scholarly journals 130 Improving Documentation of Bowel Movement on Geriatric Wards

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
A Noar ◽  
J Parkin ◽  
R Hallam ◽  
T Wijekoon ◽  
C Walker ◽  
...  
Keyword(s):  
Group Work ◽  
Bowel Movement ◽  
Behavioural Change ◽  
Baseline Data ◽  
Geriatric Ward ◽  
Post Intervention ◽  
Fishbone Diagram ◽  
Bowel Movements ◽  
Sustained Change ◽  
Ward Rounds

Abstract Introduction Constipation is a widely prevalent issue in older adults that may result in complications such as urinary retention, delirium and bowel obstruction. Previous studies have indicated that while stool charts are well completed by nursing staff, they are infrequently monitored by doctors. This project aimed to improve the documentation of bowel movement by doctors on ward rounds to 85%, by the end of a 3-month period. Methods Formulation of the project was achieved using group work and a fishbone diagram which focussed on how doctors can improve on documenting bowel movements. Baseline data were collected from inpatient notes on weekdays over a three-week period on a geriatric ward in Northern General Hospital, Sheffield. Interventions of posters and stickers of the poo emoji were placed on walls and in inpatient notes respectively as a reminder. Post-intervention data were collected on weekdays over two weeks, and then repeated a month later to assess for a sustained change. Results The data on bowel activity documentation were collected from 28 patients. The baseline data showed that bowel activity was monitored daily on the ward 56.25% of the time. There was a significant increase in documentation of 85.75% following the interventions. The sustainability study showed that bowel activity was documented on the ward 59.09% of the time. Conclusions This study shows how a strong effect on behavioural change can be accomplished through simple interventions such as stickers and posters. As most wards currently still use paper notes, this is a generalisable model that other wards can trial. However, this study also shows the difficulty in maintaining behavioural change over extended periods of time. Further PDSA cycles should examine the reasons behind the difficulty sustaining the change and implement new changes that aim to overcome them.

scholarly journals 18 The Use of A Multifactorial Intervention to Improve Bowel Chart Recording and Laxative Prescription in A Tertiary Geriatrics Department

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
A Ji-Xu ◽  
C Moezinia ◽  
N Lovett ◽  
D Krishan Sharma
Keyword(s):  
Bowel Movement ◽  
Descriptive Statistics ◽  
Multifactorial Intervention ◽  
Post Intervention ◽  
Faecal Impaction ◽  
High Prevalence ◽  
Bowel Movements ◽  
A Current ◽  
Chart Recording ◽  
Healthcare Assistant

Abstract Introduction Constipation has a high prevalence of 30-40% in those aged over 65. It can lead to complications including delirium, faecal impaction, stercoral ulceration, and bowel obstruction. Although stool charts are used in geriatric wards to monitor bowel movements to guide management of constipation, they are often inconsistently recorded. Similarly, regular laxatives are often not prescribed for constipated patients due to ward pressures or unawareness regarding their importance. Aims Our aims were to audit the rates of recording on stool charts and laxative prescription in a geriatrics department, and to assess whether a multifactorial intervention aimed at both doctors and nursing staff improved these rates. Methods Two independent assessors audited the recording of stool charts, and rates of constipating medications and laxative prescription in two geriatrics wards in a tertiary UK hospital. A multifactorial intervention was implemented, consisting of didactic sessions for doctors and nurses, healthcare assistant champions to promote the recording of stool charts, and consolidation of bowel movement recording onto a single paper stool chart by the bedside rather than multiple charts. After the intervention, the data was re-audited on the same wards. Descriptive statistics and frequency tabulation were used for data analysis. Results Data was collected from 33 patients. Pre-intervention, stool charts were recorded daily in 13 patients, 10 patients had no stool chart record, 20 patients were on at least one constipating medication, 12 patients were prescribed at least one laxative, and 5 out of 7 patients with opiates had laxatives co-prescribed. Post-intervention, stool charts were recorded daily in 21 patients, all patients had a stool chart record, 20 patients were on at least one constipating medication, 23 patients were prescribed at least one laxative, and 2 out of 4 patients with opiates had laxatives co-prescribed. Our intervention improved daily recording on stool charts by 24%, resulted in all patients having a current stool chart and improved prescription of regular laxatives by 34%. Conclusions A multifactorial intervention based on educational sessions, healthcare assistants acting as champions, and consolidation of recording of bowel movements into a single chart, improved stool chart recording and prescription of regular laxatives in a tertiary geriatrics department. Future auditing will extend the sample size and generalise the intervention to other hospital departments.

