasive sphincter-sparing techniques resulted in lower rates of healing. In spite of their intended sphincter-sparing design, a certain degree of FI was observed for several of these techniques.
Collapse
Affiliation(s)
- Ó Cano-Valderrama
- Hospital Álvaro Cunqueiro, Complejo Hospitalario de Vigo, Pontevedra, Spain
| | | | | | - J Sancho Muriel
- Hospital Universitario Y Politécnico de La Fe, Valencia, Spain
| | | | - E Peña Ros
- Hospital Universitario Reina Sofía, Murcia, Spain
| | | | | |
Collapse
|
18
|
Ferrari L, Cuinas K, Hainsworth A, Darakhshan A, Schizas A, Kelleher C, Williams AB. Preoperative predictors of success after transvaginal rectocoele repair. Tech Coloproctol 2023; 27:859-866. [PMID: 37212926 DOI: 10.1007/s10151-023-02822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Determine predictors of success for transvaginal rectocoele repair (TVRR). Primary aim is to establish predictors of successful treatment analysing patients' characteristics, baseline symptoms, pelvic floor test results and pre-operative conservative treatment. METHODS Retrospective single institution study in a tertiary referral centre for pelvic floor disorders. 207 patients underwent TVRR for symptomatic rectocoele. Information about symptoms related to obstructive defaecation, anal incontinence and vaginal prolapse, results of pelvic floor investigations, multimodality conservative management and variation in surgical technique have been recorded. Symptom related information have been collected at surgical follow-up. RESULTS 115 patients had residual symptoms after surgical repair of rectocoele, while 97 were symptoms free. Factors associated with residual symptoms after surgical repair are previous proctological procedures, urge AI symptoms, absence of vaginal bulge symptoms, use of transanal irrigation and having a concomitant enterocoele repair during procedure. CONCLUSION Factors able to predict a less favourable outcome after TVRR in patients with concomitant ODS are previous proctological procedures, presence of urge AI, short anal canal length on anorectal physiology, seepage on defaecating proctography, use of transanal irrigation, absence of vaginal bulge symptoms and enterocoele repair during surgery. These information are important for a tailored decision making process and to manage patients' expectations before surgical repair.
Collapse
Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK.
| | - Karina Cuinas
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Amir Darakhshan
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Alexis Schizas
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Cornelius Kelleher
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| | - Andrew Brian Williams
- Pelvic Floor Unit, Mitchener Ward, St Thomas' Hospital, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London, SE17EH, UK
| |
Collapse
|
19
|
Zacchè MM, Ghosh J, Liapis I, Chilaka C, Latthe P, Toozs-Hobson P. Anal incontinence following obstetric anal sphincter injury: Is there a difference between subtypes? A systematic review. Neurourol Urodyn 2023; 42:1455-1469. [PMID: 37431160 DOI: 10.1002/nau.25235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
AIMS Obstetric anal sphincter injury (OASI) is associated with long-term anal incontinence (AI). We aimed to address the following questions: (a) are women with major OASI (grade 3c and 4) at higher risk of developing AI when compared to women with minor OASI (grade 3a and 3b)? (b) is a fourth-degree tear more likely to cause AI over a third-degree tear? METHODS A systematic literature search from inception until September 2022. We considered prospective and retrospective cohort studies, cross-sectional and case-control studies without language restrictions. The quality was assessed by the Newcastle-Ottawa Scale and the Joanna Briggs Institute critical appraisal checklist. Risk ratios (RRs) were calculated to measure the effect of different grades of OASI. RESULTS Out of 22 studies, 8 were prospective cohort, 8 were retrospective cohort, and 6 were cross-sectional studies. Length of follow-up ranged from 1 month to 23 years, with the majority of the reports (n = 16) analysing data within 12-months postpartum. Third-degree tears evaluated were 6454 versus 764 fourth-degree tears. The risk of bias was low in 3, medium in 14 and high in 5 studies, respectively. Prospective studies showed that major tears are associated with a twofold risk of AI for major tears versus minor tears, while retrospective studies consistently showed a risk of fecal incontinence (FI) which was two- to fourfold higher. Prospective studies showed a trend toward worsening AI symptoms for fourth-degree tears, but this failed to reach statistical significance. Cross-sectional studies with long-term (≥5 years) follow-up showed that women with fourth-degree tear were more likely to develop AI, with an RR ranging from 1.4 to 2.2. Out of 3, 2 retrospective studies showed similar findings, but the follow-up was significantly shorter (≤1 year). Contrasting results were noted for FI rates, as only 5 out of 10 studies supported an association between fourth-degree tear and FI. CONCLUSIONS Most studies investigate bowel symptoms within few months from delivery. Data heterogeneity hindered a meaningful synthesis. Prospective cohort studies with adequate power and long-term follow-up should be performed to evaluate the risk of AI for each OASI subtype.
Collapse
Affiliation(s)
- Martino Maria Zacchè
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Jayasish Ghosh
- Department of Obstetrics and Gynaecology, Walsall Manor Hospital, Walsall, UK
| | - Ilias Liapis
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Chioma Chilaka
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Pallavi Latthe
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| | - Philip Toozs-Hobson
- Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, Birmingham, UK
| |
Collapse
|
20
|
Muñiz KS, Grado L, Gomez M, Ortiz C, Cerna R, Brioso X, Carson KA, Chen CCG. Pelvic floor disorder assessment of knowledge and symptoms: an educational intervention for Spanish-speaking women (PAKS study). Int Urogynecol J 2023; 34:1789-1796. [PMID: 36735052 DOI: 10.1007/s00192-023-05459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/25/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Educational interventions have been effective in improving postpartum knowledge, performance of pelvic floor exercises, and bowel-specific quality-of-life. Our primary objective was to determine if a video-based educational intervention on pelvic floor disorders (PFDs) would increase Spanish-speaking women's knowledge of PFDs, and secondarily to assess if it would decrease pelvic floor symptoms. We hypothesized that Spanish-speaking women would improve their pelvic floor knowledge and symptoms post-intervention. METHODS Inclusion criteria included women age 18 years and older and self-reported as a predominantly Spanish-speaker or equally bilingual English- and Spanish-speaker. Changes in knowledge were assessed with the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Changes in symptoms were assessed with the Pelvic Floor Distress Inventory-20 (PFDI-20). Linear regression assessed for independent effects. RESULTS One hundred and fourteen women were enrolled and 112 completed the pre- and post-intervention PIKQ. Mean (standard deviation [SD]) age was 50 (14) years. Immediate post-intervention scores showed significant improvement in knowledge. Total PIKQ score improved by 5.1 (4.7) points (p < 0.001). POP subscore improved by 2.7 (2.7) points (p<0.001) and UI subscore improved by 2.3 (2.5) points (p < 0.001). Improvement in knowledge continued after four weeks (p < 0.001). PFDI-20 prolapse (p=0.02), colorectal-anal (p < 0.001) and urinary (p = 0.01) scores significantly improved only for the most symptomatic women at baseline. Using linear regression, total PIKQ (p = 0.03) and total PFDI-20 scores (p = 0.04) were associated with predominantly Spanish-speakers versus fully bilingual. CONCLUSION Findings support the efficacy of a video-based educational intervention to improve knowledge of PFDs in Spanish-speaking women. The most symptomatic women benefitted from this intervention.
Collapse
Affiliation(s)
- Keila S Muñiz
- St. Joseph's Health Hospital, 104 Union Ave, Suite 804, Syracuse, NY, 13203, USA.
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Maria Gomez
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Rosa Cerna
- University of Maryland, College Park, MD, USA
| | - Xiomara Brioso
- Yale New Haven Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Kathryn A Carson
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
21
|
Abstract
Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health-related quality of life scores typically related to pain and fecal incontinence. In addition, patients with perianal Crohn's disease have higher rates of hospitalizations, surgeries, and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation and the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring, and a close follow-up. Surgical management is critical to drain abscesses before immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps, and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.
