Advanced Nursing Practice in Orthogeriatrics

In the last few decades, all the countries aim to combine the improvement of the quality of health care with the reduction of health costs. In order to harmonize the above-mentioned contradictory goals, newly enhanced roles, as in the case of Advanced Nursing Practice, have been introduced, initially in the private sector and more recently in the public hospital setting. The orthogeriatric advanced nursing practitioners’ role is valuable for providing pain relief, diagnosing and treating postoperative delirium, deep vein thrombosis, and secondary infections, preventing subsequent injuries and pressure sores, helping patients deal with postoperative constipation, and assist them in early mobilizing. After patients’ discharge from the hospital, their role is essential for ensuring the patients are adhering to their osteoporotic treatment and have the adequate skills to prevent falls. Their role is significant for older adults living in nursing homes or long-term care facilities. Their care is cost-effective compared to regular care.

Pediatric Surgery Rate of Constipation After Sagittal Anorectoplasty For Rectoperineal Fistula

Background Rectoperineal fistula is a congenital low anorectal malformation that is presented with constipation and straining at stool. There is argument as regarding name, diagnosis and surgical treatment. Objectives to estimate the incidence of postoperative constipation among patients with rectoperineal fistula treated with anorectoplasty using Krickenbeck classification for postoperative outcomes. Patients and Methods The study was conducted between January 2018 and August 2018. The study included patients with rectoperineal fistula who underwent sagittal anorectoplasty (SARP) in the last five years in two tertiary hospitals; Ain Shams University Children Hospital and Banha Specialized Children Hospital. We excluded patients who underwent operations other than SARP and patients having Currarino syndrome and sacral anomaly like hemisacrum and caudal regression. Krickenbeck classification was used for assessment of constipation before and after operation. A simple questionnaire was used for follow up assessment. Results The study included 30 patients (19 female and 11 male). Their age at time of repair ranged from 3m to 78 months with a median age of 7.5 months. Rate of constipation in patients with rectoperineal fistula after SARP was 39%, while improvement rate was 65%. 14 patients out of 23 having preoperative constipation (61%) were treated from constipation, and one patient (4%) got improved regarding constipation grade and frequency, while remaining 8 patients (35%) were still having the same degree of constipation. There were 7 children who had no constipation before and after repair. These results were statistically significant as measured using McNemar test. Postoperative soiling was recorded in 7 patients; all of them had pseudo-incontinence (ORSI). Conclusion Rectoperineal fistula patients can gain benefit from SARP not just cosmetically, but also functionally (65% of constipated patients got improved).

Assessment of patients’ psychological state and self-efficacy associated with postoperative constipation after thoracolumbar fracture surgery

Objective We aimed to explore the relationship among the duration of constipation at 30 days after thoracolumbar fracture surgery, self-efficacy, and anxiety or depression in patients with constipation after thoracolumbar fracture surgery. Methods In this descriptive correlational study, 108 patients with thoracolumbar fracture undergoing pedicle screw fixation surgery were recruited from January 2015 to May 2017 in our hospital. From the day of surgery, we conducted a 1-month follow-up investigation. We evaluated the pattern of defecation, stool consistency, and incidence of defecation-related problems using a structured interview. Clinical data were obtained using a patient intake form, and we applied the Health Behavior Self-Efficacy Scale (HBSES), and Hospital Anxiety and Depression Scale (HADS). Results Approximately 83.3% of patients experienced postoperative constipation, and most exhibited normal defecation by postoperative day 13. Self-efficacy and anxiety and depression were graded at a medium level in most patients. The average HBSES score was 74.39 ± 11.08, and the mean HADS score was 7.97 ± 4.08. The duration of postoperative constipation was negatively correlated with self-efficacy and positively associated with anxiety or depression. Conclusions Self-efficacy, anxiety, and depression are important sociopsychological factors associated with the duration of postoperative constipation.

Duhamel and Transanal Endorectal Pull-throughs for Hirschsprung' Disease: A Systematic Review and Meta-analysis

Aim The Duhamel pull-through and transanal endorectal pull-through (TEPT) are commonly used for the treatment of Hirschsprung's disease (HD). To date, there has been no meta-analysis evaluating postoperative outcomes following Duhamel pull-through and TEPT. The purpose of this meta-analysis was to compare patient outcome after Duhamel pull-through and TEPT for HD. Materials and Methods Original articles published between 1998 and 2016 were identified using the MEDLINE database. Studies comparing Duhamel pull-through and TEPT were included. Outcomes evaluated included incidence of postoperative constipation, incontinence/soiling, enterocolitis, anastomotic stricture, and leak. We analyzed dichotomous variables by estimating odds ratios (OR) with 95% confidence intervals (CI) and continuous variables using the weighted mean difference with 95% CI. The meta-analysis was done using RevMan 5.3. Result There were no randomized controlled trials. Seven observational clinical studies were included, comprising 260 cases of Duhamel pull-through and 170 cases of TEPT. Anastomotic stricture (OR = 0.10; 95%CI 0.02–0.48; p = 0.004) was lower following Duhamel pull-through than TEPT. There were no significant differences in the incidence of postoperative incontinence/soiling and anastomotic leak. After TEPT, postoperative constipation seems to be lower and enterocolitis higher compared with those after Duhamel pull-through; however, these differences are not significant when the follow-up period is equal between groups. Conclusion The Duhamel pull-through seems to be associated with lower incidence of anastomotic stricture compared with TEPT. The effects of the two analyzed operative techniques on constipation and enterocolitis remain unclear. The quality of evidence supporting the above findings is suboptimal, indicating the need for prospective studies.