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 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.

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.

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.

scholarly journals Evaluation of Development of Cooperation in South Bohemian Municipalities in the Years 2007–2014

2017 ◽  
Vol 9 (2) ◽  
pp. 342-358 ◽  
Author(s):  
Jiří Dušek
Keyword(s):  
Czech Republic ◽  
Statistical Methods ◽  
Rural Areas ◽  
Current Problem ◽  
Descriptive Statistics ◽  
Financial Resources ◽  
Healthy Cities ◽  
The Czech Republic ◽  
A Current ◽  
Action Groups

Abstract The article presents results of the research of cooperation of municipalities in the South Bohemian Region, focused on the analysis of forms and means of cooperation between 2007 and 2014. The published results are part of an internal research that lasted for many years, the goal of which was both to analyse the development of cooperation of municipalities in the studied region and to identify the prerequisites and barriers of all cooperative relations. The research was done on a sample of 623 South Bohemian municipalities in the period of 2007-2010 and 2013- 2016, the obtained data was processed using descriptive statistics and multidimensional statistical methods, and the results show an almost 20% increase in the means of municipal cooperation across the entire South Bohemian Region. Based on the respective means of cooperation, National Healthy Cities Network of the Czech Republic saw the biggest growth, amounting to +3.275% between 2007 and 2014. Participation in local action groups, where the total of 580 municipalities are already engaged, increased by 32.12%. Although less dynamic, this growth is much more important, as it significantly contributes to the development of rural areas and their absorption abilities, mainly as regards financial resources from the national and European sources. However, fragmented means of municipal cooperation is a current problem of cooperation of municipalities, leading to the disintegrated power of the respective municipalities.

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.

scholarly journals ADESÃO ÀS MEDIDAS PARA PREVENÇÃO DA INFECÇÃO DA CORRENTE SANGUÍNEA RELACIONADA AO CATETER VENOSO CENTRAL

2017 ◽  
Vol 8 (2) ◽  
Author(s):  
Alanna Gomes Da Silva ◽  
Adriana Cristina De Oliveira
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Descriptive Statistics ◽  
Intervention Period ◽  
Central Venous ◽  
Post Intervention ◽  
Period Analysis ◽  
Quasi Experimental ◽  
Terapia Intensiva

Objetivo: verificar a adesão da equipe multiprofissional para as medidas de prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central. Metodologia: estudo quase-experimental, realizado na unidade de terapia intensiva de um hospital de urgência e emergência. A população foi composta pelas equipes médicas e de enfermagem. A coleta de dados ocorreu em três fases distintas: Período pré-intervenção, Período de intervenção e Período pós-intervenção. As análises foram por meio de estatística descritiva e pelos testes ?² de Pearson e exato de Fisher. Resultados: verificou-se uma baixa adesão global pelos enfermeiros e técnicos, especialmente à higiene das mãos (22,7%) e desinfecção do hub (10,4%) e uma adesão de 100% da equipe médica ao utilizar a barreira máxima de precaução. Conclusão: mesmo com um resultado satisfatório para a inserção dos cateteres nos períodos pré e pós-intervenção, essas medidas não representam completa adesão pela equipe de enfermagem.Descritores: Infecções Relacionadas a Cateter, Unidades de Terapia Intensiva, Cateteres Venosos Centrais.ADHERENCE TO MEASURES TO PREVENT BLOODSTREAM INFECTION RELATED TO THE CENTRAL VENOUS CATHETERObjective: To verify the multiprofessional staff adherence to measures to prevent bloodstream infection related to the central venous catheter. Methodology: A quasi-experimental study, carried out at an intensive care unit from emergency and urgency hospital. The population was composed by medical and nursing staff. Data collection took place in three distinct phases: Pre-intervention period, intervention period and post-intervention period. Analysis were made through descriptive statistics and Pearson’s ?² and Fisher’s exact tests. Results: There was a low overall adherence by nurses and technicians, especially to hand hygiene (22.7%) and hub disinfection (10.4%), and a 100% adherence from medical staff when using the maximum barrier of precaution. Conclusion: Even with a satisfactory result for catheters insertion in the pre-and post-intervention periods, these measures are not enough when the catheter maintenance measures are not fully adhered by the nursing team.Descriptors: Catheter-Related Infections, Intensive Care Units, Central Venous Catheters.ADHESIÓN PARA LA PREVENCIÓN DE INFECCIÓN DEL TORRENTE SANGUÍNEO RELACIONADAS CON EL CATÉTER VENOSO CENTRALObjetivo: Determinar la adhesión de miembros del equipo multiprofesional para la prevención de infección del torrente sanguíneo relacionadas con el catéter venoso central. Metodología: Estudio cuasi-experimental realizado en una unidad de cuidados intensivos de un hospital de emergencia y urgencia. La población estaba compuesta por el personal médico y de enfermería. La recolección de datos ocurrió en tres fases: periodo previo a la intervención; Período de intervención y después de la intervención. Los análisis fueron hechos por la estadística descriptiva y las pruebas de ?² de Pearson y la prueba exacta de Fisher. Resultados: Se observó una baja de miembros en general por las enfermeras y los técnicos, especialmente higiene de las manos (22,7%) y la desinfección del hub (10,4%) y una membresía de 100% del personal médico usando la barrera máximo precaución. Conclusión: Incluso con un resultado satisfactorio para la inserción de catéteres en el pre y post-intervención, estas medidas no son suficientes cuando las medidas para el mantenimiento de los catéteres no se cumplen por completo por el personal de enfermería.Descriptores: Infecciones Relacionadas con Catéteres, Unidades de Cuidados Intensivos, Catéteres Venosos Centrales.

scholarly journals Singapore Mandarin Chinese

2018 ◽  
Vol 9 (2) ◽  
pp. 109-135
Author(s):  
Jingxia Lin ◽  
Yong Kang Khoo
Keyword(s):  
Mandarin Chinese ◽  
Language Contact ◽  
Mainland China ◽  
Descriptive Statistics ◽  
Major Contributor ◽  
C Language ◽  
Future Studies ◽  
Individual Variations ◽  
Evaluation Of Data ◽  
A Current

Abstract Given the historical and linguistic contexts of Singapore, it is both theoretically and practically significant to study Singapore Mandarin (SM), an important member of Global Chinese. This paper aims to present a relatively comprehensive linguistic picture of SM by overviewing current studies, particularly on the variations that distinguish SM from other Mandarin varieties, and to serve as a reference for future studies on SM. This paper notes that (a) current studies have often provided general descriptions of the variations, but less on individual variations that may lead to more theoretical discussions; (b) the studies on SM are primarily based on comparisons with Mainland China Mandarin; (c) language contact has been taken as the major contributor of the variation in SM, whereas other factors are often neglected; and (d) corpora with SM data are comparatively less developed and the evaluation of data has remained largely in descriptive statistics.

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