scholarly journals How Much Knowledge and Awareness of Faecal Incontinence Is There in Primary Care?

Surgeries ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 150-156
Author(s):  
Michael Shinkwin ◽  
Jade Brown ◽  
Lily Scourfield ◽  
Julie Cornish
Keyword(s):  
Faecal Incontinence ◽  
Treatment Options ◽  
Bowel Function ◽  
Vital Role ◽  
Online Questionnaire ◽  
Increased Risk ◽  
Faecal Urgency ◽  
Educational Groups ◽  
Patient Groups ◽  
Underlying Diseases

Faecal incontinence (FI) is a debilitating symptom with a likely underreported incidence in the general population. Postpartum or postmenopausal women are at increased risk of this. General Practitioners (GPs) have a vital role in screening patient groups with FI. Knowledge of the underlying diseases associated with FI is important for all clinicians who have contact with this patient group. An online questionnaire (Survey MonkeyTM, San Mateo, CA, USA) was sent to GPs in Wales and England through a deanery, social media and GP educational groups. Questions: A total of 250 participants completed the questionnaire—195 GPs and 55 GPSTs. Two-thirds had no coloproctology experience, but 70% had worked in obstetrics and gynaecology. In total, 70% had no formal FI training and 75% felt insufficiently informed about FI. A total of 80% felt that GPs need specific training on FI. A third of respondents used the 6-week postnatal check to assess maternal bowel function and most did not appreciate faecal urgency as a symptom. Patients should be asked about FI symptoms by GPs, particularly those populations at increased risk. Our GP survey participants were enthusiastic for more education on the treatment options and where to signpost patients with FI.

Faecal incontinence and anorectal dysfunction

2020 ◽  
pp. 716-726
Author(s):  
Karen Nugent
Keyword(s):  
Quality Of Life ◽  
Faecal Incontinence ◽  
Bowel Function ◽  
Western World ◽  
General Mental Health ◽  
Surgical Options ◽  
Normal Defecation ◽  
And Function ◽  
Underlying Diseases

Continence and normal defecation relies on the complex interaction of the colon (motility and consistency of stools), rectum (sensation, compliance, and anatomy), and the anus (sensation, structure, and function). The overriding complex neurological control is also important. A disorder of any of these may lead to faecal incontinence. This can affect over 10% of adults and at least 1–2% of patents will report these as major symptoms. In itself, faecal incontinence is not a disease but a symptom and it is necessary to take a full history and examine a patient to identify any underlying diseases or pathology that may need treatment before focusing on managing incontinence. The aim of any treatment for faecal incontinence is to improve the patient’s quality of life and give them some control back over their bowel function. Constipation is an increasing problem in the Western world and it is widely accepted that approximately 50% of adults are constipated at any point in time. Constipation encompasses a multitude of symptoms; the general mental health and social functioning of people with constipation is impaired when compared to health controls. The symptoms of constipation occur in a large percentage of the general population. The impact on quality of life when they occur for a long period of time is large. However, patients often have many coexisting other pelvic floor disorders. Although there are surgical options available, it is important to treat conservatively and understand the complexity of the other issues involved in patients presenting with constipation.

scholarly journals Ethnic Disparities in the Development of Sight-Threatening Diabetic Retinopathy in a UK Multi-Ethnic Population with Diabetes: An Observational Cohort Study

2021 ◽  
Vol 11 (8) ◽  
pp. 740
Author(s):  
Manjula D. Nugawela ◽  
Sarega Gurudas ◽  
Andrew Toby Prevost ◽  
Rohini Mathur ◽  
John Robson ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Ethnic Differences ◽  
Minority Groups ◽  
Treatment Options ◽  
Ethnic Disparities ◽  
Ethnic Minority Groups ◽  
The United Kingdom ◽  
Increased Risk ◽  
Observational Cohort ◽  
General Practices

