Who is managing the bowels? A survey of clinical practice patterns in spina bifida clinics

2021 ◽  
pp. 1-5
Author(s):  
Maryellen S. Kelly ◽  
Jennifer Stout ◽  
John S. Wiener
Keyword(s):  
Spina Bifida ◽  
Nurse Practitioners ◽  
Practice Patterns ◽  
Response Rate ◽  
Bowel Dysfunction ◽  
Rehabilitation Medicine ◽  
The United States ◽  
Medical Specialties ◽  
Dissemination Of Research ◽  
Neurogenic Bowel

PURPOSE: Neurogenic bowel dysfunction (NBD) affects 80% of individuals with spina bifida. Performing and disseminating research on NBD to reach the appropriate audience is difficult given the variability among medical specialties managing NBD. This study aimed to identify which medical specialties and types of providers are currently managing NBD in the United States. METHODS: A survey was developed and sent to 75 spina bifida clinics. Surveys queried which specialty was primarily responsible for medical and surgical management of NBD and any others that assist in NBD care. The license and certification level of the providers were collected. Descriptive statistics were performed to describe the results. RESULTS: Response rate was 68%. Urology was the leading specialty primarily responsible for NBD management (39%) followed by rehabilitation medicine and developmental pediatrics (22% and 20%, respectively). Physicians were the primary providers of care followed by nurse practitioners (54% vs 31%). Urology performs 65% of NBD surgeries. CONCLUSION: Multiple specialties and providers are involved in NBD management with variation among clinics. Development of improved NBD care should include a spectrum of specialties and providers. Dissemination of research should be aimed at multiple specialty groups.

scholarly journals Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

2020 ◽  
Vol 13 (4) ◽  
pp. 685-693
Author(s):  
Maryellen S. Kelly ◽  
John S. Wiener ◽  
Tiebin Liu ◽  
Priya Patel ◽  
Heidi Castillo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Spina Bifida ◽  
Research Collaboration ◽  
Statistical Tests ◽  
Private Insurance ◽  
Bowel Dysfunction ◽  
Individual Characteristics ◽  
Treatment Modalities ◽  
Inclusion Criteria ◽  
Neurogenic Bowel

PURPOSE: Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics. METHODS: Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age ⩾ 5 years (n= 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status. RESULTS: At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40–69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged ⩾ 12 years, female, non-Hispanic white, and with private insurance.

Variation in Practice Patterns for the Management of Newborn Spina Bifida in the United States

Urology ◽  
2017 ◽  
Vol 100 ◽  
pp. 207-212 ◽  
Author(s):  
Daniel Lodwick ◽  
Lindsey Asti ◽  
Katherine Deans ◽  
Peter Minneci ◽  
Daryl McLeod
Keyword(s):  
United States ◽  
Spina Bifida ◽  
Practice Patterns ◽  
The United States

INTRAVESICAL ELECTRICAL STIMULATION IMPROVES NEUROGENIC BOWEL DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA

2004 ◽  
Vol 171 (6 Part 2) ◽  
pp. 2648-2650 ◽  
Author(s):  
SANG WON HAN ◽  
MYOUNG JIN KIM ◽  
JANG HWAN KIM ◽  
CHANG HEE HONG ◽  
JAE WOOK KIM ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Spina Bifida ◽  
Bowel Dysfunction ◽  
Neurogenic Bowel

Hospice and Palliative Medicine and Supportive Care Flashcards

2018 ◽  
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Nurse Practitioners ◽  
Palliative Medicine ◽  
Core Curriculum ◽  
Ideal Point ◽  
The United States ◽  
Ease Of Use ◽  
Rapid Review ◽  
Medical Specialties

In the United States, the subspecialty of hospice and palliative medicine has seen rapid growth since it was recognized by the American Board of Medical Specialties. During the past decade, there has been a dramatic increase in the number of palliative care programs and improved access to palliative and hospice for patients with life-limiting illness. There has also been an increase in the educational opportunities as well as growth of fellowship programs to train palliative care fellows. Unfortunately, there are limited study aids available for learning and retaining essential concepts in palliative care. Hospice and Palliative Medicine and Supportive Care Flashcards is a comprehensive, evidence-based book of flashcards for clinicians caring for patients who require hospice and palliative care and supportive care. Written in a clinical scenario/vignette, question-and-answer format by experts with first-hand experience in the field, the flashcards are highly readable and serve as a source of fast answers to clinical questions in the field. A total of 300 flashcards are organized into chapters by disease and provide readers with up-to-date information that follows the core curriculum of American Board of Hospice and Palliative Medicine for ease of use and rapid review for exams. This book will equip care professionals with key concepts related to the assessment and management of palliative care, making it an ideal point-of-care quick reference for physicians, nurse practitioners, fellows, residents, and students.

