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"continous improvement"

H A Owen, G N Buchanan, A Schizas, A Emmanuel, R Cohen, A B Williams
INTRODUCTION: Anal fistula causes pain, discharge of pus and blood. Fistulotomy has the highest success, however, can risk continence; treatment balances cure with continence. This study assessed the impact of fistulotomy on Quality Of Life (QOL) and continence. METHODS: Patients selected for fistulotomy prospectively completed St Mark's Continence Score (full incontinence = 24) and Short Form - 36 questionnaires pre-operatively at two institutions with an interest in anal fistula, and reassessed 3 months post-operatively...
October 5, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Thomas G Clifford, Swar H Shah, Soroush T Bazargani, Gus Miranda, Jie Cai, Kevin Wayne, Hooman Djaladat, Anne K Schuckman, Siamak Daneshmand
PURPOSE: We evaluated continence outcomes in male patients undergoing orthotopic neobladder (ONB) diversion following radical cystectomy (RC) using a validated questionnaire. MATERIALS AND METHODS: Using our IRB approved bladder cancer database, we identified 1269 patients who underwent open RC from 2002 to 2015. ONB was constructed in 935 (74%) patients, of whom 798 (85%) were male. Beginning in 2012, patients completed a validated pictorial pad usage questionnaire at each follow up visit...
May 30, 2016: Journal of Urology
Anne-Sophie Blais, Geneviève Nadeau, Katherine Moore, Lucie Genois, Stéphane Bolduc
BACKGROUND: Antimuscarinics are the pharmacologic mainstay of overactive bladder (OAB) management, but side effects limit their use. Mirabegron, a new molecule with a distinct mechanism of action (β3-adrenoreceptor agonist), was recently approved as monotherapy for idiopathic OAB in adults but has not been studied in the pediatric population. OBJECTIVE: To evaluate the efficacy and safety of mirabegron to treat urinary incontinence in children with idiopathic OAB who were refractory to and/or intolerant of antimuscarinics...
July 2016: European Urology
N Vásquez, S L Knight, J Susser, A Gall, P H Ellaway, M D Craggs
STUDY DESIGN: Two case studies. OBJECTIVES: To determine whether 6 weeks of regular pelvic floor muscle training (PFMT) can improve the strength and endurance of voluntary contractions in incomplete spinal cord injury and reduce neurogenic detrusor over-activity (NDO) and incontinence. SETTING: The London Spinal Cord Injury Centre, Stanmore, London, UK. METHODS: A 6-week programme of PFMT was conducted in two male subjects with stable supra-sacral motor incomplete (AIS C and D) spinal cord injuries...
December 2015: Spinal Cord
Timothée Wallenhorst, Guillaume Bouguen, Charlène Brochard, Diane Cunin, Véronique Desfourneaux, Alain Ropert, Jean-François Bretagne, Laurent Siproudhis
BACKGROUND: Fecal incontinence is frequently associated with rectal prolapse, but little is known about recovery after treatment of the prolapse. OBJECTIVE: We therefore aimed to investigate the long-term outcome of fecal incontinence in a cohort of patients suffering from full-thickness rectal prolapse. DESIGN: A database of 145 patients diagnosed with full-thickness rectal prolapse was compiled prospectively over a 7-year period (2003-2010)...
July 2015: Surgery
Paul Cathcart, Ashwin Sridhara, Navin Ramachandran, Timothy Briggs, Senthil Nathan, John Kelly
BACKGROUND: National Health Service England recently oversaw a whole-scale reconfiguration of cancer services in London, UK, for a number of different cancer pathways. Centralisation of cancer surgery has occurred with prostate cancer (PCa) surgery only being commissioned at a single designated pelvic cancer surgical centre. This process has required surgeons to work in teams providing a hub-and-spoke model of care. OBJECTIVE: To report the extent to which the initiation of a quality assurance programme (QAP) can improve the quality of PCa surgical care during reorganisation of cancer services in London...
