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Journal articles on the topic 'Bowel protocol'

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Published: 10 December 2022
Last updated: 29 January 2023

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1

F??BI??N, ANGELA S. "Before Bowel Protocol." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 3, no. 1 (January 1985): 43. http://dx.doi.org/10.1097/00004045-198501000-00029.

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2

Rychlik, A., M. Nowicki, M. Kander, and M. Szweda. "The effect of macrogol administration on the quality of macroscopic images and transit time in canine capsule endoscopy." Polish Journal of Veterinary Sciences 17, no. 4 (December 1, 2014): 673–79. http://dx.doi.org/10.2478/pjvs-2014-0098.

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Abstract The present experiment evaluated the quality of macroscopic images and the mean time of capsule passage through different sections of the gastrointestinal tract in dogs subjected to different preparation protocols before capsule endoscopy. In the first examination, the colonoscopy preparation protocol was applied, and in the second examination, the animals were administered macrogol. The study revealed that macrogol administration before capsule endoscopy significantly improved the quality of macroscopic images. The colonoscopy preparation protocol may not support accurate visualization of the large bowel mucosa and, in selected patients, also the small bowel mucosa. Macrogol administration had no effect on capsule transit time through the alimentary canal. Capsules used in endoscopic evaluations of the small bowel in humans may have limited applications in macroscopic examinations of large bowel mucosa in dogs.
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3

KIRN, TIMOTHY F. "Protocol Works for Narcotic Bowel Syndrome." Clinical Psychiatry News 36, no. 3 (March 2008): 59. http://dx.doi.org/10.1016/s0270-6644(08)70181-4.

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4

Evbuomwam, Ehimwenma, Dan Kinnair, Mohammad Mirza, and Julian Coleman. "Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)." BJPsych Open 7, S1 (June 2021): S79. http://dx.doi.org/10.1192/bjo.2021.248.

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AimsConstipation in patients on Clozapine is the biggest cause of mortality. We have no set protocol in LPT for how to manage and monitor Constipation in Clozapine initiation in the inpatient setting. Internationally protocols, (such as the Porirua protocol) exist but have not been widely used locally.We wanted to assess local compliance with monitoring constipation in patients admitted to hospital and started on Clozapine. We also wanted to assess whether patients are prescribed PRN or regular laxatives, before considering implementing a local protocol.MethodIn LPT we use the ZTAS system for prescribing Clozapine. They provided us with a list of patient IDs who had recently started on Clozapine.We captured data on patients started on Clozapine. 1.What date was this started?2.What date was either PRN or regular laxatives started?3.Was a bowel chart recorded?4.Any evidence of constipation or significant bowel issues relating to Clozapine?ResultWe initially analysed 30 patients, (20 of whom were initiated on Clozapine as inpatients, and 10 as outpatients). A bowel chart was started in only 1 inpatient. Laxatives were started in 50% (15, only 3 of whom were outpatients). 14 were regular and 1 was a PRN prescription. 12 inpatients had constipation, and 1 outpatient suffered with constipation. 2 patients suffered with diarrhoea but there were no other significant issues with bowel problems.ConclusionFrom our initial data we can see that there are many inconsistencies in practice.Existing patients on Clozapine attend a local clinic, (Clozapine clinic) where ongoing monitoring of constipation, (and other parameters, e.g. ECGs etc are completed).We have written a new protocol which we will share, that the trust has implemented, that identifies when PRN and regular laxatives should be prescribed. We have also expanded the protocol to agree for initiation of Olanzapine bowel charts and PRN laxatives should be used.
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5

Smith, Anita, Christopher Stimson, and Penelope Stevens. "High-Intensity Bowel Protocol for Trauma Patients." Journal of Trauma Nursing 25, no. 3 (2018): 207–10. http://dx.doi.org/10.1097/jtn.0000000000000369.

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6

Alvarez-Gonzalez, Marco Antonio, Miguel Ángel Pantaleón Sánchez, Belén Bernad Cabredo, Ana García-Rodríguez, Santiago Frago Larramona, Oscar Nogales, Pilar Díez Redondo, et al. "Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial." Endoscopy 52, no. 11 (June 17, 2020): 1026–35. http://dx.doi.org/10.1055/a-1178-9844.

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Background The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. Methods We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. Results 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). Conclusion Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases.
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7

Hsu, Wei-Fan, Cheng-Chao Liang, Cheng-Kuan Lin, Tzong-Hsi Lee, and Chen-Shuan Chung. "A modified bowel preparation protocol improves the quality of bowel cleansing for colonoscopy." Advances in Digestive Medicine 3, no. 3 (March 23, 2016): 144–47. http://dx.doi.org/10.1016/j.aidm.2015.12.001.

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8

Ibrahim, Fandi, and Philippa Stribling. "A 5Ad Dietary Protocol for Functional Bowel Disorders." Nutrients 11, no. 8 (August 17, 2019): 1938. http://dx.doi.org/10.3390/nu11081938.

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Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.
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9

Ring, M. "Implementation of a bowel care protocol within ICU." Australian Critical Care 24, no. 1 (February 2011): 73–74. http://dx.doi.org/10.1016/j.aucc.2010.12.053.

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10

Aldana, Jose A., Javier E. Rincon, Ricardo A. Fonseca, Rohit K. Rasane, Christina X. Zhang, Qiao Zhang, Maya J. Sorini, Kelly M. Bochicchio, Grant V. Bochicchio, and Obeid Ilahi. "Adhesive Small Bowel Obstruction Protocol in Geriatric Patients." Journal of the American College of Surgeons 229, no. 4 (October 2019): S87. http://dx.doi.org/10.1016/j.jamcollsurg.2019.08.200.

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11

R., Ambika, and Vidhya Rani Reddy. "Computed Tomography Enterography: Better Luminal Distension with a Shorter Ingestion Time Protocol in an Indian Population." Journal of Gastrointestinal and Abdominal Radiology 01, no. 01 (December 2018): 033–40. http://dx.doi.org/10.1055/s-0038-1673317.

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Abstract Aim This article prospectively evaluates the adequacy of bowel distension in computed tomography enterography (CTE) with a 45-minute contrast ingestion time and compares it with the most widely used protocol in the literature of 1 hour 20 minutes. Materials and Methods The CTE was performed in 42 consecutive patients divided into two groups—A and B. Group A patients were instructed to drink 2 L of polyethylene glycol electrolyte solution over 1 hour 20 minutes. Group B patients were instructed to do the same over 45 minutes. At the end of contrast ingestion, plain and contrast CT abdomen was performed and CTE images were reviewed. Manual quantitative analysis of degree of small bowel distension was performed in the following manner: on coronal images, the abdominal cavity was divided into four quadrants: right upper, left upper, right lower, and left lower quadrants. The maximum small bowel lumen diameter (inner-to-inner wall) was measured in five different loops within each of the four quadrants. If four or more measurements in a quadrant ≥ 1.8 cm (considered “adequate luminal distension”), a score of 1 was assigned to that quadrant. If less than 4 measurements in the quadrant > 1.8 cm, a score of 0 was assigned to that quadrant. The ensuing sum of scores from all four quadrants resulted in the distension grade for that CTE study (Grades 1–4). Results There was a statistically significant difference in the degree of small bowel distension between the two groups with better distension seen in group B (p < 0.001). Conclusion Indians have a rapid gut transit time compared with Western populations. Hence, CTE contrast ingestion time protocols optimized in Western populations may not be suitable in Indians. The shorter 45-minute ingestion protocol provided consistently better luminal distension in our population than the longer 1 hour 20-minute protocol described in the literature. To the best of our knowledge, there are no other studies comparing CTE ingestion time protocols in a given population.
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12

Mazor, Yoav, John E. Kellow, Gillian M. Prott, Michael P. Jones, and Allison Malcolm. "Anorectal biofeedback: an effective therapy, but can we shorten the course to improve access to treatment?" Therapeutic Advances in Gastroenterology 12 (January 2019): 175628481983607. http://dx.doi.org/10.1177/1756284819836072.