Collapse
Affiliation(s)
- Alyssa M Parian
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Obi
- Department of General Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Phillip Fleshner
- Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - David A Schwartz
- Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
22
|
Cohen MB, Hopson B, Swanson-Kimani E, Davis D, Rocque BG. Improving Bowel Management in Children With Spina Bifida. J Pediatr Gastroenterol Nutr 2023; 77:198-202. [PMID: 37229746 DOI: 10.1097/mpg.0000000000003847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES In individuals with spina bifida (SB), bowel incontinence is associated with lower quality of life and lower likelihood of employment. In an effort to maximize bowel continence in children and adolescents, we created a bowel management assessment and follow-up protocol in a multidisciplinary clinic. Here we report the results of this protocol using quality-improvement methodology. METHODS Continence was defined as no unplanned bowel movements. Our protocol involved: (1) a standardized 4-item questionnaire about bowel continence and consistency; (2) if the patient was not achieving continence, an intervention starting with oral medication (stimulant and/or osmotic laxatives), and/or suppositories (glycerin or bisacodyl) followed by an escalation to trans-anal irrigation, or continence surgery; and (3) follow-up phone calls at regular intervals to monitor progress and make changes as needed. Results are summarized with descriptive statistics. RESULTS We screened 178 eligible patients in the SB clinic. Eighty-eight agreed to participate in the bowel management program. Of those who did not participate, the majority (68/90, 76%) were already achieving continence with their bowel regimen. Of children in the program, most (68/88, 77%) had a diagnosis of meningomyelocoele. At 1 year, the proportion of patients who were bowel accident free improved to 46% (vs 22% initially, P = 0.0007). CONCLUSIONS A standardized bowel management protocol, primarily the use of suppositories and trans-anal irrigation to achieve social continence, as well as frequent telephone follow-up, can reduce bowel incontinence in children and adolescents with SB.
Collapse
Affiliation(s)
- Mitchell B Cohen
- From the UAB Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Alabama at Birmingham, Birmingham, AL
- Children's of Alabama, Birmingham, AL
| | - Betsy Hopson
- Children's of Alabama, Birmingham, AL
- the UAB Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
| | - Erin Swanson-Kimani
- Children's of Alabama, Birmingham, AL
- the UAB Department of Pediatrics, Division of Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Drew Davis
- Children's of Alabama, Birmingham, AL
- the UAB Department of Pediatrics, Division of Rehabilitation Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brandon G Rocque
- Children's of Alabama, Birmingham, AL
- the UAB Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
23
|
Trinidad S, Garrison A, Encisco EM, Canteria R, VanderBrink B, Strine A, Reddy P, Kotagal M, Rosen N, Rymeski B, Frischer JS. Long-Term Male Sexual Function and Fecal Incontinence Outcomes for Adult Patients with Hirschsprung Disease or Anorectal Malformation. J Pediatr Surg 2023; 58:1573-1577. [PMID: 37221125 DOI: 10.1016/j.jpedsurg.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND This study sought to characterize sexual function and fecal incontinence related quality of life (QOL) outcomes for adult males with anorectal malformation (ARM) or Hirschsprung's Disease (HD). METHODS We conducted a cross-sectional survey study of male patients ≥18 years with ARM or HD. Patients were identified from our institutional database, contacted and consented by telephone, and sent a REDCap survey via email. The International Index of Erectile Function (IIEF-5) and Male Sexual Health Questionnaire (MSHQ) evaluated erectile dysfunction (ED) and ejaculatory dysfunction (EjD), respectively. The Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Scale (FIQLS) assessed fecal incontinence-related outcomes. A linear regression analysis of IIEF-5 scores compared to CCIS scores was used to evaluate for an association between ED and incontinence. RESULTS Of 63 patients contacted, 48 completed the survey. The median age for respondents was 22.5 years (IQR 20-25). There were 19 patients with HD and 29 patients with ARM. On the IIEF-5 survey, 35.3% report some level of ED. On the MSHQ-EjD survey, the median score was 14 out of 15 (IQR 10.75-15), indicating few EjD concerns. The median CCIS was 5 (IQR 2.25-7.75) and the median FIQL scores ranged from 2.7 to 3.5 depending on the domain assessed, demonstrating some QOL challenges secondary to fecal incontinence. On linear regression analysis, IIEF-5 and CCIS scores were weakly associated (B = -0.55, p = 0.045). CONCLUSIONS Male adult patients with ARM or HD may have ongoing concerns with sexual function and fecal incontinence. LEVEL OF EVIDENCE Level 4. TYPE OF STUDY Cross-Sectional Survey Study.
Collapse
Affiliation(s)
- Stephen Trinidad
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron Garrison
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ellen M Encisco
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rey Canteria
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew Strine
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Meera Kotagal
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nelson Rosen
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Beth Rymeski
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason S Frischer
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
24
|
Verkuijl SJ, Trzpis M, Broens PM. The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study. J Pediatr Gastroenterol Nutr 2023; 77:47-54. [PMID: 37098114 PMCID: PMC10259211 DOI: 10.1097/mpg.0000000000003804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/11/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence. METHODS For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria. RESULTS The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06-7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78-9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24-3.42). CONCLUSIONS Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
Collapse
Affiliation(s)
- Sanne J. Verkuijl
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monika Trzpis
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- From the Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- the Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
25
|
Xavier TDS, Duarte LMR, Martins G. Transanal irrigation to manage neurogenic bowel in the pediatric population with spina bifida: a scoping review. J Pediatr (Rio J) 2023; 99:322-334. [PMID: 36852756 PMCID: PMC10373142 DOI: 10.1016/j.jped.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To map available scientific evidence about the pediatric population with spina bifida submitted to transanal irrigation to manage signs and symptoms of neurogenic bowel. SOURCE OF DATA This research was developed according to recommendations from the Joanna Briggs Institute Reviewers' Manual and the PRISMA Extension for Scoping Reviews. Searches were carried out in the databases: CINAHL, Medline/Pubmed, Scielo, Scopus, Web of Science, Embase, LILACS, Proquest, and the CAPES catalog of theses and dissertations. Quantitative and qualitative studies on the topic were included, as long as they dealt with this population. There was no predetermined time frame. SUMMARY OF THE FINDINGS The authors found 1.020 studies, selected 130 for close reading, and included 23 in the review, all of which had been published from 1989 to 2021. The authors mapped the characteristics of the studies, including their definitions of concepts and use of scales, criteria for the indication of transanal irrigation, training to carry out the procedure, devices and solutions used, number and frequency of transanal irrigations, health care actions, time spent, associated complications, complementary exams, adherence rate, follow-up, and outcomes, focusing on the benefits for bowel management. CONCLUSIONS Despite the variability of evaluation parameters and term definitions, evidence suggests that transanal irrigation is a safe and effective method to manage fecal incontinence. Studies in the field are likely to grow, using standardized scales and longitudinal follow-ups. The authors suggest further research on transanal irrigation in the pediatric population with spina bifida in the Latin American context.
Collapse
Affiliation(s)
- Thayane de Souza Xavier
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília/DF, Brasil; Rede SARAH de Hospitais de Reabilitação, Programa de Reabilitação Infantil, Brasília/DF, Brasil.
| | - Lenamaris Mendes Rocha Duarte
- Rede SARAH de Hospitais de Reabilitação, Departamento de Pediatria e Escola Superior de Ciências da Saúde (ESCS), Brasília/DF, Brasil
| | - Gisele Martins
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília/DF, Brasil
| |
Collapse
|
26
|
Dibley L, Hart A, Duncan J, Knowles CH, Kerry S, Lanz D, Berdunov V, Madurasinghe VW, Wade T, Terry H, Verjee A, Fader M, Norton C. Supported Intervention Versus Intervention Alone for Management of Fecal Incontinence in Patients With Inflammatory Bowel Disease: A Multicenter Mixed-Methods Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2023; 50:235-244. [PMID: 37146115 DOI: 10.1097/won.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The aims of this study were to test a noninvasive self-management intervention supported by specialist nurses versus intervention alone in patients with inflammatory bowel disease (IBD) experiencing fecal incontinence and to conduct a qualitative evaluation of the trial. DESIGN Multicenter, parallel-group, open-label, mixed-methods randomized controlled trial (RCT). SUBJECTS AND SETTING The sample comprised patients from a preceding case-finding study who reported fecal incontinence and met study requirements; the RCT was delivered via IBD outpatient clinics in 6 hospitals (5 in major UK cities, 1 rural) between September 2015 and August 2017. Sixteen participants and 11 staff members were interviewed for qualitative evaluation. METHODS Adults with IBD completed the study activities over a 3-month period following randomization. Each participant received either four 30-minute structured sessions with an IBD clinical nurse specialist and a self-management booklet or the booklet alone. Low retention numbers precluded statistical analysis; individual face-to-face or telephone interviews, recorded digitally and transcribed professionally, were conducted to evaluate the RCT. Transcripts were analyzed thematically using an inductive method. RESULTS Sixty-seven participants (36%) of the targeted 186 participants were recruited. The groups comprised 32 participants (17% of targeted participants) allocated to the nurse + booklet intervention and 35 (18.8% of targeted participants) allocated to the booklet alone. Less than one-third (n = 21, 31.3%) completed the study. Given the low recruitment and high attrition, statistical analysis of quantitative data was considered futile. Participant interviews were conducted concerning study participation and 4 themes emerged that described experiences of patients and staff. These data provided insights into reasons for low recruitment and high attrition, as well as challenges of delivering resource-heavy studies in busy health service environments. CONCLUSIONS Alternative approaches to trials of nurse-led interventions in hospital settings are needed as many interfering factors may prevent successful completion.