scholarly journals Bowel function and care: Guidelines for the care of people with spina bifida

2020 ◽  
Vol 13 (4) ◽  
pp. 491-498
Author(s):  
Patricia Beierwaltes ◽  
Paige Church ◽  
Tiffany Gordon ◽  
Lusine Ambartsumyan
Keyword(s):  
Spina Bifida ◽  
Bowel Function ◽  
Bowel Dysfunction ◽  
Secondary Complications ◽  
Social Opportunities ◽  
Care Guidelines ◽  
Children And Young Adults ◽  
Evidence Based Guidelines ◽  
Neurogenic Bowel

PURPOSE: Bowel dysfunction, such as constipation and fecal incontinence, has a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Secondary complications may result from bowel dysfunction and include urologic dysfunction, loss of skin integrity, shunt (hydrocephalus) function, as well as loss of social opportunities and employability. METHODS: Using a consensus building methodology, the guidelines for management of bowel dysfunction in spina bifida were written by experts in the field of spina bifida and bowel function and care. RESULTS: The evidence-based guidelines are presented in table format and provide age-specific recommendations to achieve fecal continence without constipation. Recommended treatments are presented from least to most invasive options. Literature supporting the recommendations and the interval research published to date is also presented. CONCLUSION: These guidelines present a standardized approach to management of bowel dysfunction in spina bifida. Bowel management in children and young adults with spina bifida is limited by variability in clinical practice and paucity of robust research in neurogenic bowel. Collaborative multi-institutional efforts are needed to overcome research barriers and provide innovative solutions.

Responsibilities and Interests of Pediatricians Practicing Hospital Medicine in the United States

2021 ◽  
Author(s):  
JoAnna K Leyenaar ◽  
Wade Harrison ◽  
Jessica J Truelove ◽  
Samantha House ◽  
Gary L Freed ◽  
...  
Keyword(s):  
Professional Development ◽  
Response Rate ◽  
Hospital Medicine ◽  
The United States ◽  
Certification Program ◽  
Medical Specialties ◽  
Maintenance Of Certification ◽  
Survey Response Rate ◽  
Pediatric Subspecialty ◽  
Ongoing Monitoring

BACKGROUND AND OBJECTIVES: In 2016, the American Board of Medical Specialties (ABMS) approved pediatric hospital medicine (PHM) as the newest pediatric subspecialty. To characterize development of the field, this article aims to: (1) describe the responsibilities and practice settings of US pediatricians self-identifying as hospitalists; and (2) determine how exclusive PHM practice, compared with PHM practice in combination with general or subspecialty care, was associated with professional development interests. METHODS: Pediatricians enrolling in the 2017-2018 American Board of Pediatrics (ABP) Maintenance of Certification program were offered a voluntary survey about their responsibilities, interests, and practice settings. Logistic regression was employed to characterize associations between exclusive PHM practice and: (1) interest in quality improvement (QI) leadership; (2) intention to take the PHM certifying exam; (3) satisfaction with allocation of professional time; and (4) intention to maintain more than one ABP certification. RESULTS: The survey response rate was 70.0%; 1662 (13.1%) self-reported PHM practice. Four hundred ninety-one (29.5%) practiced PHM exclusively, 518 (31.1%) practiced PHM and general pediatrics, and 653 (39.3%) practiced PHM and one or more subspecialties. Respondents reporting exclusive PHM practice were significantly more likely to report interest in QI leadership or consultation (adjusted odds ratio [OR], 1.39; 95% CI, 1.09-1.79), PHM exam certification (adjusted OR, 7.10; 95% CI, 5.45-9.25), and maintenance of more than one ABP certification (adjusted OR, 2.64; 95% CI, 1.89-3.68). CONCLUSIONS: Hospitalists reported diverse clinical and nonclinical responsibilities. Those practicing PHM exclusively expressed high levels of interest in board certification and QI leadership. Ongoing monitoring of PHM responsibilities and practice settings will be important to support the professional development of the PHM workforce.

Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida

2014 ◽  
Vol 35 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Maryellen S. Kelly ◽  
Margaret Hannan ◽  
Brenda Cassidy ◽  
Guy Hidas ◽  
Blake Selby ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Pediatric Patients ◽  
Bowel Dysfunction ◽  
Neurogenic Bowel
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