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[PMID]: 29289407
[Au] Autor:Jarczyk KS; Pieper P; Brodie L; Ezzell K; D'Alessandro T
[Ti] Title:An Integrated Nurse Practitioner-Run Subspecialty Referral Program for Incontinent Children.
[So] Source:J Pediatr Health Care;32(2):184-194, 2018 Mar - Apr.
[Is] ISSN:1532-656X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Evidence suggests that urinary and fecal incontinence and abnormal voiding and defecation dynamics are different manifestations of the same syndrome. This article reports the success of an innovative program for care of children with incontinence and dysfunctional elimination. This program is innovative because it is the first to combine subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population and the first reported independent nurse practitioner-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. Currently, services for affected children are siloed in the aforementioned subspecialties, fragmenting care. METHODS: Retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess this program. RESULTS: Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing. DISCUSSION: This model has potential transformative significance: (a) the impact of children achieving continence cannot be underestimated, (b) configuration of services that cross traditional subspecialty boundaries may have broader application to other populations, and (c) demonstration of effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice may extend to the care of other populations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180219
[Lr] Last revision date:180219
[St] Status:In-Data-Review

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[PMID]: 29292564
[Au] Autor:De S; Teixeira-Pinto A; Sewell JR; Caldwell PH
[Ad] Address:Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
[Ti] Title:Prevalence, patient and consultation characteristics of enuresis in Australian paediatric practice.
[So] Source:J Paediatr Child Health;, 2018 Jan 02.
[Is] ISSN:1440-1754
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:AIM: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years. METHODS: Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013. RESULTS: Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008; 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008; 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001). CONCLUSION: The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180102
[Lr] Last revision date:180102
[St] Status:Publisher
[do] DOI:10.1111/jpc.13834

  3 / 793 MEDLINE  
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[PMID]: 29212476
[Au] Autor:Fugazza A; Bizzarri B; Gaiani F; Manfredi M; Ghiselli A; Crafa P; Carra MC; de'Angelis N; de'Angelis GL
[Ad] Address:Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
[Ti] Title:The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature.
[So] Source:BMC Pediatr;17(1):203, 2017 Dec 06.
[Is] ISSN:1471-2431
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The role of endoscopic ultrasound (EUS) in the management of pancreatobiliary and digestive diseases is well established in adults, but it remains limited in children. The aim of this study was to evaluate the feasibility, safety, and clinical impact of EUS use in children. METHODS: This is a retrospective analysis of a prospectively acquired database of consecutive pediatric (< 18 years) patients presenting an indication for EUS for pancreatobiliary and gastrointestinal disorders. RESULTS: Between January 2010 and January 2016, 47 procedures were performed in 40 children (mean age of 15.1 ± 4.7 years; range 3-18). The majority of EUS (n = 32; 68.1%) were performed for pancreatobiliary and upper gastrointestinal pathologies, including suspected common bile duct stones (CBDs), acute biliary pancreatitis, recurrent/chronic pancreatitis, cystic pancreatic mass, recurrent hypoglycemia, duodenal polyp, gastric submucosal lesion, and perigastric abscess. In only 2 out of 18 children with suspected CBDs or acute biliary pancreatitis, EUS confirmed CBDs. EUS-guided fine needle aspiration was performed in 3 (6.4%) patients. Fifteen (31.9%) procedures were performed for lower gastrointestinal tract disorders, including suspected anal Crohn's disease, fecal incontinence, and encopresis. Overall, EUS had a significant impact on the subsequent clinical management in 87.2% of patients. CONCLUSION: The present findings were consistent with results observed in the current relevant literature and support EUS as a safe and feasible diagnostic and therapeutic tool, which yields a significant clinical impact in children with pancreatobiliary and gastrointestinal disorders.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171220
[Lr] Last revision date:171220
[St] Status:In-Process
[do] DOI:10.1186/s12887-017-0956-z