Collapse
Affiliation(s)
- Lesley Dibley
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Ailsa Hart
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Julie Duncan
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Charles H Knowles
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Sally Kerry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Doris Lanz
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vladislav Berdunov
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vichithranie W Madurasinghe
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Tiffany Wade
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Helen Terry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Azmina Verjee
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Mandy Fader
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Christine Norton
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| |
Collapse
|
27
|
Verkuijl SJ, Hoff C, Furnée EJ, Kelder W, Hess DA, Wit F, Zijlstra RJ, Trzpis M, Broens PM. Anastomotic Height Is a Valuable Indicator of Long-term Bowel Function Following Surgery for Rectal Cancer. Dis Colon Rectum 2023; 66:221-232. [PMID: 35714360 PMCID: PMC9829038 DOI: 10.1097/dcr.0000000000002168] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The exact relation between anastomotic height after rectal cancer surgery and postoperative bowel function problems has not been investigated in the long term, resulting in ineffective treatment. OBJECTIVE The goal of this study was to determine the effect of anastomotic height on long-term bowel function and generic quality of life. DESIGN This was a multicenter, cross-sectional study. SETTINGS Seven hospitals in the north of the Netherlands participated. PATIENTS All patients who underwent rectal cancer surgery between 2009 and 2015 in participating hospitals received the validated Defecation and Fecal Continence and Short-Form 36 questionnaires. Deceased patients, patients with a permanent stoma or an anastomosis >15 cm from the anal verge, patients with intellectual disability, and patients living abroad were excluded. MAIN OUTCOME MEASURES Primary outcomes were constipation (Rome IV), fecal incontinence (Rome IV), and major low anterior resection syndrome. Secondary outcomes were the generic quality of life scores. RESULTS The study population ( n = 630) had a median follow-up of 58.0 months. In multivariable analysis, constipation (OR = 1.08; 95% CI, 1.02-1.15; p = 0.011), fecal incontinence (OR = 0.91; 95% CI, 0.84-0.97; p = 0.006), and major low anterior resection syndrome (OR = 0.93; 95% CI, 0.87-0.99; p = 0.027), were significantly associated with anastomotic height. The curves illustrating the probability of constipation and fecal incontinence crossed at an anastomotic height of 7 cm, with 95% CIs overlapping between 4.5 and 9.5 cm. There was no relation between quality-of-life scores and anastomotic height. LIMITATIONS The study is limited by its cross-sectional design. CONCLUSIONS This study might serve as a guide for the clinician to effectively screen and treat fecal incontinence and constipation during patient follow-up after rectal cancer surgery. More attention should be paid to fecal incontinence in patients with an anastomosis below 4.5 cm and toward constipation in patients with an anastomosis above 9.5 cm. See Video Abstract at http://links.lww.com/DCR/B858 . LA ALTURA ANASTOMTICA ES UN INDICADOR VALIOSO DE LA FUNCIN INTESTINAL A LARGO PLAZO DESPUS DE LA CIRUGA PARA EL CNCER DE RECTO ANTECEDENTES:La relación exacta entre la altura anastomótica después de la cirugía de cáncer de recto y los problemas posoperatorios de la función intestinal no se ha investigado a largo plazo, lo que causa un tratamiento ineficaz.OBJETIVO:Determinar el efecto de la altura anastomótica sobre la función intestinal a largo plazo y la calidad de vida genérica.DISEÑO:Estudio multicéntrico transversal.DISEÑO DEL ESTUDIO:Participaron siete hospitales holandeses en el norte de los Países Bajos.PACIENTES:Todos los pacientes que se sometieron a cirugía de cáncer de recto entre 2009 y 2015 en los hospitales participantes recibieron los cuestionarios validados de Defecación y Continencia Fecal y Short-Form 36. Se excluyeron pacientes fallecidos, pacientes con estoma permanente o anastomosis > 15 cm del borde anal, discapacidad intelectual o residentes en el extranjero.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios fueron estreñimiento (Roma IV), incontinencia fecal (Roma IV) y síndrome de resección anterior baja mayor. Los resultados secundarios fueron las puntuaciones genéricas de calidad de vida.RESULTADOS:La población de estudio (N = 630) tuvo una mediana de seguimiento de 58.0 meses. En el análisis multivariable el estreñimiento (OR = 1,08, IC del 95%, 1,02-1,15, p = 0,011), incontinencia fecal (OR = 0,91, IC del 95%, 0,84-0,97, p = 0,006) y síndrome de resección anterior baja mayor (OR = 0,93, IC del 95%, 0,87-0,99, p = 0,027) se asociaron significativamente con la altura anastomótica. Las curvas que ilustran la probabilidad de estreñimiento e incontinencia fecal se cruzaron a una altura anastomótica de 7 cm, con IC del 95% superpuestos entre 4,5 y 9,5 cm. No hubo relación entre las puntuaciones de calidad de vida y la altura anastomótica.LIMITACIONES:El estudio está limitado por su diseño transversal.CONCLUSIONES:Este estudio podría servir como una guía para que el médico evalúe y trate eficazmente la incontinencia fecal y el estreñimiento durante el seguimiento de los pacientes después de la cirugía de cáncer de recto. Se debe prestar más atención a la incontinencia fecal en pacientes con anastomosis por debajo de 4,5 cm y al estreñimiento en pacientes con anastomosis por encima de 9,5 cm. Consulte Video Resumen en http://links.lww.com/DCR/B858 . (Traducción-Dr. Yazmin Berrones-Medina ).
Collapse
Affiliation(s)
- Sanne J. Verkuijl
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christiaan Hoff
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Edgar J.B. Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wendy Kelder
- Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - Daniel A. Hess
- Department of Surgery, Antonius Hospital, Sneek, the Netherlands
| | - Fennie Wit
- Department of Surgery, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - Ronald J. Zijlstra
- Department of Surgery, Nij Smellinghe Hospital, Drachten, the Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
28
|
Gunasegaran N, Ang SY, Ng YZ, Lee NES, Agus N, Lee CW, Ong CE, Mostafa SS, Aloweni F. The effectiveness of a hydrocolloid crusting method versus standard care in the treatment of incontinence-associated dermatitis among adult patients in an acute care setting: A randomised controlled trial. J Tissue Viability 2023; 32:171-178. [PMID: 36717288 DOI: 10.1016/j.jtv.2023.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. METHOD A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. RESULTS Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. CONCLUSION HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management.
Collapse
Affiliation(s)
| | - Shin Yuh Ang
- Nursing Division, Singapore General Hospital, Singapore.
| | - Yi Zhen Ng
- Skin Research Institute of Singapore, Singapore.
| | | | - Nurliyana Agus
- Nursing Division, Singapore General Hospital, Singapore.
| | - Chee Woei Lee
- Nursing Division, Singapore General Hospital, Singapore.
| | - Choo Eng Ong
- Nursing Division, Singapore General Hospital, Singapore.
| | | | - Fazila Aloweni
- Nursing Division, Singapore General Hospital, Singapore.
| |
Collapse
|
29
|
Palmer SJ. Faecal incontinence management in dementia patients. Br J Community Nurs 2022; 27:534-538. [PMID: 36327202 DOI: 10.12968/bjcn.2022.27.11.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Faecal incontinence is a complex issue faced by many older adults. This article will provide an overview of this condition and its causes. It will also provide policy and guidance on the subject, its general management, complications, the support available for carers, and the issue of faecal incontinence in someone who has dementia.
