Transanal irrigation systems for managing bowel dysfunction: a review

2020 ◽  
Vol 18 (5) ◽  
pp. 18-28
Author(s):  
Alison Bardsley
Keyword(s):  
Balloon Catheter ◽  
High Volume ◽  
Distal Colon ◽  
Bowel Dysfunction ◽  
Transanal Irrigation ◽  
Balloon Catheters ◽  
Effective Use ◽  
Training And Support ◽  
Specialist Clinician

Transanal irrigation (TAI) is used to treat bowel dysfunction, including faecal incontinence and constipation, where physical exercises, dietary changes and/or medication alone are insufficient. During TAI, water is instilled via the anal canal into the distal colon, and the water expels the faecal contents via wash out and/or stimulating colonic peristalsis. This can reduce the severity and frequency of bowel dysfunction, hospitalisation rate, management time and treatment costs and promotes dignity, independence and quality of life. Different TAI systems are available that instil a low or high volume of water, through a balloon catheter or a cone, using a manual or electric pump or a gravity feed. Balloon catheters are secure, convenient and comfortable, while cone systems may be considered less invasive but require patient or carer dexterity to be held in place. Low-volume systems are compact and convenient, but high-volume systems achieve better results for some conditions. Gravity-fed systems need to be suspended above the user, while electric pumps may be cumbersome. Bed systems are designed for patients who are bedbound or require hoisting. The optimal system should be selected based on assessment, informed by clinical need and patient preference. Users must be assessed by a specialist clinician for contraindications, comorbidities and capacity to consent. The clinician should then provide selected patients with ongoing structured training and support to ensure safe and effective use.

Transanal irrigation with Peristeen in neurogenic bowel dysfunction: audit of impact on symptoms and quality of life

2020 ◽  
Vol 18 (3) ◽  
pp. 27-34
Author(s):  
Sandra McCarthy ◽  
Sandra Wallwork ◽  
Bakulesh M Soni
Keyword(s):  
Quality Of Life ◽  
Rectal Bleeding ◽  
Balloon Catheter ◽  
Bowel Dysfunction ◽  
Transanal Irrigation ◽  
Cord Injury ◽  
Faecal Soiling ◽  
Neurogenic Bowel ◽  
The Impact

Background: Spinal cord injury often results in neurogenic bowel dysfunction (NBD). NBD is associated with constipation and faecal incontinence, as well as loss of sensation, faecal loading and faecal leakage, and it has a severe impact on healthcare resources and patient quality of life. NBD is treated conservatively with medication, suppositories, physiotherapy, digital rectal stimulation and digital removal of faeces. Conservative options are not always effective and long-term may lead to haemorrhoids, rectal bleeding, mucosal prolapse and faecal soiling. The National Institute for Health and Care Excellence recommends the use of the Peristeen transanal irrigation system, which instills lukewarm water into the colon via a balloon catheter to stimulate regular and complete bowel movements. Aim: To assess the impact of transanal irrigation with Peristeen on the symptoms and treatments of NBD, as well as patient quality of life and satisfaction, in a regional spinal injury centre. Method: Patients were asked to complete an adapted NBD assessment at consultation when they were prescribed Peristeen and at 8-week follow up. Answers to 10 questions on symptoms and treatment were individually weighted to provide a bowel dysfunction score, excluding two Likert-type questions on quality of life. Results: Patient numbers undergoing digital evacuations once or more a week decreased by more than 50%, and medication use decreased slightly. Patients reported a decrease in the following symptoms: peri-anal skin problems (9%); uneasiness, sweating or headaches (20%); uncontrollable flatus (27%); rectal bleeding (30%); faecal soiling (37%) and involuntary defecation (46%). Mean total bowel dysfunction score decreased by 11.6 from 20.4 to 8.8, and those with dysfunction categorised as severe decreased by 64% from 80% to 16%. Average negative emotional wellbeing improved from 4.0 to 1.2, and mean satisfaction increased from 3.2 to 7.3. Conclusion: According to the study findings, Peristeen is observed to improve quality of life in spinal NBD, and it is effective at reducing both associated symptoms and the need for digital rectal stimulation and digital removal of faeces.

