213 research outputs found
The COVID-19 pandemic: considerations for resuming normal colorectal services
No full textThis European Society of Coloproctology guidance focuses on a proposed conceptual framework to resume standard service in colorectal surgery. The proposed conceptual framework is a schematic and stepwise approach including: in-depth assessment of damage to non-COVID-19-related colorectal service; the return of service (integration with the COVID-19-specific service and the existing operational continuity planning); safety arrangements in parallel with minimizing downtime; the required support for staff and patients; the aftermath of the pandemic and continued strategic planning. This will be dynamic guidance with ongoing updates using critical appraisal of emerging evidence. We will welcome input from all stakeholders (statutory organizations, healthcare professionals, public and patients). Any new questions, new data and discussion are welcome via https://www.escp.eu.com/guidelines
Inconclusive psychometric properties of the Vaizey score in fecally incontinent patients: a prospective cohort study.
No full textAIM: To determine the psychometric properties of the total Vaizey score and its individual items. METHODS: The study was conducted as part of a prospective cohort study assessing the outcome of pelvic floor rehabilitation in patients with fecal incontinence. RESULTS: One hundred ninety-four patients were analyzed, 53 of whom provided data on the global perceived effect (GPE) score. Pelvic floor rehabilitation resulted in a significant reduction of the total Vaizey score and most individual items. The total Vaizey scores changed in agreement with the GPE scores. The total Vaizey score was responsive, but some individual items yielded inconsistent results for three different measures. The test-retest reliability was adequate or excellent for six individual items and the total Vaizey score. The internal consistency was low for the total Vaizey score at baseline, in contrast to the follow-up and change scores. The estimates for the minimally important change (MIC) and smallest detectable change yielded moderately consistent results. An MIC of -5 points seemed preferable and yielded the lowest misclassification rate. CONCLUSIONS: More research is required to confirm conclusions on the psychometric properties of the total Vaizey score and its individual items, and to justify its use in research and routine clinical practice. Neurourol. Urodynam. (c) 2009 Wiley-Liss, Inc
Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study
No full textAbstract not availablePeter R. Gibson, Carolynne Vaizey, Christopher M. Black, Rebecca Nicholls, Adèle R. Weston, Peter Bampton, Miles Sparrow, Ian C. Lawrance, Warwick S. Selby, Jane M. Andrews, Alissa J. Walshm, David J. Hetzel, Finlay A. Macrae, Gregory T. Moore, Martin D. Weltman, Rupert W. Leong, Tao Fa
The detection of patients at risk of gastrointestinal toxicity during pelvic radiotherapy by electronic nose and FAIMS : a pilot study
No full textIt is well known that the electronic nose can be used to identify differences between human health and disease for a range of disorders. We present a pilot study to investigate if the electronic nose and a newer technology, FAIMS (Field Asymmetric Ion Mobility Spectrometry), can be used to identify and help inform the treatment pathway for patients receiving pelvic radiotherapy, which frequently causes gastrointestinal side-effects, severe in some. From a larger group, 23 radiotherapy patients were selected where half had the highest levels of toxicity and the others the lowest. Stool samples were obtained before and four weeks after radiotherapy and the volatiles and gases emitted analysed by both methods; these chemicals are products of fermentation caused by gut microflora. Principal component analysis of the electronic nose data and wavelet transform followed by Fisher discriminant analysis of FAIMS data indicated that it was possible to separate patients after treatment by their toxicity levels. More interestingly, differences were also identified in their pre-treatment samples. We believe these patterns arise from differences in gut microflora where some combinations of bacteria result to give this olfactory signature. In the future our approach may result in a technique that will help identify patients at “high risk” even before radiation treatment is started
Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit
No full textBACKGROUND: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. OBJECTIVE: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. DESIGN: This was a snapshot observational prospective study. SETTING: The study was conducted as a multicenter international study. PATIENTS: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. MAIN OUTCOME MEASURES: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. RESULTS: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p > 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). LIMITATIONS: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. CONCLUSIONS: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery
Studies of pathophysiology and psychosocial functioning in adolescents with anorectal anomalies
No full textPhDIntroduction: Anorectal anomalies (ARA) are a range of congenital conditions ranging
from a slight malposition of the anus to complex anomalies of the hindgut and urogenital
organ. Despite advanced surgical and treatment modalities, voluntary bowel control is poor
following surgical care with high rates of faecal incontinence (FI), and also constipation
after all grades of reconstructive surgery. The main aim was to determine the impact that FI
and constipation has on psychosocial functioning in the context of ARA in comparison to
patients with idiopathic constipation (IC) and healthy controls. We also investigated the
pathophysiological mechanisms that might contribute to poor bowel function in patients with
ARA.