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[PMID]: 29173303
[Au] Autor:Beinvogl B; Sabharwal S; McSweeney M; Nurko S
[Ad] Address:Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA; Division of Pediatric Gastroenterology, Boston Children's Hospital, Boston, MA.
[Ti] Title:Are We Using Abdominal Radiographs Appropriately in the Management of Pediatric Constipation?
[So] Source:J Pediatr;191:179-183, 2017 Dec.
[Is] ISSN:1097-6833
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To identify the reasons why pediatric gastroenterologists obtain abdominal radiographs in the management of pediatric constipation. STUDY DESIGN: This was a prospective study surveying providers regarding their rationale, interpretation, resultant change, and confidence in their management before and after obtaining KUBs in patients seen for suspected constipation. Demographics and clinical findings were obtained from medical records. RESULTS: A total of 24 providers were surveyed after 72 patient encounters. Reasons for obtaining an abdominal radiograph included evaluation of stool burden (70%), need for a clean out (35%), fecal impaction (27%), cause of abdominal pain (24%), demonstration of stool burden to families (14%), assessment of response to therapy (13%), or encopresis (10%). The plan was changed in 47.6% of cases based on radiographic findings. In cases in which a plan was outlined before obtaining the radiograph (69%), the initial plan was implemented on average in 52.5%. In cases with no plans before obtaining the radiograph, previously unconsidered plans were implemented in 8.7%. Provider confidence in the management plan increased from 2.4 ± 2.7 to 4.1 ± 1.8 (P < .05) after the abdominal radiograph. CONCLUSION: Abdominal radiographs commonly are obtained by pediatric gastroenterologists in the evaluation and management of constipation. The majority used it to make a diagnosis, and nearly one-half changed their management based on the imaging findings. Overall, they reported an improved confidence in their management plan, despite evidence that radiographic findings poorly correlate with clinical severity. This study highlights the need for further provider education regarding the recommendations delineated in existing constipation guidelines.
[Mh] MeSH terms primary: Clinical Decision-Making/methods
Constipation/diagnostic imaging
Gastroenterology
Guideline Adherence/statistics & numerical data
Pediatrics
Practice Patterns, Physicians´/statistics & numerical data
[Mh] MeSH terms secundary: Abdominal Pain/diagnostic imaging
Abdominal Pain/etiology
Adolescent
Boston
Child
Child, Preschool
Clinical Competence
Constipation/etiology
Constipation/therapy
Female
Health Care Surveys
Humans
Male
Practice Guidelines as Topic
Prospective Studies
Radiography, Abdominal
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171211
[Lr] Last revision date:171211
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171128
[St] Status:MEDLINE

  5 / 793 MEDLINE  
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[PMID]: 29079312
[Au] Autor:Bischoff A; Brisighelli G; Dickie B; Frischer J; Levitt MA; Peña A
[Ad] Address:International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: andrea.bischoff@childrenscolorado.org.
[Ti] Title:Idiopathic constipation: A challenging but manageable problem.
[So] Source:J Pediatr Surg;, 2017 Oct 10.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: A protocol to treat idiopathic constipation is presented. METHODS: A contrast enema is performed in every patient and, when indicated, patients are initially submitted to a "clean out" protocol. All patients are started on a Senna-based laxative. The initial dosage is empirically determined and adjusted daily, during a one week period, based on history and abdominal radiographs, until the amount of Senna that empties the colon is reached. The management is considered successful when patients empty their colon daily and stop soiling. If the laxatives dose provokes abdominal cramping, distension, and vomiting, without producing bowel movements, patients are considered nonmanageable. RESULTS: From 2005 to 2012, 215 patients were treated. 121 (56%) were males. The average age was 8.2years (range: 1-20). 160 patients (74%) presented encopresis. 67 patients (32%) needed a clean out. After one week, 181 patients (84%) achieved successful management, with an average Senna dose of 67mg (range: 5-175mg). In 34 patients (16%) the treatment was unsuccessful: 19 were nonmanageable, 3 noncompliant, and 12 continued soiling. At a later follow-up (median: 329days) the success rate for 174 patients was 81%. CONCLUSION: We designed a successful protocol to manage idiopathic constipation. The key points are clean out before starting laxatives, individual adjustments of laxative, and radiological monitoring of colonic emptying. TREATMENT STUDY: Level IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171028
[Lr] Last revision date:171028
[St] Status:Publisher