scholarly journals Enhancing Class IX Students Participants in Group Work in Chemistry

2019 ◽  
pp. 1-12
Author(s):  
Dorji Penjor ◽  
Galay Wangchuk ◽  
Lam Dorji ◽  
Sangay Dorji ◽  
Choki Wangmo
Keyword(s):  
Group Work ◽  
Science Research ◽  
Baseline Data ◽  
Heterogeneous Grouping ◽  
Post Intervention ◽  
Group Activities ◽  
Intervention Process ◽  
Group Members ◽  
Students Success ◽  
Difficult Subject

This action research has investigated ways to enhance students’ participation in group work in chemistry. It is observed that Bhutanese students participate minimally in group activities especially in science. Most   Bhutanese students shy away from participating or interacting in the classroom. To enhance participation and interaction, the curriculum experts developed the curriculum considering the need of every students in Bhutan in science. Research in Bhutan found out that heterogeneous grouping is an effective way to maximize students’ success and collaborative learning is effective for meaningful learning and in solving problems. Some researchers found that in Bhutan science subjects are seen as difficult for both students and teachers. Through our experience of being science student, we saw that many students do not like to study Chemistry because they believe it is a difficult subject. Aim of this study is to identify effectiveness strategies that teacher can use to enhance students’ participation in group work in Chemistry. This study was carried out with class IX students of Taktse Central School. We collected our data through observation and questionnaire. A tally was used to record their participation in the group such as the frequency volunteering to do presentation and taking initiatives in the group work. The data collection also involved survey questionnaire which consist of open ended questions.  Baseline data was collected and analyzed after which intervention strategies, such as allocation of group members and cooperative-learning methods was applied. After two months of the intervention process, post-intervention data was collected, analyzed and compared with the baseline data. The findings from this two sources reveal that students are more open for discussion and participation after the intervention process, and their initiative, contribution and understanding of contents increased. We were impressed by some student, who were usually quiet, shy and unsociable themselves to the teacher, became so close with us toward the end of our academic session.

Chronic Nonspecific Diarrhea

1996 ◽  
Vol 17 (11) ◽  
pp. 379-384
Author(s):  
Robert H. Judd
Keyword(s):  
Child Care ◽  
Young Child ◽  
Physical Examination ◽  
Bowel Movement ◽  
Laboratory Evaluation ◽  
Gastrointestinal Disorders ◽  
Office Visits ◽  
Case Presentation ◽  
Abdominal Symptoms ◽  
Bowel Movements

Case Presentation A toddler is seen for his 2-year well child examination. His parents are concerned and have received complaints from his child care provider that he has three to four loose, watery bowel movements daily; each bowel movement requires a clean-up and change of clothes. This diarrhea has been present intermittently for at least 6 months. He has a very good appetite, no other abdominal symptoms, and no blood in his stools. His development appears normal. Physical examination is entirely normal, including a weight of 13 kg and height of 90 cm, both at the 75th percentile for age. What additional history is useful, what laboratory evaluation would you perform, and how would you advise his parents? Introduction Gastrointestinal disorders account for approximately 5% of pediatric office visits. Many of these visits are for acute diarrhea that usually is infectious in origin and resolves in fewer than 7 days. Diarrhea in the young child that persists for longer than 3 weeks is termed chronic and can be frustrating and anxiety provoking for both physicians and parents. Through careful clinical assessment, the clinician can separate the majority of patients who require only observation from those who require a limited number of simple tests or those who require extensive testing. Definition

scholarly journals Severe Postoperative Chronic Constipation Related to Anorectal Malformation Managed with Osteopathic Manipulative Treatment

2020 ◽  
Vol 14 (1) ◽  
pp. 220-225
Author(s):  
Luca Vismara ◽  
Vincenzo Cozzolino ◽  
Luca Guglielmo Pradotto ◽  
Riccardo Gentile ◽  
Andrea Gianmaria Tarantino
Keyword(s):  
Pelvic Floor ◽  
Chronic Constipation ◽  
Anorectal Malformation ◽  
Bowel Movement ◽  
Functional Constipation ◽  
Good Prognosis ◽  
Osteopathic Manipulative Treatment ◽  
Severe Constipation ◽  
Bowel Movements ◽  
Functional Alteration