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Background: Instrumented anorectal biofeedback (BF) improves symptoms and quality of life in patients with faecal incontinence and defecation disorder-associated chronic constipation. However, demand for BF greatly outweighs availability, so refinement of the BF protocol, in terms of the time and resources required, is of importance. Our aim was to evaluate the outcomes of an abbreviated BF protocol in patients with defecation disorder-associated chronic constipation and/or faecal incontinence compared to standard BF. Methods: Data were collected from consecutive patients ( n = 31; age 54 ± 15; 29 females; 61% functional constipation) undergoing an intentionally abbreviated BF protocol, and compared in a 1:2 ratio with 62 age, gender and functional anorectal disorder-matched control patients undergoing a standard BF. Outcomes included change in symptoms, physiology, patient satisfaction and quality of life. Results: On intention to treat, patients in both protocols showed significant improvement in symptom scores and the magnitude did not differ between groups. Impact on quality of life, satisfaction and control over bowel movements improved in both protocols, but satisfaction improved to a greater extent in the standard BF protocol ( p = 0.009). Physiological parameters were unchanged after BF apart from improvement in rectal sensation in the standard BF group compared to abbreviated BF ( p ⩽ 0.002). Conclusions: Abbreviated anorectal BF offered to patients travelling from far away was not different to a standard BF in providing substantial, at least short term, improvements in symptoms of constipation and faecal incontinence, quality of life and feeling of control over bowel movements. Refinement of the standard BF protocol according to individual patient phenotypes and desired outcomes warrants further study in order to maximize efficacy and improve access for patients.
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13

Stethen, Trent W., Yasir A. Ghazi, R. Eric Heidel, Brian J. Daley, Linda Barnes, and James M. McLoughlin. "Factors Influencing Length of Stay after Elective Bowel Resection within an Enhanced Recovery Protocol." American Surgeon 84, no. 7 (July 2018): 1240–45. http://dx.doi.org/10.1177/000313481808400746.

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A multimodality approach to enhance recovery after bowel surgery is demonstrated to reduce complications and decrease patient length of stay (LOS). This study evaluates the factors that influence patient LOS within a formal enhanced recovery protocol. From January 2014 to December 2016, all consecutive patients admitted to one ward, who had undergone bowel resection and were enrolled in an enhanced recovery protocol, were evaluated prospectively. We entered every patient's data into the American College of Surgeons Risk Calculator (ACSRC) to compare predicted versus actual outcomes. Statistical analysis of clinical factors, patient participation, and outcomes compared with the overall LOS was performed. Of 670 bowel resections performed during the study period, a total of 127 (19%) patients met the criteria and were analyzed for comorbidities, type of surgery, complications, and participation in recovery protocols. The median length of stay (mLOS) for all patients was 4.0 days (1.8–24.6 days). Factors influencing mLOS included laparoscopic versus open surgery (P = 0.006), COPD (P = 0.003), missing 24 hours of ambulation (P < 0.001), use of patient-controlled analgesia (P = 0.011), and diagnosis of insulin-dependent diabetes mellitus (P = 0.041). Increasing the use of morphine equivalents (MEs) increased mLOS beyond the ACSRC estimate (P = 0.003). Developing a major complication increased mLOS by 8.5 times the ACSRC estimate. Conclusion: A multimodality approach to enhance surgical recovery after bowel surgery decreases the LOS. The surgical approach, participation in ambulation, insulin-dependent diabetes mellitus, and COPD influenced the overall LOS. Increasing use of morphine equivalents and developing a complication increased mLOS beyond the ACSRC preoperative risk estimates.
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14

Wanik, Jillian, Colleen Teevan, Lynn Pepin, Laura Andrews, Linda Dalessio, Jennifer Feda, Noubar M. Kevorkian, and Sharon Weintraub. "Implementation of a Bowel Protocol to Improve Enteral Nutrition and Reduce Clostridium difficile Testing." Critical Care Nurse 39, no. 6 (December 1, 2019): e10-e18. http://dx.doi.org/10.4037/ccn2019304.

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Background Underfeeding is common among adult patients receiving enteral nutrition. Constipation and diarrhea have been associated with low enteral nutrition volume in critically ill patients. In patients with diarrhea, Clostridium difficile is often suspected and tested for, although medications, illness, or enteral formulas are usually the cause. The use of bowel protocols to proactively address constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, thereby improving enteral nutrition, remains unclear. Objective To evaluate the efficacy of implementing protocols to decrease constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, and to deliver larger enteral nutrition volumes in a critical care unit. Methods A prospective convenience sample was used. The primary outcome was the proportion of patients receiving greater than or equal to 80% of their prescribed caloric volume 1 week (minimum 4 days) after initiating enteral nutrition. Rates of testing for hospital-onset C difficile infection were analyzed before and after the protocol was implemented. Results After the protocol was implemented, patients experienced significant increases in delivery of enteral nutrition volume—up to 78% of the goal volume (P = .048). The standardized infection ratio of hospital-onset C difficile infection decreased 43% (P = .04). Conclusions The implementation of bowel protocols improved delivery of total enteral volumes and reduced inappropriate testing for hospital-onset infections with C difficile, and they may improve patient safety and facilitate positive patient outcomes.
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15

Zoumpos, Alexandros, Ngoc Anh Huy Ho, Ralf Loeschhorn-Becker, and Frank Schuppert. "Haemorrhagic small bowel melanoma metastasis: a clinical rarity." BMJ Case Reports 12, no. 9 (September 2019): e230454. http://dx.doi.org/10.1136/bcr-2019-230454.

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We report on a clinical case with haemorrhagic small bowel metastases in a malignant melanoma patient with anaemia, diagnosed using small bowel video capsule endoscopy (VCE). A 67-year-old male patient with a previous diagnosis of malignant melanoma presented with anaemia and vertigo on admission. The standard diagnostic protocol for gastrointestinal (GI) bleeding investigation including a gastroscopy, colonoscopy and small bowel capsule endoscopy, as well as abdominal sonography and a restaging protocol including chest–abdomen–pelvis CT (CAP-CT), echocardiography and ECG was applied. Gastroscopy and colonoscopy were not conclusive in determining the bleeding source. VCE provided evidence for numerous haemorrhagic small bowel metastases. The CAP-CT was unremarkable for small bowel findings. Due to a diffuse metastatic disease diagnosed in heart, brain, liver, spleen and bone metastasis, the patient was treated in a conservative/palliative manner. VCE can provide precious information about GI bleeding of unknown origin when classical diagnostic methods are non-conclusive.
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16

Ring, Michelle. "Implementation of a bowel care protocol within intensive care." Connect: The World of Critical Care Nursing 8, no. 1 (March 2011): 17–20. http://dx.doi.org/10.1891/1748-6254.8.1.17.