Collapse
Affiliation(s)
- Sarah Jane Palmer
- Registered nurse and freelance writer, based at the Department of Work and Pensions as a disability analyst
| |
Collapse
|
30
|
Pan W, Goldstein AM, Hotta R. Opportunities for novel diagnostic and cell-based therapies for Hirschsprung disease. J Pediatr Surg 2022; 57:61-68. [PMID: 34852916 PMCID: PMC9068833 DOI: 10.1016/j.jpedsurg.2021.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/17/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022]
Abstract
Despite significant progress in our understanding of the etiology and pathophysiology of Hirschsprung disease (HSCR), early and accurate diagnosis and operative management can be challenging. Moreover, long-term morbidity following surgery, including fecal incontinence, constipation, and Hirschsprung-associated enterocolitis (HAEC), remains problematic. Recent advances applying state-of-the art imaging for visualization of the enteric nervous system and utilizing neuronal stem cells to replace the missing enteric neurons and glial cells offer the possibility of a promising new future for patients with HSCR. In this review, we summarize recent research advances that may one day offer novel approaches for the diagnosis and management of this disease.
Collapse
Affiliation(s)
- Weikang Pan
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA; Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Allan M Goldstein
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA
| | - Ryo Hotta
- Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 185 Cambridge St, CPZN 6-215, Boston, MA 02114, USA.
| |
Collapse
|
31
|
Koloms K, Cox J, VanGilder CA, Edsberg LE. Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey. J Wound Ostomy Continence Nurs 2022; 49:405-415. [PMID: 36108224 PMCID: PMC9592164 DOI: 10.1097/won.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units. RESULTS Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00). CONCLUSION Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.
Collapse
Affiliation(s)
- Kimberly Koloms
- Correspondence: Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, IL 60015 ()
| | - Jill Cox
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Catherine A. VanGilder
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Laura E. Edsberg
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| |
Collapse
|
32
|
Bradko V, Castillo H, Fremion E, Conklin M, Dahl B, Castillo J. What is the Role of Scoliosis Surgery in Adolescents and Adults with Myelomeningocele? A Systematic Review. Clin Orthop Relat Res 2022; 480:773-787. [PMID: 34939968 PMCID: PMC8923593 DOI: 10.1097/corr.0000000000002087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Life expectancy of individuals with spina bifida has continued to improve over the past several decades. However, little is known about the longitudinal course of scoliosis in individuals with myelomeningocele (MMC), a spina bifida subtype, across their lifespan. Specifically, it is not known whether management during or after the transition years from adolescence to adulthood is associated with comorbidities in adulthood nor if these individuals benefit from scoliosis treatment later in life. QUESTIONS/PURPOSES In this systematic review, we asked: (1) Is the risk of secondary impairments (such as bladder or bowel incontinence, decreased ambulation, and skin pressure injuries) higher among adolescents and adults with MMC and scoliosis than among those with MMC without scoliosis? (2) Is there evidence that surgical management of scoliosis is associated with improved functional outcomes in adolescents and adults with MMC? (3) Is surgical management of scoliosis associated with improved quality of life in adolescents and adults with MMC? METHODS We performed a systematic review of articles in Medline and Embase from 2000 until February 5, 2021. Search terms such as "spinal dysraphism," "spina bifida," "meningomyelocele," and "scoliosis" were applied in diverse combinations. A total of 1429 publications were identified, and 13 were eligible for inclusion. We included original studies reporting on scoliosis among individuals older than 15 years with MMC. When available, we extracted the prevalence of MMC and scoliosis, studied population age, percentage of patients experiencing complications, functional outcomes, and overall physical function. We excluded non-English articles and those with fewer than 10 individuals with scoliosis and MMC. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses, and registered the review before data collection (PROSPERO: CRD42021236357). We conducted a quality assessment using the Methodologic Index for Nonrandomized Studies (MINORS) tool. In 13 included studies, there were 556 individuals with MMC and scoliosis. Most were retrospective case series, although a minority were retrospective/comparative studies. The mean MINORS score was 12.3 ± 1.65 (a MINORS score over 12 generally is considered good reporting quality, scores below 12 are considered at high risk of bias). RESULTS In general, studies found that individuals with MMC and scoliosis were more likely to have secondary impairments such as bladder/bowel incontinence, decreased ambulation, and pressure injuries than were patients with MMC without scoliosis. These secondary impairments were associated with hydrocephalus and high-level MMC lesions. However, when one study evaluated mortality, the results showed that although most deceased individuals who had spina bifida had scoliosis, no association was found between the age of death and scoliosis. Among the studies evaluating functional outcomes, none supported strong functional improvement in individuals with MMC after surgery for scoliosis. No correlation between the Cobb angle and sitting balance was noted; however, the degree of pelvic obliquity and the level of motor dysfunction showed a strong correlation with scoliosis severity. There was no change in sitting pressure distributions after spinal surgery. The lesion level and scoliosis degree independently contributed to the degree of lung function impairment. Although studies reported success in correcting coronal deformity and stopping curve progression, they found no clear benefit of surgery on health-related quality of life and long-term outcomes. These studies demonstrated that the level of neurologic function, severity of hydrocephalus, and brainstem dysfunction are greater determinants of quality of life than spinal deformity. CONCLUSION This systematic review found that adolescents and adults with MMC and scoliosis are more likely to have secondary impairments than their peers with MMC only. The best-available evidence does not support strong functional improvement or health-related quality of life enhancement after scoliosis surgery in adolescents and adults with MMC. The level of neurologic dysfunction, hydrocephalus, and brainstem dysfunction are greater determinants of quality of life. Future prospective studies should be designed to answer which individuals with MMC and scoliosis would benefit from spinal surgery. Our findings suggest that the very modest apparent benefits of surgery should cause surgeons to approach surgical recommendations in this patient population with great caution, and surgeons should counsel patients and their families that the risk of complications is high and the benefits may be small. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Viachaslau Bradko
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ellen Fremion
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Michael Conklin
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benny Dahl
- Department of Orthopedic Surgery and Scoliosis Surgery, Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
33
|
Abstract
Moisture-associated skin damage (MASD) occurs when skin is repeatedly exposed to various sources of bodily secretions or effluents, often leading to irritant contact dermatitis with inflammation, with or without denudation of affected skin. In 2020, the Wound, Ostomy and Continence Nurses Society took an initiative that led to the addition of multiple International Classification for Diseases codes for irritant contract dermatitis caused by various forms of MASD for use in the United States (ICD-10-CM). In the last issue of the Journal of Wound, Ostomy and Continence Nursing, a clinical practice alert identifying the various new codes was published that summarized each of the new codes and provided highlights of the descriptions of each of the these codes. This is the first in a series of 2 articles providing a more detailed description of the newest irritant contact dermatitis codes linked to MASD. Specifically, this article reviews the clinical manifestations and assessment, pathophysiology, epidemiology, prevention, and management of irritant contact dermatitis due to saliva, respiratory secretions, and fecal or urinary incontinence.