CURRENT SITUATION OF MANAGEMENT AND USE OF TEACHING EQUIPMENT UNDER ORIENTATIONS FOR DEVELOPING STUDENT CAPACITY IN LOWER SECONDARY SCHOOLS IN DIEN BIEN DISTRICT, DIEN BIEN PROVINCE IN THE PRESENT PERIOD

2019 ◽  
Vol 8 (4) ◽  
Author(s):  
Pham Van Phuc ◽  
Ngo Quang Son
Keyword(s):  
Secondary Schools ◽  
Teaching Methods ◽  
Time Management ◽  
Current Trend ◽  
Equipment Management ◽  
Full Time ◽  
Special Cases ◽  
Effective Use ◽  
Lower Secondary Schools

Last time, management of equipment, maintenance and use of teaching equipment in lower secondary schools in Dien Bien district, Dien Bien province has been paid more attention, making important contributions to keeping sustainably, improve the quality of education in the district. Every year the lower secondary schools have been given funding and have plans to equip additional teaching equipment. Most lower secondary schools have full-time staff in charge of teaching equipment; with equipment storage rooms, cabinets are gradually added; laboratories and classrooms have been built more and more; have a system of records of teaching equipment management established; The work of inventorying and purifying teaching equipment periodically was also concerned. The movement of innovating teaching methods has made education managers and teachers more interested in using teaching equipment effectively. The positive management measures have caused many teachers to use teaching equipment as an integral part of the lesson, helping the quality of the lessons be increasingly improved to meet the requirements of changes. New teaching methods. Education administrators, teachers, teaching equipment staff are becoming more and more serious in teaching device management. However, the reality of teaching equipment management still reveals many limitations: The management of teaching equipment in schools is still administrative and ineffective. The equipment has no overall and detailed plans; The procurement of teaching equipment is not guaranteed in terms of quantity, lack of uniformity (some are redundant, some are lacking), quality is limited (durability, accuracy is not guaranteed, some new ones are not used); preservation still has many shortcomings; lack of specialized staff; lack of storage space or insufficient storage; lack of cabinets, prices, laboratories, subject classrooms; specially managing the use of teaching equipment is not tight; Many places teachers have not paid attention to use, ineffective use. The situation of “teaching vegetarianism” is still common, teaching equipment used is still movement, mostly used only in special cases such as competitions for good teachers, lectures or when there is a delegation check; There are many cases of information technology abuse in teaching. The effective use of teaching equipment oriented student capacity development is not much. The management of the use of teaching equipment oriented to develop student competencies in the current trend of Industry Revolution 4.0 is a matter of great concern to educational managers.Thus, the task of surveying the situation of managing the effective use of teaching equipment, finding subjective and objective reasons in order to propose measures to effectively manage the use of teaching equipment in the direction of developing students’ practical capacities and contributing to improving the quality of teaching in secondary schools in Dien Bien district, Dien Bien province is a very important and necessary task today.

scholarly journals Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Josephine Obel ◽  
Antonio Isidro Carrion Martin ◽  
Abdul Wasay Mullahzada ◽  
Ronald Kremer ◽  
Nanna Maaløe
Keyword(s):  
Quality Of Care ◽  
Birth Outcomes ◽  
Birth Outcome ◽  
High Volume ◽  
Maternal Health Service ◽  
Service Access ◽  
Intrapartum Care ◽  
Health Service Access ◽  
Low Volume

Abstract Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

scholarly journals Face Grinding Surface Quality of High Volume Fraction SiCp/Al Composite Materials

2021 ◽  
Vol 34 (1) ◽  
Author(s):  
Xu Zhao ◽  
Yadong Gong ◽  
Guiqiang Liang ◽  
Ming Cai ◽  
Bing Han
Keyword(s):  
Friction Coefficient ◽  
Surface Morphology ◽  
Surface Quality ◽  
Volume Fraction ◽  
High Volume ◽  
Spindle Speed ◽  
High Volume Fraction ◽  
Machining Parameters ◽  
Al Composite

