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Anton Emmanuel - One of the best experts on this subject based on the ideXlab platform.

  • validation of the monitoring efficacy of Neurogenic Bowel treatment on response mentor tool in a japanese rehabilitation setting
    Journal of Clinical Medicine, 2021
    Co-Authors: Masashi Nomi, Anton Emmanuel, Klaus Krogh, Atsushi Sengoku, Albert Bohn Christiansen
    Abstract:

    Study design: Prospective observational study. Objective: To validate the Monitoring Efficacy of NBD Treatment On Response (MENTOR) tool in individuals with a spinal cord injury (SCI) or spina bifida, suffering from Neurogenic Bowel dysfunction (NBD) in a rehabilitation center in Japan. Methods: First, the MENTOR tool was translated from English to Japanese using a validated translation process. Second, the MENTOR tool was validated in a rehabilitation clinic in Japan. Participants completed the MENTOR tool prior to a consultation with an expert physician. According to the results of the tool, each participant was allocated to one of three categories regarding change in treatment: “adequately treated,” “further discussion,” and “recommended change.” The results of the MENTOR tool were compared with the treatment decision made by an expert physician, who was blinded to the results of the MENTOR tool. Results: A total of 60 participants completed the MENTOR tool. There was an acceptable concordance between individuals allocated as respectively, being adequately treated (100%) and recommended change in treatment (61%) and the physicians’ decision on treatment. The concordance was lower for individuals allocated as requiring further discussion (48%). Conclusions: In this study the MENTOR tool was successfully validated in a Japanese rehab setting. The tool will help identify individuals with SCI that need further treatment of their NBD symptoms.

  • transanal irrigation for Neurogenic Bowel disease low anterior resection syndrome faecal incontinence and chronic constipation a systematic review
    Journal of Clinical Medicine, 2021
    Co-Authors: Mira Mekhael, Anton Emmanuel, Klaus Krogh, Peter Bondo Christensen, Helle Kristensen, Helene Mathilde Larsen, Therese Juul
    Abstract:

    Transanal irrigation (TAI) has received increasing attention as a treatment option in patients with Bowel dysfunction. This systematic review was conducted according to the PRISMA guidelines and evaluates the effect of TAI in Neurogenic Bowel dysfunction (NBD), low anterior resection syndrome (LARS), faecal incontinence (FI) and chronic constipation (CC). The primary outcome was the effect of TAI on Bowel function. Secondary outcomes included details on TAI, quality of life (QoL), the discontinuation rate, adverse events, predictive factors for a successful outcome, and health economics. A systematic search for articles reporting original data on the effect of TAI on Bowel function was performed, and 27 eligible studies including 1435 individuals were included. Three randomised controlled trials, one non-randomised trial, and 23 observational studies were included; 70% of the studies were assessed to be of excellent or good methodological quality. Results showed an improvement in Bowel function among patients with NBD, LARS, FI, and CC with some studies showing improvement in QoL. However, discontinuation rates were high. Side effects were common, but equally prevalent among comparative treatments. No consistent predictive factors for a successful outcome were identified. Results from this review show that TAI improves Bowel function and potentially QoL; however, evidence remains limited.

  • an open prospective study on the efficacy of navina smart an electronic system for transanal irrigation in Neurogenic Bowel dysfunction
    PLOS ONE, 2021
    Co-Authors: Anton Emmanuel, Peter Christensen, Klaus Krogh, G Del Popolo, Gabriele Bazzocchi, Ines Kurze, Maria Elena Ferreiro Velasco, Claes Hultling, Brigitte Perrouin Verbe, R Bothig
    Abstract:

    Background Transanal irrigation (TAI) has emerged as a key option when more conservative Bowel management does not help spinal cord injured (SCI) individuals with Neurogenic Bowel dysfunction (NBD). Aim To investigate the short-term efficacy and safety of an electronic TAI system (Navina Smart) in subjects with NBD. Design We present an open, prospective efficacy study on Navina Smart, in individuals with NBD secondary to SCI, studied at three months. Population Eighty-nine consecutive consenting established SCI individuals (61 male; mean age 48, range 18–77) naive to TAI treatment were recruited from ten centres in seven countries. Subjects had confirmed NBD of at least moderate severity (NBD score ≥10). Methods Subjects were taught how to use the device at baseline assisted by the Navina Smart app, and treatment was tailored during phone calls until optimal TAI regime was achieved. The NBD score was measured at baseline and at three months follow up (mean 98 days). Safety analysis was performed on the complete population while per protocol (PP) analysis was performed on 52 subjects. Results PP analysis showed a significant decrease in mean NBD score (17.8 to 10, p<0.00001). In subjects with severe symptoms (defined as NBD score ≥14), mean NBD scores decreased (19.4 to 10.9, p<0.0001). The number of subjects with severe symptoms decreased from 41 (79%) subjects at baseline to 16 (31%) at three months follow-up. Device failure accounted for the commonest cause for loss of data. Side effects possibly related to the device developed in 11 subjects (12%). Discontinuation due to failure of therapy to relieve symptoms was reported by 5 subjects (6%). Conclusion Navina Smart is effective for individuals with NBD, even those with severe symptoms; long-term data will follow. Whilst there were some device problems (addressed by the later stages of subject recruitment) the treatment was generally safe. Clinical trial (ClinicalTrials.gov number NCT02979808)