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17

Simpson, J., Xiaodong Bao, and Aalok Agarwala. "Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols." Clinics in Colon and Rectal Surgery 32, no. 02 (February 28, 2019): 121–28. http://dx.doi.org/10.1055/s-0038-1676477.

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AbstractPain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.
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18

Nikoupoor, Hamed, Ali Mohammad Moradi, Peyman Arasteh, Alireza Shamsaeefar, Mohammad Yasin Karami, Hesameddin Eghlimi, Mojtaba Shafiekhani, and Saman Nikeghbalian. "Guideline for Management of Mesenteric Ischemia: Shiraz Intestinal Failure Unit Protocol." Archives of Iranian Medicine 23, no. 6 (June 1, 2020): 422–25. http://dx.doi.org/10.34172/aim.2020.38.

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We have recently established an intestinal rehabilitation unit (IRU) in Abu Ali Sina transplantation center affiliated to Shiraz University of Medical Sciences, Iran. Our intestinal failure rehabilitation and transplant program aims to provide state-of-the-art care for adult patients with different degrees of intestinal insufficiency and failure. In the IRU, we aimed to design an algorithmic approach to patients with small bowel ischemia and short bowel syndrome (SBS) based on our institutional experience in our country and based on other pioneering studies from other regions of the world.
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Vilanova-Sanchez, Alejandra, Monica Ivanov, Devin R. Halleran, Andrea Wagner, Carlos Albert Reck-Burneo, Brenda Ruth, Meghan FIsher, et al. "Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol." European Journal of Pediatric Surgery 30, no. 04 (August 20, 2019): 309–16. http://dx.doi.org/10.1055/s-0039-1694744.

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Introduction Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. Materials and Methods We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. Results We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3–5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. Conclusion TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.
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20

Melehin, A. I. "Cognitive Behavioral Psychotherapy of Interoceptive Influence in the Treatment of Irritable Bowel Syndrome." Клиническая и специальная психология 9, no. 2 (2020): 1–33. http://dx.doi.org/10.17759/cpse.2020090201.

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Based on foreign research, the article describes psychotherapeutic tactics for treating refractory irritable bowel syndrome (IBS), which emphasizes that it is a disorder of dysregulation of the «brain-gut» axis under the influence of negative cognitive-affective features of the patient. The range of Personal characteristics of patients with IBS is presented. Afferent and efferent routes of influence of psychological processes in provoking and maintaining IBS in the patient are described. It is shown that dysregulation in the «brain-gut» axis is eliminated by combined therapy, including cognitive-behavioral psychotherapy of interoceptive influence. Differences between the «standard» and interoceptive protocol of cognitive behavioral psychotherapy are shown. Psychotherapeutic targets in the treatment of IBS are identified. An interoceptive model of gastro-specific anxiety is presented for the first time. We describe and demonstrate the effectiveness of face-to-face, remote cognitive-behavioral protocols of the «second wave» of «third wave», CBT of IBS-induced agoraphobia, multimodal СBT protocol.
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Wang, Jiali, Fushun Kou, Xiao Han, Lei Shi, Rui Shi, Zhibin Wang, Tangyou Mao, and Junxiang Li. "Inflammatory bowel disease and risk of idiopathic pulmonary fibrosis: A protocol for systematic review and meta-analysis." PLOS ONE 17, no. 6 (June 24, 2022): e0270297. http://dx.doi.org/10.1371/journal.pone.0270297.

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Introduction Inflammatory bowel disease is a relapsing chronic gastrointestinal inflammatory disease. Idiopathic pulmonary fibrosis is a rare but serious extraintestinal pulmonary manifestation of inflammatory bowel disease. However, the relationship between these two conditions is unclear. Therefore, this study aims to elucidate this relationship through a systematic review and meta-analysis, focusing on the risk of idiopathic pulmonary fibrosis in patients with inflammatory bowel disease. Methods The systematic review will be outlined according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols and its extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions: checklist and explanations. Original articles published in any language will be searched in the following databases: PubMed, Web of Science, EMBASE, Google Scholar, and Ovid. Observational studies that reveal an association measure between idiopathic pulmonary fibrosis and inflammatory bowel disease will be included (cross sectional, cohort, and case-control trials). Two independent reviewers will be assigned to evaluate study quality using the Newcastle–Ottawa scale for assessing the quality of non-randomized studies in meta-analyses. Sensitivity analyses will be conducted based on the quality of included studies. All relevant studies will be assessed based on the study type, sample size, inflammatory bowel disease subtype, odds ratio, confidence interval, treatment strategy, and follow-up. The Grading of Recommendations Assessment, Development, and Evaluation approach will be used to rate the quality of the evidence. Discussion The results of this meta-analysis may show that patients with inflammatory bowel disease are at higher risk of developing idiopathic pulmonary fibrosis. This study will be the first meta-analysis to focus on the association between inflammatory bowel disease and idiopathic pulmonary fibrosis. Exploring the relationship between the two conditions may further enhance our understanding of the pathogenesis of inflammatory bowel disease and idiopathic pulmonary fibrosis and promote the development of related research fields.
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Jollett, Erin, and Penni Coates Huffman. "Evidence-Based Guideline for When to Transfuse Neonates and How to Feed with the Transfusion." Neonatal Network 35, no. 6 (2016): 353–58. http://dx.doi.org/10.1891/0730-0832.35.6.353.

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AbstractBlood transfusions are common in the NICU. Although blood transfusions can be lifesaving, they are not without risks such as necrotizing enterocolitis (NEC). NEC is an inflammation in the bowel that can lead to perforation, bowel loss, and death. Research indicates that there is a correlation between NEC and blood transfusions. There is no agreed-upon cause of NEC, but most of the research supports the need for holding feedings while being transfused. This article provides an evidence-based protocol, based on retrospective chart reviews of 24 neonates, for how long to hold the feedings before, during, and after the transfusion. This protocol was implemented in an NICU where the NEC cases related to blood transfusions were as high as 25 percent and decreased to as low as 4 percent after the protocol was implemented.
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Vogt, Peggy, Renee Tolly, Matt Clifton, Tom Austin, and Joelle Karlik. "The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy." Children 9, no. 11 (October 31, 2022): 1675. http://dx.doi.org/10.3390/children9111675.

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Balancing post-operative adequate pain control, respiratory depression, and return of bowel function can be particularly challenging in infants receiving the Kasai procedure (hepatoportoenterostomy). We performed a retrospective chart review of all patients who underwent the Kasai procedure from a single surgeon at Children’s Healthcare of Atlanta from 1 January 2018, to 1 September 2022. 12 patients received the Kasai procedure within the study period. Average weight was 4.47 kg and average age was 7.4 weeks. Most patients received multimodal pain management including dexmedetomidine and/or ketorolac along with intravenous opioids. A balance of colloid and crystalloids were used for all patients; 57% received blood products as well. All patients were extubated in the OR and transferred to the general surgical floor without complications. Return of bowel function occurred in all patients by POD2, and enteral feeds were started by POD3. One patient had a presumed opioid overdose while admitted requiring a rapid response and brief oxygen supplementation. Simultaneously optimizing pain control, respiratory safety, and bowel function is possible in infants receiving the Kasai procedure. Based on our experience and the current pediatric literature, we propose an enhanced recovery protocol to improve patient outcomes in this fragile population. Larger, prospective studies implementing an enhanced recovery protocol in the Kasai population are required for stronger evidence and recommendations.
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Sey, Michael Sai Lai, Daniel von Renteln, Richard Sultanian, Cassandra McDonald, Myriam Martel, and Alan Barkun. "Multicentre endoscopist-blinded randomised clinical trial to compare two bowel preparations after a colonoscopy with inadequate cleansing: a study protocol." BMJ Open 9, no. 7 (July 2019): e029573. http://dx.doi.org/10.1136/bmjopen-2019-029573.

