ABSTRACT
BACKGROUND: Bowel management is a term used to describe a medical approach to the management of faecal incontinence. AIMS: To present the outcomes of an individualised bowel management programme developed by a tertiary paediatric centre and evaluate contributory factors for successful bowel management in children. METHODS: A retrospective review of children attending a bowel management clinic in a tertiary centre in Dublin, Ireland, over 5 years (2010-2015). The main outcome measure was the ability to achieve a regular bowel pattern and remain socially clean. Multiple linear regression analyses were used to determine the factors contributing to successful bowel management. RESULTS: One hundred ninety-two children attended the clinic over 5 years. The median age at commencement of washouts was 7 years. Underlying diagnosis was spina bifida in 50%, imperforate anus in 17.7%, Hirschsprung's disease in 14.6%, idiopathic constipation in 7.8%, and other conditions in 9.9% of patients. Children with spina bifida and Hirschsprung's disease preferred Peristeen washouts, while those with imperforate anus and idiopathic constipation preferred Willis washouts (p < 0.001). Our programme was successful in 93.7% of cases. Regression analysis showed that the underlying condition (p < 0.001), washout medication (p = 0.016), and individuals administering washouts (p < 0.001) contributed to a successful bowel management programme. CONCLUSION: Treatment protocols should be individualised based on the underlying condition and outcomes. Decision-making must be cognisant of the physical, social, psychological, and developmental needs of the child and family. A partnership approach is advocated, which includes child and parent/carer preferences allowing them to make an informed decision.
Subject(s)
Disease Management , Fecal Incontinence/therapy , Anus, Imperforate/complications , Child , Child, Preschool , Constipation/therapy , Enema , Fecal Incontinence/etiology , Female , Hirschsprung Disease/complications , Humans , Male , Program Evaluation , Retrospective Studies , Spinal Dysraphism/complications , Tertiary Care CentersABSTRACT
INTRODUCTION: We conducted a study at two main centres for paediatric surgery in the Republic of Ireland, Temple Street Children's University Hospital (TSCUH) and Our Lady's Children's Hospital Crumlin (OLCHC). AIM: The aim of the study was to assess doctors' opinions, frequency and methods of smartphone use in clinical practice. METHODS: Doctors (n = 265) at the two hospitals were invited to complete a 12-item survey. Descriptive statistics were calculated accordingly. RESULTS: Almost 50% (132/256) responded; 98.4% owned a smartphone and 76% owned an iPhone. Seventy-nine percent used medical apps and 59% used the OLCHC formulary. Ninety-seven percent used smartphones for inter-team communication with 73.5% (n = 97) using WhatsApp. Smartphone camera was used by 57% for clinical photos and 41% for photos of radiological imaging. Only 42% reported obtaining consent for smartphone camera use from patients or guardians. Ninety-two percent either 'strongly agreed' or 'agreed' that smartphones positively impact their practice. CONCLUSION: Smartphone usage is universal among healthcare professionals and their influence is growing in patient care.