Collapse
Affiliation(s)
- Mikel Gray
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Donna Z Bliss
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| | - Laurie McNichol
- Mikel Gray, PhD, RN, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, University of Virginia, Charlottesville
- Donna Z. Bliss, PhD, RN, FGSA, FAAN, University of Minnesota School of Nursing, Minneapolis
- Laurie McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN, WOC Nurse, Cone Health, Greensboro, North Carolina
| |
Collapse
|
34
|
Verkuijl SJ, Meinds RJ, van der Steeg AF, van Gemert WG, de Blaauw I, Witvliet MJ, Sloots CE, van Heurn E, Vermeulen KM, Trzpis M, Broens PM. Functional Outcomes After Surgery for Total Colonic, Long-Segment, Versus Rectosigmoid Segment Hirschsprung Disease. J Pediatr Gastroenterol Nutr 2022; 74:348-354. [PMID: 34775429 PMCID: PMC8860201 DOI: 10.1097/mpg.0000000000003355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Knowledge on long-term outcomes in patients with Hirschsprung disease is progressing. Nevertheless, differences in outcomes according to aganglionic lengths are unclear. We compared long-term bowel function and generic quality of life in Hirschsprung patients with total colonic or long-segment versus rectosigmoid aganglionosis. METHODS In this nationwide, cross-sectional study participants with proven Hirschsprung disease received the Defecation and Fecal Continence questionnaire, and the Child Health Questionnaire Child Form-87, or the WHO Quality of Life-100. We excluded deceased patients, patients who were younger than 8 years, lived abroad, had a permanent enterostomy, or were intellectually impaired. RESULTS The study population (n = 334) was operated for rectosigmoid (83.9%), long-segment (8.7%), or total colonic aganglionosis (7.5%). Fecal incontinence in general was not significantly different between the three groups, but liquid fecal incontinence was significantly associated with total colonic aganglionosis (odds ratio [OR] = 6.00, 95% confidence interval [CI] 2.07-17.38, P = 0.001). Regarding constipation, patients with total colonic or long-segment aganglionosis were less likely to suffer from constipation than the rectosigmoid group (OR = 0.21, 95% CI, 0.05-0.91, P = 0.038 and OR = 0.11, 95% CI, 0.01-0.83, P = 0.032). Quality of life was comparable between the three groups, except for a lower physical score in children with total colonic aganglionosis (P = 0.016). CONCLUSIONS Over time Hirschsprung patients with total colonic or long-segment aganglionosis do not suffer from worse fecal incontinence in general. A difference in stool consistency may underlie the association between liquid fecal incontinence and total colonic aganglionosis and constipation in patients with rectosigmoid aganglionosis. Despite these differences, generic quality of life is comparable on reaching adulthood.
Collapse
Affiliation(s)
- Sanne J. Verkuijl
- Department of Surgery, Division of Pediatric Surgery
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen
| | - Rob J. Meinds
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede
| | | | - Wim G. van Gemert
- Department of Pediatric Surgery, University Medical Centre Maastricht, University of Maastricht, Maastricht
| | - Ivo de Blaauw
- Department of Surgery, Division of Pediatric Surgery, Radboudumc–Amalia Children's Hospital, Nijmegen
| | - Marieke J. Witvliet
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht
| | - Cornelius E.J. Sloots
- Department of Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam
| | - Ernst van Heurn
- Department of Pediatric Surgery, Emma Children's Hospital, Academic Medical Centre and VU University Medical Centre, Amsterdam
| | - Karin M. Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen
| | - Paul M.A. Broens
- Department of Surgery, Division of Pediatric Surgery
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen
| |
Collapse
|
35
|
Barakat-Johnson M, Stephenson J, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Lai M, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Clinician Knowledge of Incontinence-Associated Dermatitis: A Multisite Survey of Healthcare Professionals in Acute and Subacute Settings. J Wound Ostomy Continence Nurs 2022; 49:159-167. [PMID: 35255068 DOI: 10.1097/won.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined clinicians' knowledge of incontinence-associated dermatitis (IAD) using the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge Tool (Know-IAD). DESIGN A cross-sectional multicenter survey. SUBJECTS AND SETTING The setting was 6 hospitals across 5 health districts in New South Wales, Australia. The participants were nurses (registered nurses and enrolled nurses), physicians, allied health (occupational therapists, dietitians, and physiotherapists), and students (nursing and allied health). METHODS Data about IAD knowledge were collected from November 2019 to January 2020. The Know-IAD, an 18-item validated instrument that measures knowledge of IAD in 3 domains (etiology and risk, classification and diagnosis, and prevention and management), was administered to a cross section of eligible clinicians. The participants anonymously completed hard copy surveys. Descriptive and exploratory analyses were conducted to quantify clinicians' knowledge about the etiology and risk, classification and diagnosis, and prevention and management of IAD. A mean knowledge score of 70% was considered to be satisfactory. RESULTS Four hundred twelve respondents completed the survey. One hundred twenty nine respondents (31.3%) achieved 70% correct responses and greater for the entire set of items. For the etiology and risk domain, 348 respondents (84.5%) obtained a score of 70% correct responses and greater, 67 respondents (16.3%) achieved 70% correct responses and greater for the classification and diagnosis domain, and 84 respondents (20.4%) achieved 70% correct responses and greater for the prevention and management domain. CONCLUSION Clinicians tend to have low knowledge and recognition of IAD, particularly in the areas of classification and diagnosis along with prevention and management. They tend to have higher knowledge of how IAD is caused and the risk factors. This study has identified knowledge gaps for further education that can improve assessment, prevention, and management of IAD.
Collapse
Affiliation(s)
- Michelle Barakat-Johnson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - John Stephenson
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Shifa Basjarahil
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jayne Campbell
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michelle Cunich
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Gary Disher
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samara Geering
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natalie Ko
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michelle Lai
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Catherine Leahy
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Thomas Leong
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Eve McClure
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Melissa O'Grady
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Joan Walsh
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Kate White
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Fiona Coyer
- Michelle Barakat-Johnson, PhD, MN, RN , Skin Integrity, Sydney Local Health District; Faculty of Medicine and Health, University of Sydney; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Queensland, Australia
- John Stephenson, PhD, MSc (Eng), BSc , School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Shifa Basjarahil, GradCert (Wound), BN, RN, Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Jayne Campbell, BNurs, MHCL, BN, RN, Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia
- Michelle Cunich, PhD , Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney and Sydney Health Economics Collaborative, Sydney Local Health District, New South Wales, Australia
- Gary Disher, BBus, GradDip (Health Services Management), Strategic Reform and Planning Branch, New South Wales Ministry of Health, New South Wales, Australia
- Samara Geering, GradDip (Midwifery), BN, RN, Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia
- Natalie Ko, GradDip (Acute Care Nursing), BN, RN, Nursing and Midwifery Services, Concord Repatriation General Hospital, New South Wales, Australia
- Michelle Lai, PhD, MRes (Philosophy), BA-Psychology , Nursing and Midwifery Services, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- Catherine Leahy, PostGradCert (Stomal Therapy Nursing), BN, RN , Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia
- Thomas Leong, MClinSci (Nurs), BN, RN , Nursing and Midwifery Services, Royal Prince Alfred Hospital, New South Wales, Australia
- Eve McClure, MBBS, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Melissa O'Grady, MNursManag, BN, RN, Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, New South Wales, Australia
- Joan Walsh, GradDip (Adult Education and Training), BN, RN , Nursing and Midwifery Services, South Eastern Sydney Local Health District, New South Wales, Australia
- Kate White, PhD, RN, Sydney Local Health District and Susan Wakil School of Nursing and Midwifery, The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, New South Wales, Australia
- Fiona Coyer, PhD, MSc (Nursing), RN, School of Nursing, Queensland University of Technology, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
36
|
Mizuno S, Wakabayashi H, Yamakawa M, Wada F, Kato R, Furiya Y, Nishioka S, Momosaki R. Sarcopenia Is Associated with Fecal Incontinence in Patients with Dysphagia: Implication for Anal Sarcopenia. J Nutr Health Aging 2022; 26:84-88. [PMID: 35067708 DOI: 10.1007/s12603-021-1711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the relationship between sarcopenia and fecal incontinence in patients with dysphagia. DESIGN Cross-sectional study using the Japanese sarcopenic dysphagia database. SETTING 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation center. PARTICIPANTS 460 dysphagic patients, aged 20 years and older. MEASUREMENTS Sarcopenia was diagnosed by the 2019 criteria of the Asian Working Group for Sarcopenia. Fecal incontinence was assessed by health care professionals at baseline according to the definition of the Japanese Practice Guidelines for Fecal Incontinence. We examined whether there was a significant difference between the rate of fecal incontinence in patients with/without sarcopenia. Age, sex, type of dwelling, Barthel index, Charlson comorbidity index (CCI), calf circumference, handgrip strength, body mass index, malnourishment, C-reactive protein level, serum albumin level, and delivery of enteral nutrition by nasogastric and/or gastrostomy tube were measured. To examine the relationship between sarcopenia and fecal incontinence, logistic regression analysis was performed with adjustments for age, sex, sarcopenia, CCI, enteral nutrition, and dwelling. RESULTS The mean age of patients was 81 ± 10 years. Of the 460 study patients, 404 (88%) patients had sarcopenia and 104 had fecal incontinence (23%). The rate of fecal incontinence was higher in the sarcopenia group than the non-sarcopenia group (25% vs. 7%, P = 0.003). Logistic regression analysis showed that sarcopenia was independently associated with fecal incontinence (odds ratio: 3.114, 95% confidence interval: 1.045, 9.282). CONCLUSION The prevalence of fecal incontinence was 23% in patients with dysphagia. Sarcopenia was independently associated with fecal incontinence, which suggests the presence of anal sarcopenia. Defecation control should be assessed in patients with sarcopenia.