  • the monitoring efficacy of Neurogenic Bowel dysfunction treatment on response mentor in a non hospital setting
    Journal of Clinical Medicine, 2021
    Co-Authors: Sofie Dagmar Studsgaard Slot, Anton Emmanuel, Peter Christensen, Simon Mark Dahl Baunwall, K Krogh
    Abstract:

    Background: Most patients with a spinal cord injury (SCI) suffer from Neurogenic Bowel dysfunction (NBD). In spite of well-established treatment algorithms, NBD is often insufficiently managed. The Monitoring Efficacy of Neurogenic Bowel dysfunction Treatment On Response (MENTOR) has been validated in a hospital setting as a tool to support clinical decision making in individual patients. The objective of the present study was to describe clinical decisions recommended by the MENTOR (either “monitor”, “discuss” or “act”) and the use of the tool to monitor NBD in a non-hospital setting. Methods: A questionnaire describing background data, the MENTOR, ability to work and participation in various social activities was sent by mail to all members of The Danish Paraplegic Association. Results: Among 1316 members, 716 (54%) responded, 429 men (61%) and 278 women (39%), aged 18 to 92 (median 61) years. Based on MENTOR, the recommended clinical decision is to monitor treatment of NBD in 281 (44%), discuss change in treatment in 175 (27%) and act/change treatment in 181 (28%). A recommendation to discuss or change treatment was associated with increasing age of the respondent (p = 0.016) and with impaired ability to work or participate in social activities (p < 0.0001). Conclusion: A surprisingly high proportion of persons with SCI have an unmet need for improved Bowel care. The MENTOR holds promise as a tool for evaluation of treatment of NBD in a non-hospital setting.

  • creation and validation of a new tool for the monitoring efficacy of Neurogenic Bowel dysfunction treatment on response the mentor tool
    Spinal Cord, 2020
    Co-Authors: Anton Emmanuel, Peter Christensen, Klaus Krogh, Steven Kirshblum, Michele Spinelli, Dirk Van Kuppevelt, Rainer Abel, Dietrich Leder, Bruno Gallo Santacruz, Kimberly Bain
    Abstract:

    Prospective observational study. A tool to help decision-making tool for Neurogenic Bowel Dysfunction (NBD) in individuals with SCI is needed. We present a project to create and validate a new tool, the Monitoring Efficacy of NBD Treatment On Response (MENTOR), and to determine its level of concordance with decisions made by experienced clinicians in the field. UK, Denmark, USA, Italy, The Netherlands, Germany. The first phase was creation of the tool through a modified Delphi process. The second phase was the validation, wherein individuals with spinal cord injury with NBD were asked to complete the MENTOR tool immediately prior to clinic consultation. From the responses to the questionnaire of the tool, each participant was allocated into one of three categories reflecting the possible therapeutic recommendations (“recommend change”, “further discussion” and “monitoring”). An expert clinician then assessed the participant, blinded to MENTOR results, and made an independent treatment decision. A total of 248 MENTOR forms were completed. Strong agreement was found when the MENTOR tool recommended monitoring (92%) or treatment change (83%); the lowest concordance when the decision was for the “further discussion” option (59%). Patient acceptability was reported by 97% of individuals. MENTOR is an easy to use tool to monitor the treatment of NBD and determinate progression through the clinical pathway. This validation study shows good correspondence between expert clinician opinion and MENTOR result. The tool has potential to be used in other patient groups, following further studies.

Douglas B Barber - One of the best experts on this subject based on the ideXlab platform.