Constipation is frequent amongst infants who have undergone surgery for anorectal malformation (ARM). Faecal retention, due to a dysfunctional enteric reflex of defaecation, can cause abdominal cramps, pseudoincontinence and, in the worst cases, megacolon. Prokinetic protocols are used to stimulate at least 1 bowel movement per day, including laxatives, enema, stools softeners and dietary schedules. While osteopathic manipulative treatment is adopted in adults for functional constipation, it has not been described for infants. Herein, we report the case of an infant undergoing anorectoplasty for a low ARM who was referred to the osteopath 2 years after the onset of severe constipation associated with pseudoincontinence and abdominal cramps and was refractory to the prokinetic protocol. In a child with a good ARM prognosis, autonomous daily bowel movements should be achieved. In this child, the imbalanced tension of the pelvic floor and immaturity of the parasympathetic plexus led to a functional alteration of the defaecation reflex. After adjunction of osteopathic manipulative treatment (OMT) to the therapeutic panel, the constipation showed gradual remission, with acquisition of autonomous defaecation 4 months after the therapy began. This suggests the importance of investigating the efficacy of OMT inclusion in the postsurgical prokinetic protocols for ARM patients with a good prognosis.

scholarly journals Geriatric ward rounds by video conference: a solution for rural hospitals

2009 ◽  
Vol 191 (11-12) ◽  
pp. 605-608 ◽  
Author(s):  
Leonard C Gray ◽  
Olivia R Wright ◽  
Alison J Cutler ◽  
Paul A Scuffham ◽  
Richard Wootton
Keyword(s):  
Rural Hospitals ◽  
Video Conference ◽  
Geriatric Ward ◽  
Ward Rounds

P121 REAL WORLD PREVALENCE OF BOWEL MOVEMENT URGENCY – A SNAPSHOT OF SYMPTOM EXPERIENCE REPORTED BY PATIENTS WITH ULCERATIVE COLITIS PARTICIPATING IN SPARC IBD

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S44-S45
Author(s):  
April Naegeli ◽  
Yan Dong ◽  
Xian Zhou ◽  
Nathan Morris ◽  
Vipin Arora ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Real World ◽  
Ad Hoc ◽  
Bowel Movement ◽  
Severe Disease ◽  
Symptom Experience ◽  
Biologic Treatment ◽  
Patient Reported ◽  
Bowel Movements

Abstract Background Urgency, also referred to as bowel movement urgency or bowel urgency, is the sudden need for a bowel movement. Bowel urgency is one of the most bothersome and important symptoms experienced by patients with ulcerative colitis (UC), contributing to decrements in quality of life. Bowel urgency is distinct from the common symptoms associated with UC, namely stool frequency and rectal bleeding, however patients often experience all symptoms, urgent, frequent bowel movements with bleeding, concurrently. Bowel movement urgency is a key symptom for triggering clinical consideration of UC diagnosis and for defining more severe disease activity in clinical practice. Methods The results published here are based on data obtained from the IBD Plexus program of the Crohn’s & Colitis Foundation. To better understand the prevalence of bowel movement urgency in patients with UC, an ad hoc analysis was performed using data from a Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study of adult patients with IBD that collects and links clinical data, patient-reported outcome (PRO) data, and serial bio-samples throughout the course of the patients’ disease. The enrollment visit was defined as 7 days from the patients’ date of enrollment in SPARC IBD. At study enrollment, patients were asked to answer questions based on their symptom experiences. Patients reported how much urgency they experienced before bowel movements on average during the past 3 days (none, mild, moderate, moderately severe, severe, not applicable). Descriptive analyses for patient demographic and disease characteristics were conducted. Additionally, contingency table analyses were conducted exploring the association of urgency with other UC symptoms and other measures of UC disease severity. Results Of 1,833 patients included in the SPARC IBD data cutoff of May 13, 2019 (Enrolled from 08 November 2016 to 15 May 2019), 582 were patients with UC, of which 514 had urgency data available. Overall, 51.8% of patients were male, and the mean age is 42.4 years (Table 1). At enrollment, 59.7% of patients reported some level (mild, moderate, moderately severe/severe) of urgency. Forty-six percent of UC patients with urgency data were receiving biologic treatment with 31% still reporting mild urgency, and 32% reporting moderate to severe urgency (Table 1). The severity of urgency was associated with patient reported severity of other UC symptoms and disease activity (Table 2). Conclusion Results from ad hoc analyses using a real-world sample of patients with UC suggest that bowel movement urgency is a prevalent symptom of UC which varies with disease activity.

scholarly journals INFLUENCE OF DRINKING A PROBIOTIC FERMENTED MILK BEVERAGE CONTAINING BIFIDOBACTERIUM ANIMALIS ON THE SYMPTOMS OF CONSTIPATION