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IntroductionInadequate bowel preparation is common and negatively impacts colonoscopy quality. The objective of this study is to compare two bowel preparation regimens in cleansing the colon after an index colonoscopy with failed bowel preparation.Methods and analysisThis is a phase III, multicentre, randomised clinical trial comparing two bowel preparation regimens after failure to adequately cleanse at the index colonoscopy. Regimen A consists of 4 L split-dose polyethylene glycol electrolyte solution (PEG-ELS) and Regimen B consists of 6 L split-dose PEG-ELS, both preceded by 15 mg of bisacodyl the day before the procedure along with a low-fibre diet 3 and 2 days before the procedure followed by a clear fluid diet starting the day before the procedure. The primary outcome is adequate bowel preparation, defined as a Boston Bowel Preparation Scale (BBPS) score of ≥6 with each segment score ≥2. Secondary outcomes include mean BBPS score, bowel preparation adequacy using the US Multi-Society Task Force on Colorectal Cancer definition, detection rate by polyp subtype, caecal intubation rate, mean Validated Patient Tolerability Questionnaire for Bowel Preparation score, subject willingness to repeat the preparation and faecal incontinence rate.Ethics and disseminationThe study will be conducted in accordance with Good Clinical Practice guidelines and local institutional standards. Study findings will be disseminated at an international gastroenterology conference and published in peer-reviewed journals.Trial registration numberNCT02976805; Pre-results.
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Zhao, Yi, Jhia Jiat Teh, Victor Kung, and Sreelakshmi Mallappa. "Bowel ischaemia in COVID-19 infection: a scoping review protocol." BMJ Open 12, no. 9 (September 2022): e060566. http://dx.doi.org/10.1136/bmjopen-2021-060566.

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IntroductionCOVID-19 disease was declared as a pandemic by WHO since March 2020 and can have a myriad of clinical presentations affecting various organ systems. Patients with COVID-19 are known to have an increased risk of thromboembolism, including cardiovascular, pulmonary and cerebral ischaemic events. However, an increasing number of case studies have reported that COVID-19 infection is also associated with gastrointestinal ischaemia. This scoping review aims to collate the current evidence of COVID-19-related gastrointestinal ischaemia and raise awareness among healthcare professionals of this lesser known, but serious, non-pulmonary complication of COVID-19 infection.MethodsThe proposed scoping review will be conducted as per the Arksey and O’Malley methodological framework (2005) the Joanna Briggs Institute methodology for scoping reviews. A systematic search will be undertaken on different databases including EMBASE, PubMed and MEDLINE. Two independent reviewers will screen titles, abstracts and full-text articles according to the inclusion criteria and extract relevant data from the included articles. Results will be presented in a tabular form with a narrative discussion.Ethics and disseminationEthical approval will not be required for this scoping review. This scoping review will provide an extensive overview of the association between COVID-19 infection and bowel ischaemia. Further ethical and methodological challenges will also be discussed in our findings to define a new research agenda. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.
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Loftus, Tyler, Frederick Moore, Erin VanZant, Trina Bala, Scott Brakenridge, Chasen Croft, Lawrence Lottenberg, et al. "A protocol for the management of adhesive small bowel obstruction." Journal of Trauma and Acute Care Surgery 78, no. 1 (January 2015): 13–21. http://dx.doi.org/10.1097/ta.0000000000000491.

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Konijeti, Gauree G., NaMee Kim, James D. Lewis, Shauna Groven, Anita Chandrasekaran, Sirisha Grandhe, Caroline Diamant, et al. "Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease." Inflammatory Bowel Diseases 23, no. 11 (November 2017): 2054–60. http://dx.doi.org/10.1097/mib.0000000000001221.

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Palsson, Olafur S. "Standardized Hypnosis Treatment for Irritable Bowel Syndrome:The North Carolina Protocol." International Journal of Clinical and Experimental Hypnosis 54, no. 1 (January 2006): 51–64. http://dx.doi.org/10.1080/00207140500322933.

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Coggrave, Maureen, Dee Burrows, and Mary Alison Durand. "Progressive protocol in the bowel management of spinal cord injuries." British Journal of Nursing 15, no. 20 (November 2006): 1108–13. http://dx.doi.org/10.12968/bjon.2006.15.20.22295.

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Beddar, Sandra A. Mitchell, Lynn Holden-Bennett, and Anne Marie Mccormick. "Development and Evaluation of a Protocol to Manage Fecal Incontinence in the Patient with Cancer." Journal of Palliative Care 13, no. 2 (June 1997): 27–38. http://dx.doi.org/10.1177/082585979701300206.

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Fecal incontinence is an important yet often overlooked clinical problem in the care of patients with cancer. This paper presents a protocol for the assessment and management of this distressing symptom. The objective of the protocol is to regulate bowel motion, thereby minimizing fecal incontinence and improving patients’ physical functioning, self-esteem, dignity, and quality of life. A comprehensive assessment addressing the patient's physical status, previous elimination routines, dietary habits, and medications provides the foundation for successful management. Components of the intervention include dietary modification, Pharmacotherapy with laxatives and suppositories, and attention to routines that capitalize on the normal, involuntary gastrointestinal reflexes. Promotion of normal bowel elimination patterns, positioning, and comprehensive patient teaching and support are also critical components of the intervention. Our experience with this protocol and the outcomes achieved in a small series of patients are discussed.
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Paily, Abhilash, Jalpa Kotecha, Loveena Sreedharan, and Bhaskar Kumar. "Resolution of adhesive small bowel obstruction with a protocol based on Gastrografin administration." Journal of Medicine and Life 12, no. 1 (January 2019): 10–14. http://dx.doi.org/10.25122/jml-2018-0082.

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The use of Gastrografin may have a therapeutic effect on resolving adhesive small bowel obstruction. Adhesive Small Bowel obstruction (ASBO) accounts for the majority of patients with small bowel obstruction. Most patients are managed conservatively; frequent admissions create a considerable burden. We sought to examine the adherence to the Bologna guidelines for the management of ASBO in a high volume tertiary center and whether or not Gastrografin had a therapeutic effect. A comparison was made between an initial retrospective audit looking at ASBO and a prospective re-audit after applying standards derived from the Bologna guidelines. During re-audit it was found that more patients underwent conservative management and fewer patients had surgery as first line management. In the re-audit, those who had to undergo surgery within/after a period of 72h of conservative management were also fewer. Whether they were managed surgically primarily or after a period of conservative management, the average length of stay was also shorter. In comparison to the preliminary audit, there appeared to be no change in the way that medical history and physical examination was documented during the re-audit. However, there was a marked difference in the use of appropriate blood tests and CT scans. Changes were made successfully following the initial audit results and have been implemented, thus closing the audit loop. This study shows that the use of Gastrografin has decreased the need for surgical intervention in a group of patients with small bowel obstruction.
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Lovato, Antonello. "Treatment of Irritable Bowel Syndrome with Auricular Acupuncture: A controlled pilot study." Journal of Alternative, Complementary & Integrative Medicine 8, no. 5 (October 6, 2022): 1–9. http://dx.doi.org/10.24966/acim-7562/100267.

