scholarly journals Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

2020 ◽  
Vol 13 (4) ◽  
pp. 685-693
Author(s):  
Maryellen S. Kelly ◽  
John S. Wiener ◽  
Tiebin Liu ◽  
Priya Patel ◽  
Heidi Castillo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Spina Bifida ◽  
Research Collaboration ◽  
Statistical Tests ◽  
Private Insurance ◽  
Bowel Dysfunction ◽  
Individual Characteristics ◽  
Treatment Modalities ◽  
Inclusion Criteria ◽  
Neurogenic Bowel

PURPOSE: Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics. METHODS: Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age ⩾ 5 years (n= 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status. RESULTS: At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40–69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged ⩾ 12 years, female, non-Hispanic white, and with private insurance.

Who is managing the bowels? A survey of clinical practice patterns in spina bifida clinics

2021 ◽  
pp. 1-5
Author(s):  
Maryellen S. Kelly ◽  
Jennifer Stout ◽  
John S. Wiener
Keyword(s):  
Spina Bifida ◽  
Nurse Practitioners ◽  
Practice Patterns ◽  
Response Rate ◽  
Bowel Dysfunction ◽  
Rehabilitation Medicine ◽  
The United States ◽  
Medical Specialties ◽  
Dissemination Of Research ◽  
Neurogenic Bowel

PURPOSE: Neurogenic bowel dysfunction (NBD) affects 80% of individuals with spina bifida. Performing and disseminating research on NBD to reach the appropriate audience is difficult given the variability among medical specialties managing NBD. This study aimed to identify which medical specialties and types of providers are currently managing NBD in the United States. METHODS: A survey was developed and sent to 75 spina bifida clinics. Surveys queried which specialty was primarily responsible for medical and surgical management of NBD and any others that assist in NBD care. The license and certification level of the providers were collected. Descriptive statistics were performed to describe the results. RESULTS: Response rate was 68%. Urology was the leading specialty primarily responsible for NBD management (39%) followed by rehabilitation medicine and developmental pediatrics (22% and 20%, respectively). Physicians were the primary providers of care followed by nurse practitioners (54% vs 31%). Urology performs 65% of NBD surgeries. CONCLUSION: Multiple specialties and providers are involved in NBD management with variation among clinics. Development of improved NBD care should include a spectrum of specialties and providers. Dissemination of research should be aimed at multiple specialty groups.

INTRAVESICAL ELECTRICAL STIMULATION IMPROVES NEUROGENIC BOWEL DYSFUNCTION IN CHILDREN WITH SPINA BIFIDA

2004 ◽  
Vol 171 (6 Part 2) ◽  
pp. 2648-2650 ◽  
Author(s):  
SANG WON HAN ◽  
MYOUNG JIN KIM ◽  
JANG HWAN KIM ◽  
CHANG HEE HONG ◽  
JAE WOOK KIM ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Spina Bifida ◽  
Bowel Dysfunction ◽  
Neurogenic Bowel

scholarly journals Bowel function and care: Guidelines for the care of people with spina bifida

2020 ◽  
Vol 13 (4) ◽  
pp. 491-498
Author(s):  
Patricia Beierwaltes ◽  
Paige Church ◽  
Tiffany Gordon ◽  
Lusine Ambartsumyan
Keyword(s):  
Spina Bifida ◽  
Bowel Function ◽  
Bowel Dysfunction ◽  
Secondary Complications ◽  
Social Opportunities ◽  
Care Guidelines ◽  
Children And Young Adults ◽  
Evidence Based Guidelines ◽  
Neurogenic Bowel

PURPOSE: Bowel dysfunction, such as constipation and fecal incontinence, has a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Secondary complications may result from bowel dysfunction and include urologic dysfunction, loss of skin integrity, shunt (hydrocephalus) function, as well as loss of social opportunities and employability. METHODS: Using a consensus building methodology, the guidelines for management of bowel dysfunction in spina bifida were written by experts in the field of spina bifida and bowel function and care. RESULTS: The evidence-based guidelines are presented in table format and provide age-specific recommendations to achieve fecal continence without constipation. Recommended treatments are presented from least to most invasive options. Literature supporting the recommendations and the interval research published to date is also presented. CONCLUSION: These guidelines present a standardized approach to management of bowel dysfunction in spina bifida. Bowel management in children and young adults with spina bifida is limited by variability in clinical practice and paucity of robust research in neurogenic bowel. Collaborative multi-institutional efforts are needed to overcome research barriers and provide innovative solutions.

Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida

2014 ◽  
Vol 35 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Maryellen S. Kelly ◽  
Margaret Hannan ◽  
Brenda Cassidy ◽  
Guy Hidas ◽  
Blake Selby ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Pediatric Patients ◽  
Bowel Dysfunction ◽  
Neurogenic Bowel

Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

2019 ◽  
Vol 23 (5) ◽  
pp. 568-576
Author(s):  
Michael Ragheb ◽  
Ashish H. Shah ◽  
Sarah Jernigan ◽  
Tulay Koru-Sengul ◽  
John Ragheb
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Head Circumference ◽  
Rainy Season ◽  
Statistical Tests ◽  
Multivariate Logistic Regression Analysis ◽  
Case Series ◽  
Multivariate Logistic Regression ◽  
Surgical Case ◽  
Operative Notes

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

scholarly journals The impact of neurogenic bladder bowel dysfunction in the sexuality of female spina bifida patients

2021 ◽  
Author(s):  
Guilherme Lang Motta ◽  
Yesica Quiróz ◽  
Erika Llorens ◽  
Anna Bujons ◽  
Tiago Elias Rosito
Keyword(s):  
Spina Bifida ◽  
Neurogenic Bladder ◽  
Bowel Dysfunction ◽  
Bladder Bowel Dysfunction ◽  
The Impact

Experimental study on the factors affecting squeak noise occurrence in automotive suspension bushings

2021 ◽  
pp. 095440702110241
Author(s):  
Byunghyun Kang ◽  
Cheol Choi ◽  
Daeun Sung ◽  
Seongho Yoon ◽  
Byoung-Ho Choi
Keyword(s):  
Neural Network ◽  
Logistic Regression ◽  
Influencing Factors ◽  
Frictional Force ◽  
Prediction Models ◽  
Statistical Tests ◽  
Network Models ◽  
Multiple Logistic Regression ◽  
Neural Network Models ◽  
Automotive Suspension

In this study, friction tests are performed, via a custom-built friction tester, on specimens of natural rubber used in automotive suspension bushings. By analyzing the problematic suspension bushings, the eleven candidate factors that influence squeak noise are selected: surface lubrication, hardness, vulcanization condition, surface texture, additive content, sample thickness, thermal aging, temperature, surface moisture, friction speed, and normal force. Through friction tests, the changes are investigated in frictional force and squeak noise occurrence according to various levels of the influencing factors. The degree of correlation between frictional force and squeak noise occurrence with the factors is determined through statistical tests, and the relationship between frictional force and squeak noise occurrence based on the test results is discussed. Squeak noise prediction models are constructed by considering the interactions among the influencing factors through both multiple logistic regression and neural network analysis. The accuracies of the two prediction models are evaluated by comparing predicted and measured results. The accuracies of the multiple logistic regression and neural network models in predicting the occurrence of squeak noise are 88.2% and 87.2%, respectively.

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