2017 ◽  
Vol 54 (3) ◽  
pp. 206-210 ◽  
Author(s):  
Thaís Rodrigues MOREIRA ◽  
Daiane LEONHARDT ◽  
Simara Rufatto CONDE
Keyword(s):  
Bowel Movement ◽  
Intervention Group ◽  
Fermented Milk ◽  
Wilcoxon Test ◽  
Control Group ◽  
Rome Iii Criteria ◽  
Post Intervention ◽  
Bifidobacterium Animalis ◽  
Incomplete Evacuation ◽  
Rome Iii

ABSTRACT BACKGROUND Constipation is a chronic problem in many patients all over the world. OBJECTIVE - To evaluate the effect of consumption of a probiotic fermented milk beverage containing Bifidobacterium animalis on the symptoms of constipation. METHODS - This randomized, double-blind controlled trial included 49 female patients aged 20 to 50 years and diagnosed with constipation according to the ROME III criteria (Diagnostic Criteria for Functional Gastrointestinal Disorders) and the Bristol Stool Form Scale. The patients were randomized into two groups: the intervention group received the probiotic fermented milk beverage and the control group received non-probiotic milk. Participants were instructed to ingest 150 mL of the beverages during 60 days. At the end of this period, patients were assessed again by the ROME III criteria and Bristol scale. The Wilcoxon test was used to evaluate pre and post-intervention results of the ROME III criteria and Bristol scale. The statistical significance level was considered as 5% ( P ≤0.05). RESULTS - The intervention group showed improvement in the following criteria: straining during a bowel movement ( P <0.001), feeling of incomplete evacuation ( P <0.001) and difficulty in passing stool ( P <0.014), in addition to Bristol scale results ( P <0.001). In the control group, improvements were observed in the following criteria: straining during a bowel movement ( P <0.001), feeling of incomplete evacuation ( P <0.001) and difficulty in passing stool ( P <0.025), in addition to Bristol scale results ( P <0.001). No statistically significant post-intervention differences were observed between the two groups for the Rome III criteria and Bristol scale. CONCLUSION - The results show that the consumption of milk resulted in the improvement of constipation symptoms, regardless of the probiotic culture.

Relief of bowel-related symptoms with telotristat etiprate in octreotide refractory carcinoid syndrome: Preliminary results of a placebo-controlled, multicenter study.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 312-312 ◽  
Author(s):  
Thomas M. O'Dorisio ◽  
Alexandria T. Phan ◽  
Robert M. Langdon ◽  
Billie J. Marek ◽  
Nadeem Ikhlaque ◽  
...  
Keyword(s):  
Carcinoid Syndrome ◽  
Bowel Movement ◽  
Biochemical Response ◽  
Categorical Variables ◽  
Open Label ◽  
The Past ◽  
Day Range ◽  
Bowel Movements ◽  
Expansion Cohort ◽  
To Receive

312 Background: Diarrhea associated with carcinoid syndrome (CS) has been attributed to tumor production of serotonin. Telotristat etiprate, (LX1032, LX1606), is an oral inhibitor of peripheral serotonin synthesis. This study explored the safety, tolerability, and efficacy of telotristat etiprate in carcinoid patients with octreotide-refractory diarrhea. Methods: Carcinoid patients with >4 bowel movements (BM)/day on octreotide were randomized 3:1 to receive telotristat etiprate or placebo. Patients enrolled in sequential, escalating dose cohorts of 150, 250, 350, or 500 mg tid, followed by a 500 mg tid expansion cohort. Patients were followed for toxicity, 24-hr urinary 5-HIAA (u5-HIAA) secretion, BM frequency, and self-reported relief of bowel-related symptoms. Subjects were asked “In the past 7 days, have you had adequate relief of your carcinoid syndrome bowel complaints such as diarrhea, urgent need to have a bowel movement, abdominal pain or discomfort?” Responses (yes or no) were analyzed as categorical variables. Results: 16 patients enrolled in the 4 escalating dose cohorts and 7 in the expansion cohort; 18 on telotristat etiprate and 5 on placebo. Median age was 62 yrs with a mean 6.2 BMs/day (range 4-10). AEs included primarily mild-moderate diarrhea, nausea, and abdominal discomfort. In treated subjects, adequate relief was reported as follows: Week 1 – 6/18 (33.3%), Week 2 – 5/16 (31.3%), Week 3 - 5/15 (33.3%), and Week 4 – 6/12 (50.0%). No placebo subjects reported improvement at any timepoint. Biochemical response (>50%reduction in u5-HIAA) and BM response (>30% reduction in daily BM for 2 weeks) were associated with reporting of adequate relief. For evaluable telotristat etiprate-treated patients, 9/16 (56%) experienced a biochemical response and 5/18 (28%) experienced a clinical (BM) response; no placebo subjects achieved either biochemical or clinical response. Conclusions: Treatment with telotristat etiprate was associated with decreases in u5-HIAA and BM frequency, and with self-reported relief of bowel related symptoms. Treatment in an extension phase with open-label telotristat etiprate is ongoing.

