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Eke H, Ball S, Allinson A, Anderson R, Hunt H, Hutton E, Lindsay C, Logan S, Madden N, Melluish J, Richardson D, Rogers J, Thompson Coon J, Whear R, Wright A, Morris C. Interventions to improve continence for children and young people with neurodisability: a national survey of practitioner and family perspectives and experiences. BMJ Paediatr Open 2024; 8:e002238. [PMID: 38242630 PMCID: PMC10806478 DOI: 10.1136/bmjpo-2023-002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Describe families' experiences of interventions to improve continence in children and young people with neurodisability, and health professionals' and school and social care staff's perspectives regarding factors affecting intervention use. DESIGN Four online surveys were developed and advertised to parent carers, young people with neurodisability, health professionals and school and social care staff, via societies, charities, professional contacts, schools, local authorities, and national parent carer and family forums, who shared invitations with their networks. Survey questions explored: difficulties helping children and young people use interventions; acceptability of interventions and waiting times; ease of use and availability of interventions, and facilitators and barriers to improving continence. RESULTS 1028 parent carers, 26 young people, 352 health professionals and 202 school and social care staff registered to participate. Completed surveys were received from 579 (56.3%) parent carers, 20 (77%) young people, 193 (54.8%) health professionals, and 119 (58.9%) school and social care staff. Common parent carer-reported difficulties in using interventions to help their children and young people to learn to use the toilet included their child's lack of understanding about what was required (reported by 337 of 556 (60.6%) parent carers who completed question) and their child's lack of willingness (343 of 556, 61.7%). Almost all (142 of 156, 91%) health professionals reported lack of funding and resources as barriers to provision of continence services. Many young people (14 of 19, 74%) were unhappy using toilet facilities while out and about. CONCLUSIONS Perceptions that children lack understanding and willingness, and inadequate facilities impact the implementation of toileting interventions for children and young people with neurodisability. Greater understanding is needed for children to learn developmentally appropriate toileting skills. Further research is recommended around availability and acceptability of interventions to ensure quality of life is unaffected.
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Affiliation(s)
- Helen Eke
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Susan Ball
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Annette Allinson
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | - Rob Anderson
- Medical School, University of Exeter, Exeter, UK
| | - Harriet Hunt
- Medical School, University of Exeter, Exeter, UK
| | - Eve Hutton
- Canterbury Christ Church University, Canterbury, UK
| | | | - Stuart Logan
- Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Nicholas Madden
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Julia Melluish
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
| | | | | | - Jo Thompson Coon
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Anne Wright
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Christopher Morris
- Medical School, University of Exeter, Exeter, UK
- Peninsula Childhood Disability Research Unit, University of Exeter, Exeter, UK
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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Goldfeld S, Tapley A, O'Connor E, Spike N, Morgan S, Freed GL, Davey A, Holliday E, Ball J, Magin P. Prevalence and associated skills of Australian general practice registrars seeing children with functional bowel and bladder problems. J Paediatr Child Health 2023; 59:979-986. [PMID: 37231975 PMCID: PMC10946612 DOI: 10.1111/jpc.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
AIM Functional bowel (constipation and faecal incontinence) and bladder (urinary incontinence and enuresis) problems in children are often treated by paediatricians yet should mostly be managed by general practitioners (GPs). To understand whether the necessary skills and knowledge are being built in general practice, this study aimed to establish the prevalence and associated skills of Australian general practice registrars managing children with functional bowel and bladder problems. Together as paediatricians and GPs, we use these data to determine how best to ensure high quality, equitable care for children. METHODS We drew on 16 rounds of data collection from the Registrar Clinical Encounters in Training (ReCEnT) multi-site cohort study (2010-2017) of general practice registrars' in-consultation experience. It included a measure of paediatric consultations in which a functional bowel or bladder problem was managed, as well as demographic information. RESULTS Out of 62 721 problems/diagnoses for paediatric patients (0-17 years), 844 (1.4%) were coded as functional bowel (n = 709; 1.13% (95% confidence interval, CI: 1.05-1.22)) and/or bladder (n = 135; 0.22% (95% CI: 0.18-0.25)) presentations. Registrars were more likely to prescribe medication for bowel problems (odds ratio (OR) = 2.22 (95% CI: 1.86-2.64)) than for all other problems, but less likely to prescribe medication (OR = 0.31 (95% CI: 0.18-0.52)) for night-time wetting and more likely to make a specialist referral (OR = 1.99 (95% CI: 1.22-3.25)) compared to all other problems. CONCLUSIONS Only a small proportion of children with functional bowel and bladder problems were seen by registrars despite high prevalence in the community and amenability to management in the general practice setting (i.e. generally low morbidity and low complexity) versus need for specialists. Registrars appeared to be managing functional bowel and bladder problems according to evidence-based guidelines, but with relatively high levels of referral. Given the inequitable access to specialist care, paediatricians should support local general practice management of these problems. This might include (i) engaging with training programs to ensure appropriate education and (ii) liaising with individual registrars/practices to provide management advice for individual or example cases.
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Affiliation(s)
- Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Amanda Tapley
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elodie O'Connor
- Centre for Community Child Health, Murdoch Children's Research InstituteRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Neil Spike
- Eastern Victoria General Practice TrainingMelbourneVictoriaAustralia
- Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Simon Morgan
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
| | - Gary L Freed
- Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
- Centre for Health Policy, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Andrew Davey
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Elizabeth Holliday
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS)Hunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Parker Magin
- NSW and ACT Research and Evaluation UnitGP SynergyNewcastleNew South WalesAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
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Ling N, Trajanovska M, Griffith A, Phan T, Gibb S, Goldfeld S, King SK. Paediatric bladder dysfunction: A single centre experience of public hospital wait times. J Paediatr Child Health 2020; 56:797-803. [PMID: 31904904 DOI: 10.1111/jpc.14758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/18/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022]
Abstract
AIM Paediatric bladder dysfunction, including daytime urinary incontinence and enuresis, is a common and distressing condition. Unfortunately, children with these symptoms are often on waitlists for several months. This treatment delay may significantly impact upon the child and family unit. This study aimed to quantify waiting times for children who had attended hospital outpatient clinics for symptoms of wetting. METHODS A retrospective review was undertaken for patients who had been referred to The Royal Children's Hospital, Melbourne outpatient clinics for symptoms of wetting (with/without bowel symptoms). Data regarding the referral and triage pathway, up to the time of the first clinic appointment, were collected. These data were compared to a previous audit conducted in the same setting. RESULTS A total of 101 clinic attendances were included in this study. The overall waiting time, from receipt of referral to the patient's first clinic attendance, was a median of 181 days (n = 94 valid responses; range 7-695). Wait times for patients with isolated symptoms of wetting were similar to patients with mixed bowel and bladder dysfunction (187 and 171.5 days, respectively). Most patients were triaged to the continence clinic (n = 68), whilst smaller proportions of patients were seen in the encopresis (n = 14), urology (n = 13), general medicine (n = 2), gastroenterology (n = 1) and nurse-led enuresis clinic (n = 3). CONCLUSIONS The waiting times for patients with wetting generally exceeded 5 months. Alternative pathways for triage need to be explored to manage demand and improve wait times.
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Affiliation(s)
- Norman Ling
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Misel Trajanovska
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andrew Griffith
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tracey Phan
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susan Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
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