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AA is a viable treatment of IBS and Group B protocol could be a first approach of AA treatment in IBS. Nonetheless, protocol choice must be based more on results from clinical trials and less on theoretical AA reasoning
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Jilmaz, Gulseren, Esra Can, Derya Ozden Omaygenc, Nevin Tuten, Fatma Olmez, Huseyin Kiyak, Pinar Yalcin Bahat, Aysu Akca, and Ziya Salihoglu. "Comparison of enhanced recovery protocol with conventional care in patients undergoing urogynecological surgery." Česká gynekologie 87, no. 4 (August 31, 2022): 232–38. http://dx.doi.org/10.48095/cccg2022232.

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Objective: The impact of enhanced recovery after surgery (ERAS) protocol on postoperative outcomes after urogynecological surgery is yet to be a matter of investigation. This study sought to evaluate this issue by comparing the patients who had conventional or ERAS-guided perioperative care for several clinical end-points including ambulation, length of hospital stay (LOS), readmissions, and postoperative complications. Materials and methods: A total of 121 patients undergoing pelvic organ prolapse surgery were allocated to two study arms, ERAS protocol (Group E) or conventional care (Group C). Variables reflecting the restoration of appetite and bowel movements, bleeding events, other complications, LOS and readmissions were compared between the groups. Results: The patients in Group C significantly received a more intensive intravenous fluid treatment compared to Group E (2,760 ± 656 vs. 1,045 ± 218 mL, P < 0.001). Time required for first flatus, first defecation, eating solid food, and ambulation (P < 0.001) were also longer in the former group of patients. Moreover, LOS was significantly reduced when the ERAS protocol was applied (2.5 ± 1.1 vs. 2.0 ± 0.6 days, P < 0.001). On the other hand, the two groups were similar with respect to the frequency of the postoperative complications, including surgical site infections, cardiovascular complications, non-specific abdominal pain, sub-ileus, blood loss and readmission rate. Conclusion: In our sample population, ERAS protocol led to early initiation of oral intake, early recovery of bowel function, early mobilization, and early discharge of patients without compromise in safety concerns after urogynecological surgery. Key words: enhanced recovery after surgery – gynecologic surgery – pelvic organ prolapse – postoperative care – postoperative complications
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Melehin, A. I., and J. S. Ignatenko. "Home-based cognitive behavioral psychotherapy in the treatment of irritable bowel syndrome: the specifics and effectiveness." Современная зарубежная психология 7, no. 4 (2018): 56–74. http://dx.doi.org/10.17759/jmfp.2018070407.

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The irritable bowel syndrome (IBS) is a common debilitating functional disorder of the gastrointestinal tract. In the article are described, for the first time, the biopsychosocial model and the vicious circle of IBS development. Therapeutic route of maintenance IBS patients that includes pharmacological and non-pharmacological approaches is presented. Based on the analysis of foreign recommendations for the treatment of IBS, it is shown that the "gold standard" of non-drug treatment is full-time and remote cognitive behavioral psychotherapy (CBT). The advantages of the remote form of cognitive-behavioral psychotherapy of IBS are presented, psychotherapeutic targets are systematized, and the structure is described in detail. A protocol for monitoring symptoms of irritable bowel is presented. Based on the analysis of foreign studies, in the article are presented the effectiveness and limitations of remote-control protocols in the treatment of IBS.
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Zhang, Yuelun, Wei Chen, Yi Zhao, and Dong Wu. "Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review protocol." BMJ Open 9, no. 9 (September 2019): e029383. http://dx.doi.org/10.1136/bmjopen-2019-029383.

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IntroductionNon-polypoid low-grade dysplasia in inflammatory bowel disease is associated with a medium increased risk of colorectal cancer, while treatment recommendations remain controversial. We aim to evaluate the efficacy and safety of endoscopic treatment for non-polypoid dysplasia in patients with inflammatory bowel disease.Methods and analysisMedline, Embase, Cochrane Library, Scopus, Web of Science and clinical trials registry from database inception to the search date will be used to retrieve eligible studies. Studies that report the curative resection rate or any of other secondary outcomes of endoscopic treatment in patients with non-polypoid dysplasia in inflammatory bowel disease will be included in the analysis. We will conduct quantitative synthesis if the eligible studies are homogeneous judging from clinical and methodological perspectives.Ethics and disseminationEthical approval for this study was waived by the Ethics Committee of Peking Union Medical College Hospital because there are no individual data involved in the analysis and all the combined results will be retrieved from study-level data. We plan to disseminate results through peer-reviewed journals or conference abstracts.PROSPERO registration numberCRD42019120413.
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Zhao, Yi, Feng Xie, Xiaoyin Bai, Aiming Yang, and Dong Wu. "Educational virtual reality videos in improving bowel preparation quality and satisfaction of outpatients undergoing colonoscopy: protocol of a randomised controlled trial." BMJ Open 9, no. 8 (August 2019): e029483. http://dx.doi.org/10.1136/bmjopen-2019-029483.

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IntroductionColonoscopy is the reference method in screening and diagnosis of colorectal neoplasm, but its efficacy is closely related to the quality of bowel preparation. Poor patient compliance is a major risk factor for inadequate bowel preparation likely due to poor patient education. Such an education is usually provided via either oral or written instructions by clinicians. However, multiple education methods, such as smartphone applications, have been proved useful in aiding patients through bowel preparation. Also, it was reported that a large proportion of patients feel anxious before colonoscopy. Virtual reality (VR) is a novel method to educate patients and provides them with an immersive experience. Theoretically, it can make patients better prepared for bowel preparation and colonoscopy. However, no prospective studies have assessed the role of this novel technology in patient education before colonoscopy. We hypothesise that VR videos can improve bowel preparation quality and reduce pre-procedure anxiety.Methods/designThe trial is a prospective, randomised, single-blinded, single-centre trial. Outpatients who are scheduled to undergo colonoscopy for screening or diagnostic purposes for the first time will be randomised to receive either the conventional patient education or the conventional methods plus VR videos, and 322 patients will be enrolled from the Peking Union Medical College Hospital. The primary endpoint is the quality of bowel preparation, measured by the Boston bowel preparation score. Secondary endpoints include polyp detection rate, adenoma detection rate, cecal intubation rate, patient compliance to complete bowel cleansing, withdrawal time, pre-procedure anxiety, overall satisfaction and willingness for the next colonoscopy.Ethics and disseminationThe study has been approved by the institutional review board of the Peking Union Medical College Hospital (No. ZS-1647). The results of this trial will be published in an open-access way and disseminated among gastrointestinal physicians and endoscopists.Trial registration numberNCT03667911
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Khadjibaev, A. M., N. A. Khadjimukhamedova, and F. A. Khadjibaev. "Diagnosis and treatment of acute bowel obstruction." Kazan medical journal 94, no. 3 (June 15, 2013): 377–81. http://dx.doi.org/10.17816/kmj2188.