AbstractThe existing research on SiCp/Al composite machining mainly focuses on the machining parameters or surface morphology. However, the surface quality of SiCp/Al composites with a high volume fraction has not been extensively studied. In this study, 32 SiCp/Al specimens with a high volume fraction were prepared and their machining parameters measured. The surface quality of the specimens was then tested and the effect of the grinding parameters on the surface quality was analyzed. The grinding quality of the composite specimens was comprehensively analyzed taking the grinding force, friction coefficient, and roughness parameters as the evaluation standards. The best grinding parameters were obtained by analyzing the surface morphology. The results show that, a higher spindle speed should be chosen to obtain a better surface quality. The final surface quality is related to the friction coefficient, surface roughness, and fragmentation degree as well as the quantity and distribution of the defects. Lower feeding amount, lower grinding depth and appropriately higher spindle speed should be chosen to obtain better surface quality. Lower feeding amount, higher grinding depth and spindle speed should be chosen to balance grind efficiently and surface quality. This study proposes a systematic evaluation method, which can be used to guide the machining of SiCp/Al composites with a high volume fraction.

scholarly journals The emergence of coercive federal Australian labour law, 1901–2020

2021 ◽  
pp. 002218562110039
Author(s):  
Eugene Schofield-Georgeson
Keyword(s):  
Industrial Relations ◽  
High Volume ◽  
Union Power ◽  
Labour Law ◽  
Industrial Environment ◽  
The Past ◽  
Low Levels ◽  
Labour Legislation ◽  
Employment Legislation

Over the past two decades, industrial relations scholarship has observed a trend towards an increasingly punitive industrial environment along with the ‘re-regulation’ of labour law. Absent from much of this literature, however, has been an empirical and historical measurement or comparison of the scale and quality of this systemic change. By surveying coercive and penal federal industrial legislation over the period 1901–2020, this study shows empirically that over the last 40 years, there has been a steep increase in the amount of coercive federal labour legislation in Australia. It further measures and compares the volume of coercive labour legislation enacted specifically against ‘labour’ and ‘capital’ or both throughout the same period (1901–2020). Analysis reveals a correlation between a high volume of coercive labour legislation with low levels of trade union power and organisation. Argued here is that coercive labour legislation has been crucial to transitioning from a liberal conciliation and arbitration model of Australian industrial relations towards a neoliberal framework of employment legislation. In the former, regulation was more collective, informal and egalitarian (embodied by the sociological concept of ‘associative democracy’). Under a neoliberal framework, regulation is now more individualised, technical, punitive and rarely enforced, resulting in less equal material outcomes.

Defecation Induced by Stimulation of Sacral S2 Spinal Root in Cats

2021 ◽  
Author(s):  
Jicheng Wang ◽  
Zhijun Shen ◽  
Bing Shen ◽  
Jianan Jian ◽  
Travis Hannan ◽  
...  
Keyword(s):  
Distal Colon ◽  
Spinal Nerve ◽  
Ventral Root ◽  
Spinal Root ◽  
Balloon Catheters ◽  
Minimally Invasive Surgical ◽  
Lead Electrode ◽  
Cord Injury ◽  
Minute Duration ◽  
Stimulation Of

The aim of this study was to determine if stimulation of sacral spinal nerve roots can induce defecation in cats. In anesthetized cats, bipolar hook electrodes were placed on the S1-S3 dorsal and/or ventral roots. Stimulus pulses (1-50 Hz, 0.2 ms) were applied to an individual S1-S3 root to induce proximal/distal colon contractions and defecation. Balloon catheters were inserted into the proximal and distal colon to measure contraction pressure. Glass marbles were inserted into the rectum to demonstrate defecation by videotaping the elimination of marbles. Stimulation of the S2 ventral root at 7 Hz induced significantly (p<0.05) larger contractions (32±9 cmH2O) in both proximal and distal colon than stimulation of the S1 or S3 ventral root. Intermittent (5 times) stimulation (1 minute on and 1 minute off) of both dorsal and ventral S2 roots at 7 Hz produced reproducible colon contractions without fatigue, while continuous stimulation of 5-minute duration caused significant fatigue in colon contractions. Stimulation (7 Hz) of both dorsal and ventral S2 roots together successfully induced defecation that eliminated 1-2 marbles from the rectum. This study indicates the possibility to develop a novel neuromodulation device to restore defecation function after spinal cord injury using a minimally invasive surgical approach to insert a lead electrode via the sacral foramen to stimulate a sacral spinal root.

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