Reducing the wait time to initiate inpatient chemotherapy at Lyndon B. Johnson Hospital.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 210-210
Author(s):  
Andrew James Wiele ◽  
Trung Nguyen ◽  
Onyebuchi Ononogbu ◽  
Kristyn-Mae Russo ◽  
Phat Le ◽  
...  
Keyword(s):  
Wait Time ◽  
Baseline Data ◽  
Post Intervention ◽  
Port Placement ◽  
Root Cause ◽  
Pdsa Cycle ◽  
Time Stamps ◽  
Administration Time ◽  
Picc Line ◽  
The Impact

210 Background: Delays in initiating inpatient (inpt) chemotherapy (chemo) for planned admissions can decrease patient (pt) satisfaction and increase length of stay and healthcare costs. Our center, a community public teaching hospital, lacked clear standard operating procedures for scheduled chemo admissions, resulting in significant delays. We developed a process improvement initiative to reduce the pt wait time from admission to chemo administration (time to chemo [TTC]). Methods: A multidisciplinary team was formed to clarify workflows and identify root causes prolonging wait times for pts admitted to the inpt chemo unit. We implemented two Plan-Do-Study-Act (PDSA) cycles over a 6-month period. First, in early March, we collaborated with pharmacy and nursing to standardize the inpt chemo operating procedures and extend pharmacy’s evening hours for chemo preparation (prep) from 7pm to 9pm. Second, in early June, we implemented a Pre-admission Checklist that was visibly displayed in clinic for fellows to review with faculty, and began discussing pts scheduled for admission during the daily, multidisciplinary huddle that already occurred on the inpt chemo unit. Using the electronic medical record and available time stamps, baseline data was collected from November-December 2019, post-intervention data for PDSA cycle 1 was collected from March-April 2020, and data collection for PDSA cycle 2 is ongoing. Results: Root cause analysis identified late afternoon admissions and PICC line placements as two main sources for TTC delays. Hospital procedures also limited inpt PICC line placement between 8am-4pm and inpt chemo prep between 7am-7pm. Baseline data revealed 77.4% (24/31) of pts were admitted between 3pm-10pm, the median TTC was 20.4 hrs, and 6.5% (2/31) of pts had chemotherapy initiated within 12 hrs of admission (TTC < 12). Additionally, 56.5% (26/46) of pts had PICC lines placed during their admission, but 69.2% (18/26) of the pts with PICC lines were eligible for outpatient port placement according to institutional intravenous (IV) access guidelines. After PDSA cycle 1, median TTC decreased by 10% to 18.4 hrs, and 33.3% (5/15) of pts had TTC < 12. Conclusions: After standardizing inpt chemo procedures and extending chemo prep times, PDSA cycle 1 resulted in a 10% reduction in TTC and a 26.8% increase in the rate of TTC < 12. Although admission times cannot be controlled at this time, the impact of improving pre-admission planning, and specifically addressing IV access, for PDSA cycle 2 is currently being evaluated and will be reported at the time of abstract presentation.

scholarly journals Analisis Riwayat Pemberian ASI sebagai Pemicu Kejadian Diare Akut pada Anak

2019 ◽  
Author(s):  
Cindy Ayudia Pramaesti
Keyword(s):  
Public Health ◽  
Exclusive Breastfeeding ◽  
Bowel Movement ◽  
Optimal Growth ◽  
Mortality And Morbidity ◽  
Incidence And Mortality ◽  
Global Problems ◽  
Bowel Movements ◽  
Growth Development ◽  
High Degree

Diarrhea is a bowel movement characterized by bowel movements more than 3 times a day with the consistency of liquid stool, can be accompanied by blood. Diarrhea is still global problems with high degree in mortality and morbidity and one of public health problems nowadays. It specifically can be found in the developing countries including Indonesia due to the incidence and mortality. Basic Health Research in 2013 mentions the incidence of diarrhea in children in Indonesia amounted to 6.7%. One of factors that trigger diarrhea is not giving exclusive breastfeeding to infant. Exclusive breastfeeding can prevent diarrhea in children because it increases the immune system in children. Breastfeeding is the best food for babies that has an ideal nutrition content for optimal growth development and health.

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