  6 / 793 MEDLINE  
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[PMID]: 29045260
[Au] Autor:Cormier D; Reilly M; Young A; Augustyn M
[Ad] Address:*Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; †Division of Developmental and Behavioral Pediatrics, Boston medical Center, Boston University School of Medicine, Boston MA.
[Ti] Title:Encopresis Plus?
[So] Source:J Dev Behav Pediatr;38(9):772-774, 2017 Nov/Dec.
[Is] ISSN:1536-7312
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CASE: Dexter is a 12-year-old boy who presents with his maternal grandmother for follow-up to primary care for secondary encopresis. Dexter presented, 18 months ago, with a 3-month history of secondary encopresis. At that time, a comprehensive assessment revealed functional constipation resulting in encopresis. Dexter's symptoms resolved with a combination of medication management and behavioral strategies; laxatives were discontinued 12 months ago.Dexter's grandmother reports that for the past 6 months, her grandson developed encopresis once again. However, she notes that, although Dexter had small-volume episodes of soiling in the past, he is now passing fully formed stools into his underwear. These episodes usually occur once a day, either at home or at school. Frustrated, Dexter's grandmother has transitioned him to adult diapers.Dexter denies hematochezia, pain, dysuria, hematuria, urinary incontinence, dietary changes, or weight loss. He passes soft stool in his underwear once daily without blood or pain. When interviewed alone, Dexter denies drug use, depression, or significant social stressors. Surprisingly, he seems unconcerned about depression, drugs and social stress, and frequently laughs when discussing them. His physical examination, including a rectal examination, is normal.Dexter's medical history is notable for attention-deficit hyperactivity disorder, treated with stimulant medication. He was toilet trained at 3 years without any difficulty. He lives with his grandmother, who is his legal guardian; his mother has chronic mental health problems and substance abuse. Dexter maintains regular contact with his mother and reports that their relationship is positive.Dexter's grandmother is extremely distressed by his current presentation and notably, Dexter is not. What would you do next?
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[St] Status:In-Process
[do] DOI:10.1097/DBP.0000000000000517

  7 / 793 MEDLINE  
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[PMID]: 29019014
[Au] Autor:Niemczyk J; Wagner C; von Gontard A
[Ad] Address:Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany. justine.niemczyk@uks.eu.
[Ti] Title:Incontinence in autism spectrum disorder: a systematic review.
[So] Source:Eur Child Adolesc Psychiatry;, 2017 Oct 10.
[Is] ISSN:1435-165X
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Autism spectrum disorders (ASD) are defined by persistent deficits in reciprocal social interaction, communication, and language, as well as stereotyped and repetitive behavior. Functional incontinence, as well as ASD are common disorders in childhood. The aim of this systematic review was to give an overview of the co-occurrence of nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) in ASD, and vice versa, of ASD in children with incontinence. A systematic literature search of the terms "incontinence", "enuresis", and "encopresis" in combination with "autism" or "Asperger" in four databases (Scopus, PubMed, PsycInfo and Web of science) was conducted. All studies that examined incontinence frequencies in samples with ASD, and studies that measured frequencies of ASD diagnoses or symptoms in samples with incontinence were included. Risk of bias and limitations of each study were described. After eligibility assessment, 33 publications were included in the review. The published literature implies a higher prevalence of incontinence in children with ASD compared to typically developing children. Limitations and biases as inappropriate diagnostic criteria for ASD and incontinence, selected samples, or lack of control groups are reported. Associations of incontinence in ASD with psychopathological symptoms were found. Vice versa, ASD symptoms are found in incontinent children, but no study included a non-ASD control sample. Incontinence symptoms are also reported as an adverse effect of medication in ASD. Due to methodological problems and definitional discrepancies in some publications, results have to be interpreted cautiously. Research in ASD and incontinence is scarce. More systematic research including state-of-the-art assessments is needed.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1710
[Cu] Class update date: 171011
[Lr] Last revision date:171011
[St] Status:Publisher
[do] DOI:10.1007/s00787-017-1062-3