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Aim. To improve treatment outcomes in patients with acute bowel obstruction. Methods. 1479 patients with bowel obstruction (75.7% - small bowel obstruction, 24.3% - large bowel obstruction) were examined. Patients were treated according to the local treatment protocol, 1003 (68%) patients underwent surgery. Results. The following procedures were performed at the stage of bowel obstruction diagnosis and treatment: conventional adhesiolysis was performed in 425 cases, laparoscopic adhesiolysis - in 425 cases, small bowel resection with further anastomosis - in 151 cases, small bowel resection with ileostomy - in 15 cases, phytobezoar fragmenting - in 56 cases, enterotomy and phytobezoar removal - in 2 cases. In patients with large bowel obstruction the following procedures were performed: large bowel segmental resection with further anastomosis - in 38 cases, large bowel segmental resection with colostomy - in 38 cases, large bowel partial resection with colostomy - in 54 cases, right hemicolectomy with primary anastomosis - in 43 cases, left hemicolectomy with primary anastomosis - in 58 cases, manual intussusception reduction - in 65 cases, side anastomosis - in 31 cases. In 69 cases of bowel obstruction primary anastomosis was performed using the metal ring frame. Conclusion. To reduce the rate of complications, the need for the surgery should be diagnosed as soon as possible, coagulopathies should be compensated, and surgery tactics should be defined, including the primary anastomosis formation.
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Pribadi, Rabbinu Rangga, Virly Nanda Muzellina, and Marcellus Simadibrata. "Bowel Cleansing Protocol in Colonoscopy: Does It Affect Blood Thiamine Level?" Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy 21, no. 1 (July 26, 2020): 22–25. http://dx.doi.org/10.24871/211202022-25.

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Background: The burden of vitamin B1 or thiamine deficiency in patients undergoing digestive surgery is quite enormous. In the field of gastroenterology, pre-colonoscopy preparation might affect thiamine level. However the burden is not well defined. This study was conducted to confirm whether there is significant decrease of blood thiamine level in post-colonoscopy compared to pre-colonoscopy group.Method: This cross-sectional study was carried out at gastrointestinal endoscopy center of Cipto Mangunkusumo National General Hospital, Jakarta from October 2018 to January 2019. The inclusion criteria were patients equal or more than 18-year-old who underwent colonoscopy. The exclusion criteria were malnutrition, history of post-gastrointestinal resection, definitive diagnosis of cancer, and chronic alcoholism.Results: The median value of blood thiamine level is 58 (20-78) for pre-colonoscopy group and 58 (25-79) for post colonoscopy group (p=0.31).Conclusion: There was no significant decrease of blood vitamin B1 level in post-colonoscopy compared to pre-colonoscopy group.
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Karimi, Neda, Alison Rotha Moore, Annabelle Lukin, Ria Kanazaki, Astrid-Jane Williams, and Susan Connor. "Clinical communication in inflammatory bowel disease: a systematic literature review protocol." BMJ Open 10, no. 11 (November 2020): e039503. http://dx.doi.org/10.1136/bmjopen-2020-039503.

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IntroductionEvidence regarding effective communication between clinicians and patients with inflammatory bowel disease (IBD) is limited. Studies that investigate clinical communication in IBD are much fewer in number than studies that investigate the perceptions of patients and clinicians about communication in clinical encounters. The current review aims to identify, organise and summarise systematically what is currently known about (1) the characteristics of interactions between clinicians who manage IBD and patients with IBD, and (2) how clinical discussion affects health outcomes in IBD.Methods and analysisScopus, PubMed, Embase, Communication Abstracts, Health & Society, Linguistics and Language Behavior Abstracts and PsycINFO will be systematically searched for studies that investigate the characteristics of IBD clinical interactions during recorded consultations, from earliest available dates within each database to May 2020. A specifically developed quality assessment tool, grounded in linguistic theory, will be used to critically assess the evidence. In addition, a data extraction template will be developed and utilised to provide a description of the characteristics of IBD clinical communication as well as an estimation of its effect on health outcomes in a narrative synthesis.Ethics and disseminationEthical review and approval is not required for this systematic review as no primary data will be collected. The results will be published in peer-reviewed journals and presented at academic conferences.PROSPERO registration numberInternational Prospective Register of Systematic Reviews (PROSPERO) on 28 April 2020 (registration number: CRD42020169657).
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Szaflarska-Popławska, Anna, Dominika Tunowska, Ola Sobieska-Poszwa, Anna Gorecka, and Aneta Krogulska. "The Effectiveness, Tolerability, and Safety of Different 1-Day Bowel Preparation Regimens for Pediatric Colonoscopy." Gastroenterology Research and Practice 2019 (November 3, 2019): 1–7. http://dx.doi.org/10.1155/2019/3230654.

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Background. Currently, there is no generally accepted universal protocol for bowel preparation before colonoscopy in children. Aim. The aim of the study was to compare three different 1-day bowel preparation methods for a pediatric elective colonoscopy in terms of their efficacy, safety, and patient-reported tolerability. Material and Methods. The study was randomized, prospective, and investigator-blinded. All children aged 10 to 18 years consecutively referred to the tertiary pediatric gastroenterology unit were enrolled. The participants were randomized to receive polyethylene glycol 3350 combined with bisacodyl (PEG-bisacodyl group), or polyethylene glycol 4000 with electrolytes (PEG-ELS group), or sodium picosulphate plus magnesium oxide plus citric acid (NaPico+MgCit group). Bowel preparation was assessed according to the Boston Bowel Preparation Scale (BBPS). For patient tolerability and acceptability, questionnaires were obtained. Results. One hundred twenty-three children were allocated to three age- and sex-matched groups. All of the patients completed colonoscopies with visualization of the cecum. There was no difference among the groups for the mean BBPS score. A total of 73 patients (59.3%) experienced minor adverse events. No serious adverse events occurred in any group. Nausea was the only symptom more frequent in the PEG-ELS group compared to the NaPico+MgCit group (p=0.04), and apathy was the only symptom more frequent in PEG-bisacodyl than in the NaPico+MgCit group (p=0.04). All of the patients were able to complete 75% or more of the study protocol, and 85.4% were able to complete the full regimen. The acceptability was the highest in the NaPico+MgCit group with respect to the patient’s grade for palatability, low volume of the solution, and willingness to repeat the same protocol. Conclusion. All bowel cleansing methods show similar efficacy. However, because of the higher tolerability and acceptability profile, the NaPico+MgCit-based regimen appears to be the most proper for colonoscopy preparation in children.
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Dotan, Iris, Remo Panaccione, Gilaad G. Kaplan, Colm O’Morain, James O. Lindsay, and Maria T. Abreu. "Best Practice Guidance for Adult Infusion Centres during the COVID-19 Pandemic: Report from the COVID-19 International Organization for the Study of IBD [IOIBD] Task Force." Journal of Crohn's and Colitis 14, Supplement_3 (September 22, 2020): S785—S790. http://dx.doi.org/10.1093/ecco-jcc/jjaa147.

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Abstract Infusion centres are a central part in the management of patients with inflammatory bowel disease [IBD] and could be a source of transmission of SARS-COV-2. Here we aimed to develop global guidance for best practices of infusion centres for IBD patients and to determine the impact of the COVID-19 pandemic on these centres. Under the auspices of the International Organization for the Study of Inflammatory Bowel Disease [IOIBD], a task force [TF] was formed, an online survey was developed to query infusion centre protocols during COVID-19, and recommendations were made, based on TF experience and opinion. Recommendations focus mainly on patients screening, infusion centres re-organization, personnel protection, and protocol modifications such as shortening infusion duration or replacing it with subcutaneous alternatives. Implementing these recommendations will hopefully reduce exposure of both IBD patients and care givers to SARS-COV-2 and improve the function and safety of infusion centres during the COVID-19 pandemic as well as potential future threats.
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Nikolovski, Andrej, Sanja Trajkova, Dushko Dukovski, Goran Spirov, and Gordana Petrushevska. "Extranodal Diffuse Large B-Cell Lymphoma of the Small Bowel in Female Patient Causing Intestinal Obstruction: A Case Report." Lietuvos chirurgija 21, no. 3-4 (December 30, 2022): 243–47. http://dx.doi.org/10.15388/lietchirur.2022.21.72.