There is little data on ethnic differences in incidence of DR and sight threatening DR (STDR) in the United Kingdom. We aimed to determine ethnic differences in the development of DR and STDR and to identify risk factors of DR and STDR in people with incident or prevalent type II diabetes (T2DM). We used electronic primary care medical records of people registered with 134 general practices in East London during the period from January 2007–January 2017. There were 58,216 people with T2DM eligible to be included in the study. Among people with newly diagnosed T2DM, Indian, Pakistani and African ethnic groups showed an increased risk of DR with Africans having highest risk of STDR compared to White ethnic groups (HR: 1.36 95% CI 1.02–1.83). Among those with prevalent T2DM, Indian, Pakistani, Bangladeshi and Caribbean ethnic groups showed increased risk of DR and STDR with Indian having the highest risk of any DR (HR: 1.24 95% CI 1.16–1.32) and STDR (HR: 1.38 95% CI 1.17–1.63) compared with Whites after adjusting for all covariates considered. It is important to optimise prevention, screening and treatment options in these ethnic minority groups to avoid health inequalities in diabetes eye care.

P20 Parental understanding of concussion in youth rugby is significantly improved by viewing the RFU concussion education video

2019 ◽  
Vol 90 (3) ◽  
pp. e31.1-e31
Author(s):  
T Samuel ◽  
K Aquilina ◽  
W Dawes
Keyword(s):  
Parental Education ◽  
Cross Sectional Study ◽  
Educational Video ◽  
Sectional Study ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Parental Experience ◽  
Increased Risk ◽  
Significant Difference ◽  
Composite Scores

ObjectivesTo investigate the current understanding parents have of concussion in their rugby-playing children aged 9–17.DesignCross-sectional studySubjects86 parents from four clubs completed an online questionnaireMethodsAreas covered (1) Parental experience of concussion (2) Rate of viewing of the RFU concussion educational video (RFUCEV), (3) Identification of symptoms of concussion (4) Understanding of the risk of concussion. Each participant was given a composite score, out of 19, based on their performance in symptom identification and true/false questions. Independent-sample two-tailed t-tests were conducted to analyse scores, primarily controlling for viewing of the RFUCEVResultsThere was a significant difference in the scores between the group that had viewed the RFUCEV (n=32, M=14.75, SD=2.55) and those who had not (n=54, M=13.05, SD=2.87); t(84)=2.75, p=0.00721. Additionally, over 25% of parents reported that their child had suffered a concussion, and this was also found to significantly improve the awareness score (p=0.04678)ConclusionsStatistically significant improvement in composite scores after viewing the RFUCEV makes it reasonable to require compulsory parental education prior to signing up a child to play rugby. This would build on the protocol changes made by the RFU in 2014 and further progress the safety of the sport. We suggest the video be improved to emphasise the areas highlighted as inadequately understood, including the increased risk of concussion in under-18s compared to adults.

Is a Prolonged Bleeding Time Associated with an Increased Risk of Hemorrhage after Liver Biopsy?

1999 ◽  
Vol 81 (03) ◽  
pp. 378-381 ◽  
Author(s):  
Frank Brosstad ◽  
Thore Egeland ◽  
Tor Egge ◽  
Erik Schrumpf ◽  
Kirsten Boberg
Keyword(s):  
Liver Biopsy ◽  
Bleeding Time ◽  
Hemoglobin Concentration ◽  
Additional Information ◽  
Risk Of Bleeding ◽  
Prolonged Bleeding ◽  
Prolonged Bleeding Time ◽  
Increased Risk ◽  
Patient Groups ◽  
Risk Of Hemorrhage