Collapse
Affiliation(s)
- S Mizuno
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Kayser SA, Koloms K, Murray A, Khawar W, Gray M. Incontinence and Incontinence-Associated Dermatitis in Acute Care: A Retrospective Analysis of Total Cost of Care and Patient Outcomes From the Premier Healthcare Database. J Wound Ostomy Continence Nurs 2021; 48:545-552. [PMID: 34781311 PMCID: PMC8601665 DOI: 10.1097/won.0000000000000818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the prevalence of incontinence and treatment of incontinence-associated dermatitis (IAD) and associations with outcomes including total cost of care, length of stay (LOS), 30-day readmission, sacral area pressure injuries present on admission and hospital acquired pressure injuries, and progression of all sacral area pressure injuries to a higher stage. DESIGN Retrospective analysis. SUBJECTS AND SETTINGS Data were retrieved from the Premier Healthcare Database and comprised more than 15 million unique adult patient admissions from 937 hospitals. Patients were 18 years or older and admitted to a participating hospital between January 1, 2016, and December 31, 2019. METHODS Given the absence of an IAD International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, we categorized patients treated for IAD by selecting patients with a documented incontinence ICD-10-CM code and a documented charge for dermatology products used to treat IAD. The t test and χ2 tests determined whether incontinence and treatment for IAD were associated with outcomes. RESULTS Incontinence prevalence was 1.5% for the entire sample; prevalence rate for IAD among incontinent patients was 0.7%. As compared to continent patients, incontinent patients had longer LOS (6.4 days versus 4.4 days), were 1.4 times more likely to be readmitted, 4.7 times more likely to have a sacral pressure injury upon admission pressure injury, 5.1 times more likely to have a sacral hospital-acquired pressure injury, and 5.8 times more likely to have a sacral pressure injury progress to a severe stage. As compared to incontinent patients without IAD treatment, those with IAD treatment had longer LOS (9.7 days versus 6.4 days), were 1.3 times more likely to be readmitted, and were 2.0 times more likely to have a sacral hospital-acquired pressure injury. Total index hospital costs were 1.2 times higher for incontinent patients and 1.3 times higher for patients with IAD treatment. CONCLUSIONS Incontinence and IAD prevalence are substantially lower than past research due to underreporting of incontinence. The lack of an ICD-10-CM code for IAD further exacerbates the underreporting of IAD. Despite low prevalence numbers, our results show higher health care costs and worse outcomes for incontinent patients and patients with IAD treatment.
Collapse
Affiliation(s)
- Susan A. Kayser
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Kimberly Koloms
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Angela Murray
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Waqaar Khawar
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| | - Mikel Gray
- Susan A. Kayser, PhD, Hillrom Holdings, Inc, Batesville, Indiana
- Kimberly Koloms, MS, Hillrom Holdings, Inc, Chicago, Illinois
- Angela Murray, MN, RN, Hillrom Holdings, Inc, Chicago, Illinois
- Waqaar Khawar, MD, Hillrom Holdings, Inc, Chicago, Illinois
- Mikel Gray, PhD, Department of Urology, University of Virginia Charlottesville
| |
Collapse
|
38
|
Abstract
OBJECTIVE To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management. METHODS This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data. RESULTS The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD. CONCLUSIONS The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.
Collapse
Affiliation(s)
- Yu Zhang
- At the Capital Medical University in Beijing, China, Yu Zhang, MSN, RN, is Nurse, Department of Respiratory and Critical Care Medicine; Peng Zhang, MSc, is Attending Doctor, Department of Urology, Beijing Chao-Yang Hospital; Jun-E Liu, MD, is Professor, School of Nursing; and Fengli Gao, MD, is Director, Nursing Department, Beijing Chao-Yang Hospital. Acknowledgment: The authors thank the Nursing Department of Beijing Chao-Yang Hospital for supporting this study, including the ICU nurses who agreed to share their experience and devote time and effort to this project. The authors have disclosed no financial relationships related to this article. Submitted September 24, 2020; accepted in revised form December 10, 2020
| | | | | | | |
Collapse
|
39
|
Abstract
OBJECTIVE To critically appraise peer-reviewed evidence concerning the value, or implied sense of worth or benefit, of nurses specialized in wound, ostomy, and continence (WOC) care. DATA SOURCES The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used to systematically review current literature in a single database from 2009 to the date of search (July 2019). STUDY SELECTION The initial search retrieved 2,340 elements; 10 studies were retained following removal of duplicate records, title and abstract reviews, and application of the inclusion/exclusion criteria. DATA EXTRACTION Literature was graded and critiqued with regard to design and research quality and then synthesized using a narrative approach. DATA SYNTHESIS Nine values that WOC nurses demonstrate were identified: improved quality of life for patients, teaching and mentoring, cost reduction, improved efficiency, improved wound outcomes, improved incontinence outcomes, advanced treatments, research, and leadership. CONCLUSIONS Although current studies suggest that there is value in the WOC nurse role, in all areas of the trispecialty, there is a need for high-quality literature with higher-level designs focused on bias reduction.
Collapse
Affiliation(s)
- Corey Heerschap
- At the Royal Victoria Regional Health Centre, Barrie, Ontario, Canada, Corey Heerschap, MScCH (WPC), BScN, RN, NSWOC, WOCC(C), IIWCC, is Wound/Ostomy Clinical Nurse Specialist, Interprofessional Practice Department; and Victoria Duff, BScN, is Student, Research Institute. Acknowledgments: The authors thank Dr Kimberly LeBlanc and Dr Giulio Didiodato for external review of the manuscript and acknowledge the author's time allocated to this study by the Royal Victoria Regional Health Centre Interprofessional Practice Department. Ms Duff received an award from the Royal Victoria Regional Health Centre Research Institute to fund a research assistant position during manuscript development. The authors have disclosed no other financial relationships related to this article. Submitted November 2, 2020; accepted in revised form January 6, 2021
| | | |
Collapse
|
40
|
Bates AN, Ercolano E. Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2021; 48:285-291. [PMID: 34186545 DOI: 10.1097/won.0000000000000778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this quality improvement project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline ("The Guideline") for patients with minor skin lesions, including candidiasis, skin tears, incontinence-associated dermatitis, and stage 1 and stage 2 pressure injuries that would not require a WOC nurse consultation. PARTICIPANTS AND SETTING The Guideline was developed for nurses working on inpatient adult acute care units in a large community hospital in southwest Minnesota. APPROACH The Guideline was validated for its clarity and appropriateness by internal and external hospital-based wound care nurses and implemented through in-person rounding on the nursing units and distribution of badge cards and required completing an online education module. Surveys and wound documentation audits were conducted to measure changes in knowledge and skin care pre- and postimplementation of The Guideline. OUTCOMES We conducted wound documentation audits of approximately 491 records that assessed whether patients received appropriate treatment and found an improvement from 45% (104 of 231) to 80% (209 of 260). Nurses' self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 of 89) agreement to 57% (55 of 96). Nurses' self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 of 89) agreement to 65% (62 of 96). IMPLICATIONS FOR PRACTICE Although there is evidence for a variety of dressings or products to treat wounds, this quality improvement project demonstrated increased adherence with providing appropriate care when fewer treatment options were recommended to nursing staff through our structured guideline. The Guideline continues to be used at the project site and is now being implemented at affiliate hospitals.
Collapse
Affiliation(s)
- Alexandra Nicole Bates
- Alexandra Nicole Bates, DNP, RN, Yale School of Nursing, Orange, Connecticut; and Mayo Clinic Health System, Mankato, Minnesota
- Elizabeth Ercolano, DNSc, RN, Yale School of Nursing, Orange, Connecticut
| | - Elizabeth Ercolano
- Alexandra Nicole Bates, DNP, RN, Yale School of Nursing, Orange, Connecticut; and Mayo Clinic Health System, Mankato, Minnesota
- Elizabeth Ercolano, DNSc, RN, Yale School of Nursing, Orange, Connecticut
| |
Collapse
|
41
|
Motta GL, Bujons A, Quiróz Y, Llorens E, Zancan M, Rosito TE. Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function. Rev Bras Ginecol Obstet 2021; 43:467-473. [PMID: 34318472 PMCID: PMC10411230 DOI: 10.1055/s-0041-1732464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/05/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. METHODS A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. RESULTS Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. CONCLUSION The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.