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Diffuse large B cell lymphoma is the most common extranodal non-Hodgkin lymphoma of the small intestine accounting for more than 50% of cases. Forty percent of these cases initially present with small bowel obstruction. Therefore, the diagnosis is usually established after surgery for bowel obstruction. The treatment is then continued with a certain chemotherapy regimens. We present a case of a 46-years-old female patient with signs of small bowel obstruction due to previously undiagnosed diffuse large B-cell lymphoma. Postoperatively, the patient was treated with 7 cycles of R-CHOP protocol and complete response was achieved in the short follow-up period.
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SOARES, Rosa LS, Pedro Ferreira MOREIRA-FILHO, Carolina Possidente MANESCHY, Julia Fumian BREIJÃO, and Nathan Mielke SCHMIDTE. "THE PREVALENCE AND CLINICAL CHARACTERISTICS OF PRIMARY HEADACHE IN IRRITABLE BOWEL SYNDROME: a subgroup of the functional somatic syndromes." Arquivos de Gastroenterologia 50, no. 4 (December 2013): 281–84. http://dx.doi.org/10.1590/s0004-28032013000400008.

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ContextThe irritable bowel syndrome and primary headache are two chronic diseases characterized by symptoms of recurring pain and affect approximately 10%-20% of the general population.ObjectivesTo study the prevalence of primary headache in volunteers with irritable bowel syndrome in a Brazilian urban community.MethodsIt was evaluated the prevalence of primary headache associated with irritable bowel syndrome in adult volunteers 330 no patients.The protocol included the Rome III criteria, international classification of Headaches, later divided into four groups: I- Irritable bowel syndrome (n = 52), II- Primary headache (n = 45), III-Irritable bowel syndrome (n = 26) and headache, and IV- Controls (207).ResultsWe not found significant difference in the average age of the four groups and the diagnosis of irritable bowel syndrome, primary headache and their association was more frequent in females. The frequent use of analgesics was greater in groups II and III.ConclusionOur results suggest that irritable bowel syndrome and primary headache are also common in third world countries. The frequency in use of analgesics in association between the two entities was relevant. The identification of irritable bowel syndrome patients with different clinical sub-types could improve the therapeutics options and the prevention strategies.
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Hanna, Peter, Arveen Kalapara, Subodh Regmi, Kalyana Srujana, Joseph Zabell, Darrel Randle, Alexander Kaizer, et al. "Alvimopan as an essential component of ERAS protocol to decrease length of hospital stay." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 517. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.517.

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517 Background: Radical cystectomy for muscle invasive bladder cancer is the gold standard. However, it is frequently associated with a prolonged length of hospital stay (LOS). We study the effect of ERAS protocol implementations and Alvimopan use in patients undergoing radical cystectomy and its impact on length of hospital stay (LOS). Methods: Retrospective cohort study involving consecutive patients undergoing radical cystectomy for bladder cancer at our institution from 2010 through 2018. We evaluated Alvimopan use plus an ERAS protocol post radical cystectomy versus patients who underwent ERAS protocol alone versus those who were managed prior to ERAS protocol implementation. Primary outcome of interest was LOS, controlling for age, sex, smoking status and Charleson comorbidities index. Results: 146 patients (49.32 %) received standard care (non-ERAS) (group A), 102 patients (34.45 %) underwent ERAS protocol alone (group B) and 47 patients (15.87 %) underwent ERAS protocol plus Alvimopan (group C). There was no significant difference in length of stay between group A and group B (p=0.856). However, group C experienced a shorter LOS (16.6%) compared to group A (p=0.015). Similarly, group B was not significantly associated with the days to bowel movements compared to group A (p=0.112), however, group C demonstrated a significantly shorter time (16.3%) to bowel movements compared to group A (p=0.015). On other hand, group c wasn’t significantly associated with time tolerance to regular diet (p=0.068). Limitations include retrospective nature of some of the data, non-randomized approach and confounders such as a mix of robot and open approaches to cystectomy. Conclusions: Of all ERAS protocol components, Alvimopan appeared to be the most significant contributor in accelerating GI recovery and decrease LOS in our cohort.
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Saraswat, D. K., P. H. Fung, A. Dong, R. Sultanian, O. Farooq, and C. Wong. "A160 THE EFFECT OF AN INSTRUCTIVE VIDEO ON THE BOWEL PREPARATION EXPERIENCE." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 24–25. http://dx.doi.org/10.1093/jcag/gwz047.159.

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Abstract Background Over 26000 new cases of colorectal cancer (CRC) are diagnosed each year in Canada. This number has been decreased significantly by the implementation of CRC screening that includes removal of any polyps found during colonoscopies. Despite this, approximately 1 in 4 colonoscopies are inadequate for the detection of early neoplasms due to insufficient bowel preparation prior to the colonoscopy. Consequently, there is a need to improve patient adherence to the bowel preparation protocol. Previous research has shown that enhanced education, including the methods and rationale for bowel preparation prior to a colonoscopy, improves the quality of the bowel preparation. Aims We hypothesised that patients with access to a replayable video explaining the bowel preparation protocol and its importance would have increased satisfaction and noninferior bowel preparations. Methods 100 patients undergoing programmatic screening colonoscopy were randomly assigned into one of two groups. The control group was given the standard presentation currently given to patients. The experimental group was given the same presentation and also given access to an educational video. This video is based on Alberta provincial bowel preparations which have been tested and evaluated. Participants in both groups were sent a survey one day after their colonoscopy. Subjects completed a modified version of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems survey with added questions designed to assess their satisfaction with the education they received on the bowel preparation. Bowel preparation quality was assessed on a 4-point Likert scale by the endoscopist. Results 17 participants (10 female), aged 40–72 (Mage = 60) have enrolled in the study thus far; however, most have yet to have their colonoscopy. Initial results revealed that all participants had high levels of satisfaction with the presentation they were given. Those in the control group indicated that they would have liked to have had access to a video guide to the bowel preparation before their procedure. The participant in the experimental group indicated high levels of satisfaction with this video, noting that it provided important information not available from other sources. Information on the quality of their bowel preparations is pending. Conclusions The use of multimedia explanations of the bowel preparation has promise in improving patient satisfaction with the bowel preparation. Further studies may guide best methods for implementing a video assisted educational model to enhance colonoscopy preparation. Funding Agencies The first author received an Edna Wakefield Rowe Memorial Summer Research Award from the Faculty of Medicine & Dentistry at the University of Alberta to support this work.
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Bradley, Matthew, Angela Kindvall, Judy Logan, Jeffrey Bailey, Eric Elster, and Carlos Rodriguez. "Successful implementation of an appendectomy process improvement protocol." Trauma Surgery & Acute Care Open 4, no. 1 (June 2019): e000303. http://dx.doi.org/10.1136/tsaco-2019-000303.

