Children s Continence Current Awareness Bulletin

Transcription

1 Children s Continence Current Awareness Bulletin November 2018 A number of other bulletins are also available please contact the Academy Library for further details If you would like to receive these bulletins on a regular basis please contact the library. If you would like any of the full references we will source them for you. Contact us: Academy Library /98 ruh-tr.library@nhs.net

2 Title: An evaluation of bell-&-pad versus body-worn alarm systems for the management of enuresis in children: A pilot study. Citation: Australian & New Zealand Continence Journal; Sep 2018; vol. 24 (no. 3); p Author(s): Peck, B. Objective: This project aimed to evaluate the effectiveness of a body-worn (BW) alarm system, as an alternative to the traditional bell and pad (B&P) system for the treatment of enuresis (bedwetting) in children. Materials and methods: This study was a single-site evaluation of 105 children who attended a regional continence service in regional Victoria, Australia. Following a diagnosis of monosymptomatic enuresis, children between the ages of six and 16 years, who met the inclusion criteria and were considered suitable for alarm therapy, were randomly allocated to an alarm group. Assessment, diagnosis and treatment for enuresis were based on both the NICE (National Institute for Health and Care Excellence, 2010) guidelines1 as well as ICCS (International Children's Continence Society, 2008) guidelines2. Following an age-appropriate explanation and demonstration of the allocated alarm, the child commenced a maximum of a 16-week period of therapy with a review at eight weeks. If dryness (14 consecutive dry nights) had been achieved at this 8-week review the therapy was completed and the child discharged from the study and from the clinic. If dryness had not been achieved the child continued for a further eight weeks. At the completion of the 16-week period a final review was undertaken to assess achievement of dryness and to review the bedwetting diary for any further detail. Throughout alarm therapy, children and families were welcome to contact their continence nurse for advice and support or if there were any problems with their alarm device. Approval for this project was granted by a local hospital-based Human Research Ethics Committee prior to data collection. Results: The two types of device (BW, B&P) were compared with respect to a series of categorical variables (14 nights dry, relapse, nightly alarm use, child waking to the alarm, parent waking to the alarm and false alarms) using cross-tabulations and chi-square tests of independence. While there was no statistically significant difference in the achievement of the primary outcome measure --Child was Dry >=14 nights -- there were consistent indicative trends of poorer performance of the BW alarm compared to the B&P with respect to these variables. It was found that the performance of the BW alarm was poorer (though not significantly so) than the B&P in regard to the primary measure of the achievement of dryness and the alarm waking the child and parent. The BW device was found to lead to fewer false alarms. Across the duration of the study it became evident that the quality of the BW device may be impacting upon the success rates achieved with regard to overall dryness and the other categorical variables, which may be responsible in part for poorer overall results. Conclusions: While results from this study show a poorer overall trend in performance with respect to a series of categorical variables by the BW enuresis alarm, these results are not at the level of statistical significance and warrant further investigation by way of a larger study. The research team believes that the issue of the overall quality of the BW devices may have contributed to the trend in poorer performance of the device. Any larger study would include a larger sample size as well as the use of a higher quality BW device. Competing interest statement: Ferring Pharmaceuticals donated the devices for use in this study