Collapse
Affiliation(s)
- Guilherme Lang Motta
- Surgery Department, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, RS, Brazil
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Anna Bujons
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Yesica Quiróz
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Erika Llorens
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Maira Zancan
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, RS, Brazil
- Gynecology and Obstetrics Department, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, RS, Brazil
| | - Tiago Elias Rosito
- Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, RS, Brazil
- Urology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, RS, Brazil
| |
Collapse
|
42
|
Delapena S, Spadafore P, Bollenbach SE, Kowal-Vern A, Foster KN, Matthews MR. Rare Operative Intervention for Urinary and Fecal Incontinence-Associated Dermatitis. Wounds 2021; 33:E31-E33. [PMID: 33914693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Incontinence-associated dermatitis (IAD) is considered a cause of moisture-associated skin damage after prolonged exposure to urinary and fecal incontinence. While partial-thickness burns are often managed with topical therapies, daily dressing changes, patient positioning, hydration, nutrition, and pain management, deep partial-thickness and full-thickness burn injuries require surgical excision and, ultimately, skin grafting. The elderly and very young as well as those with medical comorbidities can develop urinary and fecal incontinence. Urinary ammonia and gastrointestinal lipolytic enzymes and proteases can produce caustic damage to weakened elderly or immature skin. In this report, 2 cases of IAD are presented as chemical burns. After a prolonged interval of urinary and fecal incontinence, an incapacitated 65-year-old male with 14% total body surface area (TBSA) partial-thickness wounds, and an 85-year-old female with 4% TBSA full-thickness wounds were admitted to the burn center and underwent operative management.
Collapse
Affiliation(s)
- Samantha Delapena
- Department of Surgery, Valleywise Health Medical Center, Phoenix, Arizona
| | | | | | - Areta Kowal-Vern
- Arizona Burn Center, Phoenix, Arizona;Department of Research, Valleywise Medical Center, Phoenix, Arizona
| | | | | |
Collapse
|
43
|
Fernandez-Portilla E, Moreno-Acosta L, Dominguez-Muñoz A, Gonzalez-Carranza V, Chico-Ponce de Leon F, Davila-Perez R. Functional outcome after cord detethering in fecally incontinent patients with anorectal malformations. Pediatr Surg Int 2021; 37:419-424. [PMID: 33427923 DOI: 10.1007/s00383-020-04834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.
Collapse
Affiliation(s)
- Emilio Fernandez-Portilla
- Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico.
| | - Leticia Moreno-Acosta
- Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico
| | - Alfredo Dominguez-Muñoz
- Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico
| | | | | | - Roberto Davila-Perez
- Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico
| |
Collapse
|
44
|
Zhang Q, Zhang K, Wang Y, Jia Y, Gu J, Li X, Li M. Psychometric properties of the Chinese version of the attitude towards the prevention of incontinence-associated dermatitis (C-APrIAD) among Chinese nurses. J Tissue Viability 2021; 30:421-426. [PMID: 33820693 DOI: 10.1016/j.jtv.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 03/23/2021] [Indexed: 12/26/2022]
Abstract
AIM Nurses' attitude is a significant determinant of incontinence-associated dermatitis (IAD) prevention, and a positive attitude may benefit quality improvement projects. This research aimed to translate the attitude towards the prevention of incontinence-associated dermatitis instrument (C-APrIAD) into Chinese and test the reliability and validity among Chinese nurses. METHODS The C-APrIAD was translated into Chinese using a standard procedure of backward-forward translation and cross-cultural adaption. Totally 170 nurses were recruited through the convenience sampling method from three tertiary hospitals in Tianjin, Shandong, and Heilongjiang province of China. Reliability (internal consistency, stability) and validity (content validity, structure validity, and convergent validity), were assessed. Convergent Validity was evaluated by correlation with the General Self-Efficacy Scale (GSES). RESULTS Of the 170 completed questionnaires, 158 (93%) were suitable for analysis. The item-total correlation coefficients ranged from 0.39 to 0.80. The content validity of C-APrIAD was 0.96. A factor analysis indicated the construct of a 14-item instrument in a four factors solution: (1) beliefs about the impact of IAD on patients, (2) beliefs about team responsibility to prevent IAD, (3) beliefs about personal responsibility to prevent IAD, and (4) beliefs about the effectiveness of IAD prevention products and procedures. The correlation coefficient between the GSES and C-APrIAD was 0.49 (P < 0.01). For the total instrument, the Cronbach's α coefficient was 0.87 and the test-retest reliability was 0.99. CONCLUSION The C-APrIAD is reliable and valid. The C-APrIAD may benefit nursing research as well as clinical practice to optimize interventions to improve IAD prevention.
Collapse
Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Ke Zhang
- Faculty of Education Science and Technology, Shanxi Datong University, Datong, Shanxi Province, China
| | - Yuxin Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yibo Jia
- Department of Nursing, Tianjin Chest Hospital, Tianjin, China
| | - Jiaxin Gu
- School of Nursing, Peking University, Beijing, China
| | - Xintong Li
- School of Nursing, Fenyang College of Shanxi Medical University, Lvliang, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
| |
Collapse
|
45
|
Barakat-Johnson M, Basjarahil S, Campbell J, Cunich M, Disher G, Geering S, Ko N, Lai M, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. Implementing best available evidence into practice for incontinence-associated dermatitis in Australia: A multisite multimethod study protocol. J Tissue Viability 2021; 30:67-77. [PMID: 33158742 DOI: 10.1016/j.jtv.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Abstract
AIMS Incontinence-associated dermatitis (IAD) is an insidious and under-reported hospital-acquired complication which substantially impacts on patients' quality of life. A published international guideline and the Ghent Global IAD Categorisation Tool (GLOBIAD) outline the best available evidence for the optimal management of IAD. This study aims to implement theguideline and the GLOBIAD tool and evaluate the effect on IAD occurrences and sacral pressure injuries as well as patient, clinician and cost-effectiveness outcomes. MATERIALS AND METHODS The study will employ a multi-method design across six hospitals in five health districts in Australia, and will be conducted in three phases (pre-implementation, implementation and post-implementation) over 19 months. Data collection will involve IAD and pressure injury prevalence audits for patient hospital admissions, focus groups with, and surveys of, clinicians, patient interviews, and collection of the cost of IAD hospital care and patient-related outcomes including quality of life. Eligible participants will be hospitalised adults over 18 years of age experiencing incontinence, and clinicians working in the study wards will be invited to participate in focus groups and surveys. CONCLUSION The implementation of health district-wide evidence-based practices for IAD using a translational research approach that engages key stakeholders will allow the standardisation of IAD care that can potentially be applicable to a range of settings. Knowledge gained will inform future practice change in patient care and health service delivery and improve the quality of care for patients with IAD. Support at the hospital, state and national levels, coupled with a refined stakeholder-inclusive strategy, will enhance this project's success, sustainability and scalability beyond this existing project.