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BackgroundA key component of a process improvement program is the institution of hospital-specific protocols to address certain disparities and streamline patient care. In that regard, we evaluated the implementation of an outpatient laparoscopic appendectomy (OLA) protocol at a tertiary military hospital. We hypothesized that OLA would reduce length of stay (LOS) without increasing complications.MethodsIn August 2016, our institution implemented an OLA protocol—defined as discharge within 24 hours of surgery. Exclusion criteria included age <18 years old, grade 4 or 5 appendicitis, immunosuppression, current pregnancy, and no supervision during the first 24 hours postdischarge. To determine OLA’s effect on LOS, analysis of variance was used to perform a comparison between the years 2014 and 2017. Successful outpatient appendectomies were recorded preprotocol and postprotocol, as well as readmission complications.ResultsIn 2017, the first full year of protocol implementation, 44 of 59 (75%) patients met the inclusion criteria, and all but 2 (42 of 44, 95%) stayed for less than 24 hours. Of the two outliers, one developed acute on chronic kidney disease and one had a slow return of bowel function following grade 3 appendicitis. Complications were low across all years (one per year). In 2017, the readmission was for percutaneous drainage of an abscess. Overall, protocol implementation produced a significant decrease in LOS.DiscussionOLA protocol decreased LOS at a military hospital and should be expanded to other department of defense (DoD) facilities. Further research is needed to identify cost benefit to the military health system.Level of evidenceIII.
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Love, Jonathan, Edmond-Jean Bernard, Alan Cockeram, Lawrence Cohen, Martin Fishman, James Gray, and David Morgan. "A Multicentre, Observational Study of Sodium Picosulfate and Magnesium Citrate as a Precolonoscopy Bowel Preparation." Canadian Journal of Gastroenterology 23, no. 10 (2009): 706–10. http://dx.doi.org/10.1155/2009/385619.

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BACKGROUND: Sodium picosulfate with magnesium citrate (PSMC) has been available as a precolonoscopy bowel preparation in Canada since 2005. A high patient acceptability and preference appears to have contributed to its wide adoption across the country. Despite its frequent use, there are relatively few published studies of this product, especially reports regarding its use in routine clinical practice. Moreover, to date, there have been no Canadian studies of any kind.OBJECTIVE: To conduct a preliminary evaluation of PSMC by prospectively collecting data describing its effectiveness.METHODS: In the present multicentre, observational study, sequential patients used PSMC according to each institution’s standard colonoscopy protocol. Differences in bowel cleansing protocols included dose timing, fluid intake, dietary restrictions and administration of bisacodyl. During colonoscopy, preparation quality was rated separately for the right and left sides of the colon.RESULTS: Of the 613 patients entered, 606 were evaluable for efficacy. For the right and left colon, respectively, 93.0% and 96.2% of preparations were rated either ‘excellent’ or ‘adequate’. In the 334 patients who received adjunctive bisacodyl and the 272 patients who did not, the results were similar: for the right and left colon, 92.3% and 97.1% of those who did not, and 93.4% and 95.7% of those who did receive bisacodyl, respectively, were rated either ‘excellent’ or ‘adequate’.CONCLUSIONS: Despite the differences in bowel cleansing protocols used at each hospital (including an additional laxative), PSMC consistently yielded a high percentage of positive ratings for efficacy.
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Melehin, A. I. "Remote psychological assistance for chronic visceral pain associated with irritable bowel syndrome." Russian Journal of Telemedicine and E-Health 8, no. 1 (March 25, 2022): 58–68. http://dx.doi.org/10.29188/2712-9217-2022-8-1-58-68.

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Abstract:
Chronic visceral pain, which increases with stress, is a hallmark of functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Modern pharmacological interventions, diets for patients with chronic visceral pain are usually insufficient, and many of them are fraught with undesirable side effects and short remission. Modern protocols of cognitive behavioral therapy of the third wave, which are available in a remote format, show efficiency, cost-effectiveness in relieving chronic visceral pain caused by stress. The article describes the specifics of the third wave of CBT in relation to the treatment of IBS. A cognitive-behavioral approach to the treatment of irritable bowel syndrome is detailed, which reverses increased stress reactivity and afferent sensitization in the central and peripheral nervous systems, respectively, which leads to a more complete and prolonged relief of IBS symptoms in the patient. The specificity and effectiveness of the protocol of remote cognitive behavioral therapy to enhance awareness in IBS J. is shown. Henrich and integration of cognitive behavioral therapy of the second and third waves to improve the lifestyle of patients with IBS.
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49

Di Nardo, Paola, Silvio Ken Garattini, Elena Torrisi, Valentina Fanotto, Gianmaria Miolo, Angela Buonadonna, and Fabio Puglisi. "Systemic Treatments for Advanced Small Bowel Adenocarcinoma: A Systematic Review." Cancers 14, no. 6 (March 15, 2022): 1502. http://dx.doi.org/10.3390/cancers14061502.

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Small bowel adenocarcinoma (SBA) is a rare disease for which scarce evidence is available. We summarized data available on systemic treatment of advanced SBA. Methods: Scientific literature was evaluated to find phase II or phase III clinical trials on systemic treatment for advanced SBA. MeSH terms were selected and combined for the initial search, then inclusion and exclusion criteria were set in a search protocol. Four medical oncologists looked for evidence on Medline, EMBASE and Cochrane databases. Moreover, abstracts from 2016 to June 2021 from the American Society for Clinical Oncology, European Society for Medical Oncology, Gastrointestinal Cancer Symposium and World Congress on Gastrointestinal Cancer were browsed. The selected studies, matching the inclusion and exclusion criteria, were finally tabulated and analyzed. Results: The trials finally selected were 18 phase II/III clinical trials. Four small phase II trials support the activity of oxaliplatin-based doublets in first-line treatment (CAPOX and mFOLFOX). Conclusion: No good level evidence is available on the use of bevacizumab, anti-epidermal growth factor receptor, targeted agents or immunotherapy. First-line treatments are largely derived from colorectal cancer protocols, mainly oxaliplatin-based doublets.
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50

Balmer, Aurélie, Daniel Clerc, Laura Toussaint, Olivia Sgarbura, Abdelkader Taïbi, Martin Hübner, and Hugo Teixeira Farinha. "Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases." Cancers 14, no. 10 (May 23, 2022): 2557. http://dx.doi.org/10.3390/cancers14102557.

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Background: The standard treatment protocol for PIPAC consists of three procedures. Completion of treatment has been shown to be prognostic of improved survival. The aim of this study was to identify predictors for completion of treatment. Methods: Retrospective multicentric cohort study of patients with peritoneal metastases undergoing PIPAC in three PIPAC expert centers. Per protocol (PP) treatment was defined as patients receiving ≥3 PIPACs and was compared to patients receiving <3. Results: Overall, 183 patients had 517 PIPACs. The main reasons for stopping PIPAC were disease progression in 50% patients, bowel obstruction in 15%, patient’s refusal to pursue in 10%, conversion to cytoreductive surgery in 7%, and medical reasons in 8%. Overall, 95 patients (52%) had PP treatment. The PP median OS was 17 vs. 7 months, p = 0.001. PP patients had r ascites (410 ± 100 mL vs. 960 ± 188 mL, p = 0.001), no prior history of bowel obstruction (12% vs. 24%, p = 0.028), and more bimodal treatment (39% vs. 13%, p < 0.001). After multiple regression, bimodal treatment was found as an independent predictive factor for completing PP (OR = 4.202, 95%CI [1.813, 10.630], p < 0.001), along with prior bowel obstruction (OR = 0.389, 95%CI [0.153, 0.920], p = 0.037). Conclusion: The absence of ascites and prior bowel obstruction can help to select patients suitable for PIPAC. Best results seem to be achieved when PIPAC is combined with systemic chemotherapy.
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