SummaryBleeding time determination is not advised as a general preoperative hemostasis screening test, but it might be useful in some patient groups. Patients referred for liver biopsy frequently have coagulation disturbances and are at risk of hemorrhage. In this prospective study 219 liver biopsies were carried out regardless of a prolonged bleeding time, but with minimum requirements for hemoglobin concentration, platelet count, and tests of the internal and external coagulation pathways. The bleeding time was prolonged in the case of 48 (22%) of the biopsies. Significant bleeding as defined by a hemoglobin decrease of ≥2.0 g/dl occurred in nine patients. Three of these patients were bone marrow transplanted. Patients with a prolonged bleeding time carried a five times higher risk of bleeding (odds ratio = 5.0; confidence interval = 1.1-21.8; p = 0.019). We conclude that the bleeding time may give additional information on the risk of bleeding in some patient groups undergoing liver biopsy.

scholarly journals Urinary Excretion of Phenolic Acids by Infants and Children: A Randomised Double-Blind Clinical Assay

2012 ◽  
Vol 6 ◽  
pp. CMPed.S9349
Author(s):  
J. Uberos ◽  
V. Fernéndez-Puentes ◽  
M. Molina-Oya ◽  
R. Rodrïguez-Belmonte ◽  
A. Ruïz-López ◽  
...  
Keyword(s):  
Urinary Excretion ◽  
Ferulic Acid ◽  
Phenolic Acids ◽  
Treatment Options ◽  
Randomised Clinical Trial ◽  
Phase Iii ◽  
Double Blind ◽  
Clinical Assay ◽  
Increased Risk ◽  
Study Population

Objectives The present study, which is part of the ISRCTN16968287 clinical assay, is aimed at determining the effects of cranberry syrup or trimethoprim treatment for UTI. Methods This Phase III randomised clinical trial was conducted at the San Cecilio Clinical Hospital (Granada, Spain) with a study population of 192 patients, aged between 1 month and 13 years. Criteria for inclusion were a background of recurrent UTI, associated or otherwise with vesico-ureteral reflux of any degree, or renal pelvic dilatation associated with urinary infection. Each child was randomly given 0.2 mL/Kg/day of either cranberry syrup or trimethoprim (8 mg/mL). The primary and secondary objectives, respectively, were to determine the risk of UTI and the levels of phenolic acids in urine associated with each intervention. Results With respect to UTI, the cranberry treatment was non-inferior to trimethoprim. Increased urinary excretion of ferulic acid was associated with a greater risk of UTI developing in infants aged under 1 year (RR 1.06; CI 95% 1.024–1.1; P = 0.001). Conclusions The results obtained show the excretion of ferulic acid is higher in infants aged under 1 year, giving rise to an increased risk of UTI, for both treatment options.

scholarly journals Treatment of Anterior Cruciate Ligament Injury in Skeletally Immature Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Joshua L. Hudgens ◽  
Diane L. Dahm
Keyword(s):  
Cruciate Ligament ◽  
Treatment Options ◽  
Cartilage Damage ◽  
Functional Results ◽  
Patient Treatment ◽  
Ligament Injury ◽  
Minimal Risk ◽  
Skeletally Immature ◽  
Increased Risk ◽  
Skeletally Immature Patient

The incidence of ACL tears is rising in the pediatric and adolescent populations as these individuals succumb to traumatic and nontraumatic athletic injuries. Management of this condition in the skeletally immature patient poses a challenge and is controversial. Operative reconstruction carries the concern for damage to the physis with resultant limb length inequality and angular joint deformity but provides stability to the knee and allows return of function in most patients. On the other hand, nonoperative treatment has been shown to carry an increased risk of meniscal and articular cartilage damage and is difficult from a compliance standpoint in this demographic. For the majority of skeletally immature patients, operative treatment is recommended as it has shown good clinical and functional results with minimal risk of growth disturbance. This paper aims to address the natural course of ACL injuries in the skeletally immature patient, treatment options with associated complications, and current preventative strategies.