  8 / 793 MEDLINE  
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[PMID]: 28937449
[Au] Autor:Nelson T; Chae H; Anbar RD; Stein MT
[Ad] Address:*Rady Children's Hospital, University of California San Diego, San Diego, CA; †Center Point Medicine, La Jolla, CA.
[Ti] Title:Persistent Encopresis, Enuresis, and Anxiety in a 7-Year-Old Girl.
[So] Source:J Dev Behav Pediatr;38(8):680-682, 2017 Oct.
[Is] ISSN:1536-7312
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:CASE: Sonia is a 7-year-old old girl who was referred to the Developmental-Behavioral Pediatrics Clinic by the Pediatric Urology Clinic because of persistent wetting and soiling behaviors. Since age 3 years, she has had a history of encopresis (and wetting) for which she has seen gastroenterology and urology specialists. The mother reports that Sonia has accidents almost daily, and she is not upset when sitting in her urine or feces. She dislikes going into the bathroom or sitting on the toilet by herself. She participated in a behavior modification program associated with the pediatric urology clinic, which helps children learn healthy voiding habits and achieve continence.Sonia also has anxious behaviors. She bites her nails and chews on her hair or shirt. She is afraid of small spaces such as those between the bed and the wall and needs to have stuffed animals cover them. Other instances that trigger her anxious behaviors include loud noises, having a substitute teacher, being separated from her mother, and going to certain bathrooms or new places. She also has severe tantrums, which involve throwing and breaking objects, kicking, and hitting her head against doors.A cognitive behavioral therapy program was recommended to target anxiety symptoms, in addition to timed toileting after meals and polyethylene glycol. At a clinic visit several months later, symptoms of anxiety, encopresis, and enuresis persisted. Cognitive behavior therapy was continued and sertraline 25 mg was prescribed for anxiety. In addition, she was referred to a pediatrician who specializes in relaxation techniques and hypnotherapy.Sonia showed modest improvement with these interventions. There were fewer episodes of angry outbursts and a decrease in soiling and wetting, but at times, but she continued to have intermittent periods of wetting and soiling and fear of going to the bathroom by herself persisted.(This Challenging Case extends observations reviewed in a previous Challenging Case: J Dev Behav Pediatr 2010;531:513-515; DOI: 10.1097/DBP.0b013e3181e5a464.).
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170927
[Lr] Last revision date:170927
[St] Status:In-Process
[do] DOI:10.1097/DBP.0000000000000504

  9 / 793 MEDLINE  
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[PMID]: 28807359
[Au] Autor:Muddasani S; Moe A; Semmelrock C; Gilbert CL; Enemuo V; Chiou EH; Chumpitazi BP
[Ad] Address:Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX.
[Ti] Title:Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia.
[So] Source:J Pediatr;190:74-78, 2017 Nov.
[Is] ISSN:1097-6833
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). STUDY DESIGN: Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. RESULTS: Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. CONCLUSIONS: Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 171116
[Lr] Last revision date:171116
[St] Status:In-Process

  10 / 793 MEDLINE  
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[PMID]: 28585787
[Au] Autor:Vivas Colmenares GV; Moya Jiménez MJ; Roldán Pérez S; Granero Cendón R; Vinuesa Salgueiro J; López Alonso M
[Ad] Address:Hospital Infantil Virgen del Rocío. Sevilla.
[Ti] Title:Entrenamiento anorrectal domiciliario como tratamiento de la encopresis y disinergia esfinteriana. [Home training as a treatment of faecal incontinence and sphincter dyssynergia].
[So] Source:Cir Pediatr;30(1):28-32, 2017 Jan 25.
[Is] ISSN:0214-1221
[Cp] Country of publication:Spain
[La] Language:spa
[Ab] Abstract:OBJECTIVE: The defecation disorders represents the 3% of consultations in pediatrics patients. Our goal was to demonstrate the effectiveness and efficiency of the reeducation of the defecation maneuver through home training in patients with encopresis and sphincter dyssynergia. MATERIAL AND METHODS: Study of patients with fecal incontinence treated with home training at our center between 2014-2015. Anorectal manometry was performed and was valued defecation maneuver by expulsion of rectal probe with or without the ball. Daily sessions were performed using a Foley catheter (18-20Fr.) with progressive filling of the balloon, maximum 20cc. The response to the treatment was assessed in terms of episodes of soiling. RESULTS: Seven patients (6 males and 1 female) with a mean age of 9.7 years (range, 5-15) were included; two patients with anorectal malformation history, 1 Hirschsprung disease, 1 sacrococcygeal teratoma and 3 functional encopresis. Three patients had soiling episodes daily and 4 patients frequently. The mean basal pressure of anal channel was 32.34mmHg (range, 11.74-50.75) with negative defecation maneuver in 2 cases, deficient in 3 and dyssynergic in 2 patients. The mean time of biofeedback therapy to be asymptomatic was 5.14 months (range, 2-11), with a mean of 16.14 months (range, 3-24), with the 7 patients currently maintained clean. CONCLUSIONS: The present study suggests that re-education of defecation maneuver through home training, seems to be an effective and efficient therapy, achieving excellent results in medium term.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1706
[Cu] Class update date: 170606
[Lr] Last revision date:170606
[St] Status:In-Data-Review


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