July 2015: European Urology
Amir Qaseem, Paul Dallas, Mary Ann Forciea, Melissa Starkey, Thomas D Denberg, Paul Shekelle
DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the nonsurgical management of urinary incontinence (UI) in women. METHODS: This guideline is based on published English-language literature on nonsurgical management of UI in women from 1990 through December 2013 that was identified using MEDLINE, the Cochrane Library, Scirus, and Google Scholar. The outcomes evaluated for this guideline include continence, improvement in UI, quality of life, adverse effects, and discontinuation due to adverse effects...
September 16, 2014: Annals of Internal Medicine
Anandi H W Schiphorst, Barbara S Langenhoff, John Maring, Apollo Pronk, David D E Zimmerman
BACKGROUND: Currently, the preferred method for local excision of rectal polyps is transanal endoscopic microsurgery, avoiding rectal resection. Transanal minimally invasive surgery is a relatively new technique using a disposable port in combination with conventional laparoscopic instruments. This method is less expensive as compared with transanal endoscopic microsurgery, relatively easy to learn, and available. Despite wide adoption of transanal minimally invasive surgery, to date only a few series on the implementation and use of this technique are reported, and detailed information on the effect of transanal minimally invasive surgery on fecal continence is not available...
August 2014: Diseases of the Colon and Rectum
Chuangang Fu, Xianhua Gao
Colonic pouch can improve fecal continence after low anterior resection in the short-term, but its superiority would disappear in the long-term (2 years after surgery), since fecal continence improves gradually with time in the non-pouch group. Furthermore, the incidence of incomplete defecation increases gradually with time, and a lot of patients would have difficulty in defecation and require long-term use of suppositories and enemas. Pouch enforcement will result in prolonged operation time and increased treatment cost...
May 2014: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Abdol-Mohammad Kajbafzadeh, Ali Tourchi, Nastaran Sabetkish
OBJECTIVES: To report the results of a novel technique of sub-urothelial polyp enucleation resection (SUPER) and urothelial auto-augmentation cystoplasty (UAAC) in patients with bladder exstrophy and polyposis plate. METHODS: Twenty-eight patients with bladder exstrophy covered by plate polyposis were referred for further management. From these, 12 patients had undergone SUPER, UAAC technique, and subsequent bladder closure. In this technique, the urothelium covering the polyps was utilized as tissue for auto-augmentation cystoplasty...
June 2014: Pediatric Surgery International
Mohit Kumar Mathur, Satish Kumar Aggarwal, Simmi K Ratan, Shandip Kumar Sinha
BACKGROUND: Transanal pull-through with laparoscopic assistance is gaining popularity. How much rectal dissection to do laparoscopically and how much transanally is not clear. Laparoscopic rectal mobilization is akin to open pelvic dissection of Swenson's operation - the most physiological procedure. Through this comparative study, we aim to evolve a technique that maximizes the benefits of Swenson's technique and minimizes the problems of a transanal procedure. MATERIALS AND METHODS: Twenty patients (19 boys and one girl, newborn to 6 years) with Hirschsprung's disease (HD) were randomized for laparoscopic-assisted transanal pull-through (LATAPT) either by near complete (Group A) or partial (Group B) laparoscopic mobilization of rectum...
April 2014: Journal of Indian Association of Pediatric Surgeons
Kimberly S Corbin, Rangesh Kunnavakkam, Scott E Eggener, Stanley L Liauw
PURPOSE: Although postprostatectomy radiation therapy (PPRT) has been shown to improve cause-specific survival in select high-risk men, its use may be tempered by the concern for toxicity. Limited data exist regarding the nature of how it may adversely affect quality of life in the era of intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS: Between 2007 and 2010, 78 consecutive men received PPRT. Salvage RT was administered to 61 (78%) men and adjuvant RT to 17 (22%)...
April 2013: Practical Radiation Oncology
M Adamina, T Ross, M O Guenin, R Warschkow, C Rodger, Z Cohen, M Burnstein
AIM: Curing complex anal fistula without compromising continence can be extremely challenging. This study investigated the healing rate, continence and quality of life of patients after treatment of complex anal fistula of cryptoglandular origin with a bioprosthetic plug. METHOD: Consecutive patients were prospectively followed in four referral centres. Following seton conditioning, a bioprosthetic plug was inserted into the fistula and sutured to the anal sphincter...