Collapse
Affiliation(s)
- Michelle Barakat-Johnson
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Jayne Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, Ground Floor, Officers Quarters, James Fletcher Campus, 72 Watt Street, Newcastle, New South Wales, 2300, Australia
| | - Michelle Cunich
- Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, 2006, Australia; Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, New South Wales, 2050, Australia
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, 1 Reserve Road, St Leonards, New South Wales, 2065, Australia
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, Eastern Campus, Liverpool Hospital, Scrivener Street, Warrick Farm, New South Wales, 2170, Australia
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Level 4, Building 75, Hospital Road, Concord, New South Wales, 2139, Australia
| | - Michelle Lai
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, Building 3, Bloomfield Campus, Forest Road, Orange, New South Wales, 2800, Australia
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Level 7, King George V Building, 83-117 Missenden Road, Camperdown, New South Wales, 2050, Australia
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, 29 Booth Street, Balmain, New South Wales, 2041, Australia
| | - Joan Walsh
- Nursing and Midwifery Services, South Eastern Sydney Local Health District, The Sutherland Hospital, The Kingsway, Caringbah, New South Wales, 2229, Australia
| | - Kate White
- Executive Nursing and Midwifery Services, Sydney Local Health District, Level 11, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, New South Wales, 2050, Australia
| | - Fiona Coyer
- School of Nursing, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Clinical Outcomes, Safety and Implementation Research Program, Centre for Healthcare Transformation, Faculty of Health, Queensland University Technology, Victoria Park Road, Kelvin Grove, Queensland, 4059, Australia; Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia
| |
Collapse
|
46
|
Hoedl M, Eglseer D. Which Characteristics of Fecal Incontinence Predispose Incontinence-Associated Dermatitis? A Classification and Regression Tree Analysis. Adv Skin Wound Care 2021; 34:103-108. [PMID: 33284153 DOI: 10.1097/01.asw.0000722752.86631.af] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate which characteristics of fecal incontinence (FI) are predictors for incontinence-associated dermatitis (IAD) using the Classification and Regression Tree method. DESIGN AND SETTING Data collected from 2014 to 2016 during the Austrian Nursing Quality Measurement 2.0, an annually conducted, cross-sectional, multicenter prevalence study, were merged and analyzed. MAIN OUTCOME MEASURE The duration, frequency, and amount of FI were used as predictors for IAD. Nurses were asked if the participants suffered from IAD based on their clinical judgment (yes/no). MAIN RESULTS In total, 1,513 participants with FI were included in this analysis. More than 75% of the participants with FI were to a great extent or completely care dependent. Of all FI participants, nearly 6% suffered from IAD, and more than 70% received special skin care for IAD prevention. Participants with FI had the highest risk of developing IAD if they experienced FI every day, had FI for less than 3 months, and had developed the FI in their current institution. CONCLUSIONS Nurses face many challenges while helping patients with FI maintain healthy skin. Knowledge of the results of this study and accumulated knowledge about the specific characteristics of FI that are associated with the development of IAD can help healthcare personnel prevent IAD. Based on these results, improving patient education for persons with newly diagnosed FI to prevent IAD is recommended. Research studies should use the definition of FI established by the International Continence Society.
Collapse
Affiliation(s)
- Manuela Hoedl
- At the Medical University of Graz, Institute of Nursing Science, in Styria, Austria, Manuela Hoedl, MD, and Doris Eglseer, MD, are Nurse Researchers. The authors have disclosed no financial relationships related to this article. Submitted January 13, 2020; accepted in revised form February 19, 2020; published ahead of print December 4, 2020
| | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical presentation, investigations, and treatment options for lower urinary tract and bowel dysfunction in patients with neurologic diseases. RECENT FINDINGS The site of the neurologic lesion influences the pattern of lower urinary tract dysfunction. Antimuscarinic agents are first-line management for urinary incontinence; however, the side effect profile should be considered when prescribing them. β3-Receptor agonists are a promising alternative oral medication. Botulinum toxin injections into the detrusor have revolutionized the management of neurogenic detrusor overactivity.Bowel dysfunction commonly presents as constipation and fecal incontinence. Gastrointestinal emergencies may arise, including intestinal pseudoobstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation. SUMMARY Functions of the lower urinary tract and bowel are commonly affected in neurologic disease. Neurologists play an important role in assessing lower urinary tract and bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams.
Collapse
|
48
|
Rangan V, Nee J, Singh P, Ballou S, Iturrino J, Hirsch W, Lembo A. Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea. Dig Dis Sci 2020; 65:3679-3687. [PMID: 32468228 DOI: 10.1007/s10620-020-06349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fecal urgency is classically associated with diarrhea, but is also common in individuals with normal bowel habits or constipation. Its etiology, particularly in non-diarrhea individuals, is unclear. METHODS We examined data from 368 individuals with and without diarrhea who underwent three-dimensional high-resolution anorectal manometry and balloon expulsion test. All patients completed the Rome III constipation module and the pelvic floor distress inventory (PDFI-20) survey. Patients were considered to have fecal urgency if they reported being bothered "moderately" or "quite a bit" by it in the past 3 months. RESULTS A total of 103 patients (28.0%) met our definition of fecal urgency. These patients were significantly more likely to meet criteria for irritable bowel syndrome and to report fecal incontinence, urinary incontinence, and diarrhea. Fecal urgency was associated with rectal hypersensitivity in those with diarrhea, but not in those without diarrhea. Fecal urgency was associated with urinary urge incontinence in those without diarrhea, but not those with diarrhea. CONCLUSIONS In patients with diarrhea, fecal urgency is associated with rectal hypersensitivity, whereas in patients without diarrhea, fecal urgency is associated with urinary urge incontinence. This suggests that fecal urgency has different pathophysiological mechanisms in patients with different underlying bowel habits.
Collapse
Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Prashant Singh
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sarah Ballou
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Johanna Iturrino
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - William Hirsch
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anthony Lembo
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
49
|
de Almeida RVS, Silvino JRC, Kalil JR, Dos Santos VL, de Souza VMG, Pontes J, Guglielmetti GB, Sanchez-Salas RE, Claro JFDA, Murta CB. Early Effects of High-intensity Focused Ultrasound (HIFU) Treatment for Prostate Cancer on Fecal Continence and Anorectal Physiology. Urology 2020; 148:211-216. [PMID: 33080255 DOI: 10.1016/j.urology.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate high-intensity focused ultrasound (HIFU) effects on anorectal physiology and fecal continence or constipation, and on quality of life (QoL). METHODS We prospectively evaluated 26 patients with localized prostate cancer who underwent HIFU. The Rome III criteria for functional constipation, the Cleveland Clinic Florida Fecal Incontinence Score, and the Fecal Incontinence QoL Score questionnaires were answered before and after treatment. Anorectal manometry was used to evaluate resting and squeezing pressures, sustained contraction, paradoxical puborectalis contraction, rectal sensation, and rectal capacity. RESULTS Thirteen patients underwent hemiablation and 13 underwent whole-gland ablation. There was no difference between groups regarding the Rome III criteria for functional constipation results. The Cleveland Clinic Florida Fecal Incontinence Score results showed that 3 (11.5%) of patients had mild fecal incontinence before HIFU and 5 (19.2%) had it afterward (P = .625). No patients reported poor QoL due to fecal incontinence in the Fecal Incontinence QoL Score. Anorectal manometry demonstrated no decrease in resting pressure after treatment (P = .299), while squeezing pressure significantly increased from 151.87 to 167.91 mm Hg (P = .034). The number of patients with normal sustained contraction remained the same (20 [77%]). Paradoxical puborectalis contraction was seen in 12 (46%) of the patients before the procedure and in 13 (50%) after (P = .713). Improvement in sensory parameters was not significant: first sense changed from 73.46 to 49.71 mL (P = .542) and first urge from 98.27 to 82.88 mL (P = .106). Rectal capacity had a nonsignificant decrease from 166.15 to 141.15mL (P = .073). CONCLUSION HIFU did not cause significant changes in anorectal physiology. Fecal incontinence or constipation after HIFU was not observed via validated questionnaires.
Collapse
Affiliation(s)
| | | | - Jamile Rosario Kalil
- Department of Gastrointestinal motility, University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Jose Pontes
- Department of Urology, Men's Health Centre, Hospital Brigadeiro, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
50
|
Tay C, Yuh AS, Sheau Lan EL, Ong CE, Aloweni F, Lopez V. Development and validation of the incontinence associated dermatitis knowledge, attitude and practice questionnaire. J Tissue Viability 2020; 29:244-251. [PMID: 32773358 DOI: 10.1016/j.jtv.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 05/04/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023]
Abstract
AIM This study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses. METHODS A psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability. RESULTS The instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69-0.96, p < 0.001). CONCLUSION The KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses' KAP and associations between IAD knowledge, attitudes and practices.
Collapse
Affiliation(s)
- Cheryl Tay
- National University of Singapore, Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, Singapore.
| | - Ang Shin Yuh
- Singapore General Hospital, Nursing Department, Singapore.
| | | | - Choo Eng Ong
- Singapore General Hospital, Nursing Department, Singapore
| | - Fazila Aloweni
- Singapore General Hospital, Nursing Department, Singapore.
| | - Violeta Lopez
- National University of Singapore, Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, Singapore; School of Nursing, Hubei University of Medicine, Shiyan, China.
| |
Collapse
|