Methods: Study comprised 52 patients (19 females; range 11-43 years) with ARA, 46 (13
females; range 11-31 years) IC and 51 healthy controls (26 females; range 11-42 years).
Constipation and FI were evaluated using KESS and Vaizey scores respectively (a higher
score indicating greater symptom severity). Psychometric tests included: Gastrointestinal
Quality of Life Index, Children's Depression Inventory/Beck Depression Inventory, General
Health Questionnaire-28, State-Trait Anxiety Inventory/Children, Pennebaker Inventory of
Limbic Languidness, Big Five Inventory, Level of Hopefulness, Cognitive Emotion
Regulation Questionnaire and Weinberger Attitude Inventory. Physiological investigations
were undertaken in 32 adults, presenting with a history of previous surgery for ARA and
urge FI. Physiological assessment included: anal manometry; rectal sensation (balloon
distension); pudendal nerve function (motor latencies); endo-anal ultrasound; colonic transit
and proctography.
Results: Significantly higher KESS scores were found in patients with IC (<0.0001)
compared to ARA and healthy controls and significantly higher Vaizey scores found in - 3
4
patients with ARA (<0.0001) and IC (0.0002) compared to healthy controls. Poorer
GIQOL scores were found in patients with IC compared to healthy controls (p<0.001) and
ARA compared to healthy controls (p<0.01). There was a significant relationship between
poor quality of life and high KESS scores in ARA and IC (p = 0.003) and high Vaizey
Incontinence scores (p = 0.02). Patients with ARA did not have higher psychiatric morbidity
in comparison to IC and healthy controls. Personality traits and level of hopefulness
appeared the same across the three groups. IC significantly put less emphasis on their
general physical health (p<0.0001) in comparison to ARA and healthy controls. ARA
significantly used more ‘positive reappraisal’ and ‘putting into perspective’ as their main
coping mechanism compared to healthy controls. Anorectal physiology was abnormal in all
subjects with ARA, involving multiple mechanisms. Anal resting tone and squeeze
increments were attenuated in 23/32 and 17/32 patients respectively. Both anal sphincters
were deficient on endosonography in the majority of patients with ARA. Evidence of
pudendal neuropathy in 11/13 (85%) patients studied. Rectal sensation and emptying was
abnormal in 17/22 (77%) and 9/14 patients (64%) respectively. Eight out of 17 patients had
delayed colonic transit (47%).