July 2014: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Matthias Goos, Ulrich Baumgartner, Mathias Löhnert, Oliver Thomusch, Günther Ruf
BACKGROUND: Fecal incontinence is a common and severely disabling disorder. For patients with severe fecal incontinence, surgery may prove to be the only adequate treatment option. METHODS: This study reports on 43 patients that were treated with a prosthetic sphincter system between 2005 and 2009 in three coloproctological centres. MAIN OUTCOME MEASURES: complications, anal pressures before and after surgery, fecal continence score. RESULTS: The new artificial sphincter system significantly improves continence but leads to some complications in clinical practice...
2013: BMC Surgery
Derek J Boyle, Jamie Murphy, Alexander Hotouras, Marion E Allison, Norman S Williams, Christopher L Chan
BACKGROUND: Electrically stimulated gracilis neosphincter is an established treatment for patients with end-stage fecal incontinence. Few data, however, describe its long-term efficacy. OBJECTIVE: This study aimed to assess the long-term functional outcome associated with this procedure. DESIGN: Patients who underwent gracilis neosphincter construction between1989 and 2001 were identified from a prospectively recorded database. Demographics and pretreatment anorectal physiologic data were available for all patients...
February 2014: Diseases of the Colon and Rectum
Nina Perrin, Lynn Sayer, Alison While
AIM: To investigate the efficacy of alarm therapy versus desmopressin therapy in treating primary mono-symptomatic nocturnal enuresis (PMNE). BACKGROUND: PMNE is a common childhood disorder, which if left untreated can have a significant impact on a child's self-esteem and behaviour. Alarm therapy and desmopressin therapy are the two main treatments currently available in UK-based nurse-led enuresis clinics. METHODS: A systematic review of the literature was undertaken to assess the efficacy of PMNE treatments...
January 2015: Primary Health Care Research & Development
Peter K Sand, Scott A Macdiarmid, Heather Thomas, Kim E Caramelli, Gary Hoel
BACKGROUND: In a recent placebo-controlled Phase III study, oxybutynin chloride topical gel (OTG) significantly improved urinary continence in patients with overactive bladder. In this post hoc analysis, the effect of incontinence severity on OTG-mediated improvement in continence was evaluated. METHODS: Change from baseline in the number of incontinence episodes was evaluated in patients with two to three incontinence episodes/day (moderate incontinence) and those with more than three incontinence episodes/day (severe incontinence)...
2011: Open Access Journal of Urology
Jané Joubert, Chalapati Rao, Debbie Bradshaw, Theo Vos, Alan D Lopez
BACKGROUND: Two World Health Organization comparative assessments rated the quality of South Africa's 1996 mortality data as low. Since then, focussed initiatives were introduced to improve civil registration and vital statistics. Furthermore, South African cause-of-death data are widely used by research and international development agencies as the basis for making estimates of cause-specific mortality in many African countries. It is hence important to assess the quality of more recent South African data...
2013: PloS One
Hwanhee Hong, Bradley P Carlin, Tatyana A Shamliyan, Jean F Wyman, Rema Ramakrishnan, François Sainfort, Robert L Kane
OBJECTIVES: Bayesian statistical methods are increasingly popular as a tool for meta-analysis of clinical trial data involving both direct and indirect treatment comparisons. However, appropriate selection of prior distributions for unknown model parameters and checking of consistency assumptions required for modeling remain particularly challenging. We compared Bayesian and traditional frequentist statistical methods for mixed treatment comparisons with multiple binary outcomes. DATA: We searched major electronic bibliographic databases, Food and Drug Administration reviews, trial registries, and research grant databases up to December 2011 to find randomized studies published in English that examined drugs for female urgency urinary incontinence (UI) on continence, improvement in UI, and treatment discontinuation due to harm...
July 2013: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Michał Winiarski, Daria Jóźwiak, Michal Pusty, Adam Dziki
UNLABELLED: Assessment of satisfaction with life, as a result of comparing own life situation with the individualised personal standards, is an important element for measuring satisfaction with life of the patients suffering from somatic disorders. Literature provides numerous data on satisfaction with life of different groups of patients suffering from somatic disorders. Little space is devoted to the study of the level of satisfaction of patients with rectal prolapse, which is particularly evident in relation to the Polish patient population...
January 2013: Polski Przeglad Chirurgiczny
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