scholarly journals Protection againstStaphylococcus aureusColonization and Infection by B- and T-Cell-Mediated Mechanisms

mBio ◽  
2018 ◽  
Vol 9 (5) ◽  
Author(s):  
Fan Zhang ◽  
Olivia Ledue ◽  
Maria Jun ◽  
Cibelly Goulart ◽  
Richard Malley ◽  
...  
Keyword(s):  
T Cell ◽  
Soft Tissue ◽  
Bacterial Infections ◽  
Vaccine Development ◽  
Pathological Condition ◽  
Treatment Options ◽  
Immune Defense ◽  
Invasive Infection ◽  
Content Type ◽  
Increased Risk

ABSTRACTStaphylococcus aureusis a major cause of morbidity and mortality worldwide.S. aureuscolonizes 20 to 80% of humans at any one time and causes a variety of illnesses. Strains that are resistant to common antibiotics further complicate management.S. aureusvaccine development has been unsuccessful so far, largely due to the incomplete understanding of the mechanisms of protection against this pathogen. Here, we studied the role of different aspects of adaptive immunity induced by anS. aureusvaccine in protection againstS. aureusbacteremia, dermonecrosis, skin abscess, and gastrointestinal (GI) colonization. We show that, depending on the challenge model, the contributions of vaccine-inducedS. aureus-specific antibody and Th1 and Th17 responses to protection are different: antibodies play a major role in reducing mortality duringS. aureusbacteremia, whereas Th1 or Th17 responses are essential for prevention ofS. aureusskin abscesses and the clearance of bacteria from the GI tract. Both antibody- and T-cell-mediated mechanisms contribute to prevention ofS. aureusdermonecrosis. Engagement of all three immune pathways results in the most robust protection under each pathological condition. Therefore, our results suggest that eliciting multipronged humoral and cellular responses toS. aureusantigens may be critical to achieve effective and comprehensive immune defense against this pathogen.IMPORTANCES. aureusis a leading cause of healthcare- and community-associated bacterial infections.S. aureuscauses various illnesses, including bacteremia, meningitis, endocarditis, pneumonia, osteomyelitis, sepsis, and skin and soft tissue infections.S. aureuscolonizes between 20 and 80% of humans; carriers are at increased risk for infection and transmission to others. The spread of multidrug-resistant strains limits antibiotic treatment options. Vaccine development againstS. aureushas been unsuccessful to date, likely due to an inadequate understanding about the mechanisms of immune defense against this pathogen. The significance of our work is in illustrating the necessity of generating multipronged B-cell, Th1-, and Th17-mediated responses toS. aureusantigens in conferring enhanced and broad protection againstS. aureusinvasive infection, skin and soft tissue infection, and mucosal colonization. Our work thus, provides important insights for future vaccine development against this pathogen.

Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

1999 ◽  
Vol 12 (2) ◽  
pp. 224-242 ◽  
Author(s):  
Shamez Ladhani ◽  
Christopher L. Joannou ◽  
Denise P. Lochrie ◽  
Robert W. Evans ◽  
Susan M. Poston
Keyword(s):  
Clinical Features ◽  
Treatment Options ◽  
Entire Body ◽  
Secondary Complications ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Treatment And Prevention ◽  
Causative Agents ◽  
Underlying Diseases ◽  
Disease Understanding ◽  
Significant Mortality

SUMMARY The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.

scholarly journals Regenerative Medicine Approaches for Age-Related Muscle Loss and Sarcopenia: A Mini-Review

Gerontology ◽  
2017 ◽  
Vol 63 (6) ◽  
pp. 580-589 ◽  
Author(s):  
Juan Diego Naranjo ◽  
Jenna L. Dziki ◽  
Stephen F. Badylak
Keyword(s):  
Regenerative Medicine ◽  
Treatment Options ◽  
The Elderly ◽  
Signaling Molecules ◽  
Current Treatment ◽  
Muscle Physiology ◽  
Age Related ◽  
Increased Risk ◽  
And Function ◽  
Age Related Changes