3 Title: Constipation-Associated Stercoral Colitis. Citation: Pediatric Emergency Care; Sep 2018; vol. 34 (no. 9) Author(s): Proulx, Erik; Glass, Casey Abstract: A 9-year-old white girl with a history of constipation presented to the emergency department with a few weeks of intermittent stool incontinence without any reported changes in diet or difficulty tolerating food or fluids by mouth. On the day of presentation, she developed nausea and nonbloody, nonbilious emesis, as well as multiple, loose, nonbloody stools, after becoming acutely ill during lunch at school. There was no reported fever or suspicious food intake. On examination, she was noted to be afebrile, hypotensive, and tachycardic with abdominal tenderness. Her blood work was notable for a marked leukocytosis of 66,000 and a subsequent computed tomography scan of her abdomen was performed. The imaging test identified a large fecaloma with surrounding colonic inflammation concerning for stercoral colitis. The child underwent urgent manual disimpaction and was hospitalized for supportive care with subsequent recovery and return to her normal state of health. Follow-up testing during her hospital stay did not reveal any other infectious or physiologic cause for her constipation and colitis. Title: Systematic review and meta-analysis of the effect of probiotic supplementation on functional constipation in children. Citation: Medicine; Sep 2018; vol. 97 (no. 39); p. 1-6 Author(s): Lei Jin; Lin Deng; Wei Wu; Zhenyi Wang; Wanjin Shao; Jianhua Liu; Jin, Lei; Deng, Lin; Wu, Wei; Wang, Zhenyi; Shao, Wanjin; Liu, Jianhua Publication Date: Sep 2018 Objective: To evaluate the effect of probiotic supplementation on functional constipation in children. Methods: We performed electronic searches in PubMed, Embase, and Cochrane Library without language restriction to identify relevant studies from the time of inception of these databases to March The relative risk or weighted mean difference was calculated to evaluate the treatment effect of probiotics using random-effects model. Results: We included 4 trials reporting data on 382 children with functional constipation. Overall, there were no significant differences in treatment success (P =.697), spontaneous bowel movements per week (P =.571), fecal soiling episodes per week (P =.642), straining at defecation (P =.408), use of lactulose (P =.238), use of laxatives (P =.190), fecal incontinence (P =.139), pain during defecation (P =.410), flatulence (P =.109), and adverse events (P =.979) between probiotics and placebo. Further, the use of probiotics was associated with lower frequency of glycerin enema use (weighted mean difference -2.40, P =.004) and abdominal pain (weighted mean difference -4.80, P <.001). Conclusion: The findings of this study suggested that the use of probiotics was associated with significant improvement in glycerin enema use and abdominal pain but did not affect the treatment success and other function indices. 3

4 Title: The relationship between urinary incontinence and obesity in childhood. Citation: Journal of paediatrics and child health; Oct 2018 Author(s): Monkhouse, Krista; Caldwell, Patrina Hy; Barnes, Elizabeth H Objective: To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic. Methods: We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December A random sample of 1000 children was selected from 2022 patient records, and data were collected on weight, height, age, gender, UI parameters, bowel habits and medical history. Associations between predictors (weight categories, gender, snoring, constipation, faecal incontinence) and outcomes (daytime urinary incontinence (DUI) and nocturnal enuresis (NE)) were examined using χ2 tests and logistic regression analysis. Results: A total of 862 children were included in the study; 54% were male, and 28% were overweight/obese. No evidence of difference was found between the underweight/normal and overweight/obese weight children with NE (34 vs. 39%), DUI (7 vs. 9%) or combined NE and DUI (58 vs. 52.1%), P = The frequency of NE (83 vs. 82%, P = 0.56) and DUI (52 vs. 58%, P = 0.20) was similar between the weight groups. Conclusion: In a large cohort of children presenting to a tertiary incontinence clinic, weight was not associated with the type or frequency of UI. Title: Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children s Continence Society. Citation: Pediatric Nephrology; Dec 2018; vol. 33 (no. 12); p Author(s): Yang, Stephen; Chua, Michael E.; Bauer, Stuart; Wright, Anne; Brandström, Per; Hoebeke, Piet; Rittig, Søren; De Gennaro, Mario; Jackson, Elizabeth; Fonseca, Eliane; Nieuwhof-Leppink, Anka; Austin, Paul Objective: We present a consensus view from the International Children s Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. Methods: A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. 4

5 Results: BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. Conclusions: This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI. Title: Improving the experience of young men with continence problems. Citation: Pediatric Nephrology; Dec 2018; vol. 33 (no. 12); p Author(s): Dix, Ann Abstract: About 900,000 children and young people are affected by bladder and bowel problems in the UK but, because of the stigma attached, many hide the issue and do not access the help they need. Young men are particularly vulnerable as there is little recognition of male continence problems. A survey of young people showed that almost half would feel "uncomfortable" talking about their continence problems to relatives and friends, and almost two-thirds would be embarrassed to see a doctor. This is compounded by a lack of early intervention, gaps in specialist children's bladder and bowel services, and lack of support in the transition from child to adult services. Healthcare staff often have little training in continence issues and poor awareness of its impact on young people. This article reports the experience of one young man with continence problems, while two continence specialists -- a nurse and an occupational therapist -- explain how staff can improve the experience of care for young people with incontinence. 5