Conclusions: Symptoms of FI and constipation are major determinants for poor quality of
life in patients with ARA. Contrary to our expectations, they share similar bowel and
psychosocial functioning to patients with IC. Adolescents with ARA and IC had minimal
psychiatric morbidity, yet experience condition-specific psychosocial problems affecting
their daily life. The chronic nature of the patient’s problem appeared to have stimulated
psychologically protective factors such as positive coping strategies. While the structural
integrity of the anal sphincters is the major factor contributing to continence, this study
confirms that extra-sphincteric mechanisms, particularly rectal sensory function, may be
equally important
The development of a cryptoglandular Anal Fistula Core Outcome Set (AFCOS): an international Delphi study protocol
No full textPurpose: Cryptoglandular anal fistula is a disorder with an incidence of around 1 per 5,000 people per year in European countries. Many studies have been conducted to evaluate the effectiveness of interventions for anal fistula. However, there is considerable heterogeneity in the outcomes assessed and reported in these studies. This limits research quality and complicates evidence synthesis. A solution for heterogeneity in outcome reporting is the development of a Core Outcome Set (COS). This paper describes the protocol for the development of a European COS for Anal Fistula (AFCOS). Methods: The first step will be a systematic review of the literature to identify potential outcomes that may be included in the COS. Patient interviews will be conducted in The United Kingdom and The Netherlands to ensure that both clinician-important and patient-important outcomes are captured. The outcomes will be categorized using the COMET taxonomy and taken forward to a Delphi consensus exercise. In up to three web-based Delphi surveys the outcomes will be prioritized by patients, clinicians (surgeons, gastroenterologists, and radiologists), and (clinical) researchers. The responses will be summarized and reported anonymously in subsequent round(s) facilitating convergence to a consensus opinion. The final COS will be decided during a face-to-face consensus meeting with patients, clinicians, and (clinical) researchers. Discussion: This study protocol describes the development of a European COS for anal fistula to improve research quality, evidence synthesis, and patient care
Advertising and competition in theory practice and public policy
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This study analyses and compares the theories relating to advertising and competition in economics literature with their operation in the market-place, and with the attitudes and pronouncements of public policy towards advertising and competition. A survey of the main literature in economic theory concerned with advertising and competition includes the theory of value, the theory of the firm, and theories and empirical studies on the effects of advertising and imperfect competition on prices, profits, barriers to entry and product differentiation. Since no general agreement exists on these theories and research, the review is interspersed with criticisms which have been made about specific features of them, and also a short outline of alternative theories which are considered to give a more accurate
account of the behaviour of firms in the real world. Consumer behaviour in the market is then studied from three viewpoints: a summary of the major academic theories of consumer behaviour; the results of some empirical research into consumer behaviour; and eight case histories of products and services which show how products are developed and introduced on the market. Finally, the economic theories are compared with the results of the empirical research and the case histories. The theory and practice of advertising and competition is then compared with extracts from the reports of public bodies to illustrate the attitude of public policy towards advertising and competition. The conclusions draw attention to the major discrepancies which appear to exist between theory and practice, and the implications that follow for public policy which seems to be predominantly based on the theory of the firm and the need to eliminate imperfections in the market such as product differentiation, advertising and non-price competition
Acceptability, effectiveness and safety of a Renew ® anal insert in patients who have undergone restorative proctocolectomy with ileal pouch–anal anastomosis
No full textIntroduction: Restorative proctocolectomy has gained acceptance in the surgical management of medically refractive ulcerative colitis and cancer prevention in familial adenomatous polyposis. Incontinence following restorative proctocolectomy occurs in up to 25% of patients overnight. The Renew ® insert is an inert single-use device which acts as an anal plug. The aim of this study was to assess the acceptability, effectiveness and safety of the Renew ® insert in patients who have undergone restorative proctocolectomy. The device has yet to be assessed in patients who have undergone restorative proctocolectomy. Method: This was a prospective study exploring the acceptability, effectiveness and safety of the Renew ® insert in improving incontinence in patients who had undergone restorative proctocolectomy. A total of 15 patients with incontinence were asked to use the Renew ® insert for 14 days following their standard care. The Incontinence Questionnaire–Bowels was used pre- and posttreatment to assess response and patients were asked to report the perceived acceptability, effectiveness and safety of the device at the end of the trial. Results: The device was acceptable to 8/15 (53%) of patients and was effective in 6/15 (40%). Only 2/15 (13%) of patients raised any safety concerns, and these were minor. The device was associated with a significant reduction in night seepage (P = 0.034). Conclusion: In a small study, the Renew ® insert can be both acceptable and effective and is also associated with few safety concerns. It is also associated with significant reductions in night-time seepage
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