Sarcopenia is a complex and multifactorial disease that includes a decrease in the number, structure and physiology of muscle fibers, and age-related muscle mass loss, and is associated with loss of strength, increased frailty, and increased risk for fractures and falls. Treatment options are suboptimal and consist of exercise and nutrition as the cornerstone of therapy. Current treatment principles involve identification and modification of risk factors to prevent the disease, but these efforts are of limited value to the elderly individuals currently affected by sarcopenia. The development of new and effective therapies for sarcopenia is challenging. Potential therapies can target one or more of the proposed multiple etiologies such as the loss of regenerative capacity of muscle, age-related changes in the expression of signaling molecules such as growth hormone, IGF-1, myostatin, and other endocrine signaling molecules, and age-related changes in muscle physiology like denervation and mitochondrial dysfunction. The present paper reviews regenerative medicine strategies that seek to restore adequate skeletal muscle structure and function including exogenous delivery of cells and pharmacological therapies to induce myogenesis or reverse the physiologic changes that result in the disease. Approaches that modify the microenvironment to provide an environment conducive to reversal and mitigation of the disease represent a potential regenerative medicine approach that is discussed herein.

scholarly journals Factors associated with unplanned readmissions in a major Australian health service

2019 ◽  
Vol 43 (1) ◽  
pp. 1 ◽  
Author(s):  
Julie Considine ◽  
Karen Fox ◽  
David Plunkett ◽  
Melissa Mecner ◽  
Mary O'Reilly ◽  
...  
Keyword(s):  
Health Service ◽  
Hospital Admission ◽  
Acute Care ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Factors Associated ◽  
Australian Health ◽  
Increased Risk ◽  
Patient Groups ◽  
Comorbidity Index

Objective The aim of the present study was to gain an understanding of the factors associated with unplanned hospital readmission within 28 days of acute care discharge from a major Australian health service. Methods A retrospective study of 20575 acute care discharges from 1 August to 31 December 2015 was conducted using administrative databases. Patient, index admission and readmission characteristics were evaluated for their association with unplanned readmission in ≤28 days. Results The unplanned readmission rate was 7.4% (n=1528) and 11.1% of readmitted patients were returned within 1 day. The factors associated with increased risk of unplanned readmission in ≤28 days for all patients were age ≥65 years (odds ratio (OR) 1.3), emergency index admission (OR 1.6), Charlson comorbidity index >1 (OR 1.1–1.9), the presence of chronic disease (OR 1.4) or complications (OR 1.8) during the index admission, index admission length of stay (LOS) >2 days (OR 1.4–1.8), hospital admission(s) (OR 1.7–10.86) or emergency department (ED) attendance(s) (OR 1.8–5.2) in the 6 months preceding the index admission and health service site (OR 1.2–1.6). However, the factors associated with increased risk of unplanned readmission ≤28 days changed with each patient group (adult medical, adult surgical, obstetric and paediatric). Conclusions There were specific patient and index admission characteristics associated with increased risk of unplanned readmission in ≤28 days; however, these characteristics varied between patient groups, highlighting the need for tailored interventions. What is known about the topic? Unplanned hospital readmissions within 28 days of hospital discharge are considered an indicator of quality and safety of health care. What does this paper add? The factors associated with increased risk of unplanned readmission in ≤28 days varied between patient groups, so a ‘one size fits all approach’ to reducing unplanned readmissions may not be effective. Older adult medical patients had the highest rate of unplanned readmissions and those with Charlson comorbidity index ≥4, an index admission LOS >2 days, left against advice and hospital admission(s) or ED attendance(s) in the 6 months preceding index admission and discharge from larger sites within the health service were at highest risk of unplanned readmission. What are the implications for practitioners? One in seven discharges resulted in an unplanned readmission in ≤28 days and one in 10 unplanned readmissions occurred within 1 day of discharge. Although some patient and hospital characteristics were associated with increased risk of unplanned readmission in ≤28 days, statistical modelling shows there are other factors affecting the risk of readmission that remain unknown and need further investigation. Future work related to preventing unplanned readmissions in ≤28 days should consider inclusion of health professional, system and social factors in risk assessments.

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