  • long term results for malone antegrade continence enema for adults with Neurogenic Bowel disease
    Urology, 2003
    Co-Authors: Joel M H Teichman, Mansel J Harris, Nasim Zabihi, Stephen R Kraus, Douglas B Barber
    Abstract:

    Abstract Objectives To determine the long-term outcomes from the Malone antegrade continence enema (ACE) procedure in adult Neurogenic patients. Methods A retrospective review of adult patients who underwent the ACE procedure for Neurogenic Bowel was done. Patients were studied if they had follow-up of greater than 4 years. We compared pre-ACE and post-ACE toileting times, Bowel continence status, and complications, and elicited patient subjective satisfaction with their quality of life. Results Six patients were available for study. Mean age was 35 years with a mean follow-up of 4.5 years. Urinary diversion was done in 5 patients. Pre-ACE toileting time was 190 ± 45 minutes versus post-ACE toileting time of 28 ± 20 minutes ( P P = 0.03). Five patients were continent of stool per ACE stoma. Four patients (67%) had complications. Three of five patients (60%) who underwent synchronous urinary diversion required postoperative re-exploration. Five patients (83%) were satisfied with their outcome and rated their quality of life higher after the ACE procedure compared with pre-ACE. Conclusions The ACE procedure is effective in the long-term management of adult Neurogenic Bowel. The complication and re-exploration rates are high. Patients must be properly selected to determine appropriate motivation.

  • malone antegrade continence enema for adults with Neurogenic Bowel disease
    The Journal of Urology, 1998
    Co-Authors: Joel M H Teichman, Mansel J Harris, Donald M Currie, Douglas B Barber
    Abstract:

    AbstractPurpose: We describe the outcomes of adults with Neurogenic Bowel disease who underwent a Malone antegrade continence enema procedure with or without concomitant urinary diversion.Materials and Methods: Consecutive adult patients with Neurogenic Bowel disease who underwent an antegrade continence enema procedure (continent catheterizable appendicocecostomy for fecal impaction) were retrospectively reviewed.Results: Of the 7 patients who underwent an antegrade continence enema synchronous urinary procedure (ileal conduit, augmentation ileocystoplasty with continent catheterizable abdominal stoma or augmentation ileocystoplasty) was also performed in 6. Mean patient age was 32 years and mean followup was 11 months. Of the 7 patients 6 who self-administered antegrade continence enemas regularly were continent of stool per rectum and appendicocecostomy, using the appendicocecostomy as the portal for antegrade enemas. All 6 compliant patients reported decreased toileting time and improved quality of li...

Richard A Awad - One of the best experts on this subject based on the ideXlab platform.

  • rectal hyposensitivity for non noxious stimuli postprandial hypersensitivity and its correlation with symptoms in complete spinal cord injury with Neurogenic Bowel dysfunction
    Spinal Cord, 2013
    Co-Authors: Richard A Awad, M C Santillan, Santiago Camacho, J. C. Domínguez, M Blanco, M R Pacheco
    Abstract:

    Rectal hyposensitivity for non-noxious stimuli, postprandial hypersensitivity and its correlation with symptoms in complete spinal cord injury with Neurogenic Bowel dysfunction

  • Neurogenic Bowel dysfunction in patients with spinal cord injury myelomeningocele multiple sclerosis and parkinson s disease
    World Journal of Gastroenterology, 2011
    Co-Authors: Richard A Awad
    Abstract:

    Exciting new features have been described concerning Neurogenic Bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease present with serious upper and lower Bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and Bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of Neurogenic Bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.

Lance L Goetz - One of the best experts on this subject based on the ideXlab platform.

  • a primary care provider s guide to Neurogenic Bowel dysfunction in spinal cord injury
    Topics in Spinal Cord Injury Rehabilitation, 2020
    Co-Authors: Philip Durney, Michael D Stillman, Wilda Montero, Lance L Goetz
    Abstract:

    Spinal cord injury (SCI) affects the gastrointestinal (GI) tract in several ways, most notably by causing impairment of colonic motility and sphincter dysfunction. Altered GI function in the setting of neurological injury-also known as "Neurogenic Bowel dysfunction" (NBD) -strongly impacts the quality of life (QOL) of individuals living with SCI. Characterizing the severity of NBD, its impact on an individual's QOL, and which interventions have been successful or ineffective is integral to the routine care of people living with SCI. Treatment of NBD is generally multimodal and includes attention to diet, pharmacologic and mechanical stimulation, and possibly surgery. This article discusses the pathophysiology of NBD and specific approaches to its management.

  • international standards to document remaining autonomic function in persons with sci and Neurogenic Bowel dysfunction illustrative cases
    Spinal cord series and cases, 2018
    Co-Authors: Lance L Goetz, Anton Emmanuel, Klaus Krogh
    Abstract:

    Neurogenic Bowel dysfunction (NBD) is a highly prevalent problem after spinal cord injury, with potential for significant impact on health and quality of life. The international standards to document remaining autonomic function after SCI were developed to standardize communication between professionals regarding Neurogenic Bowel and other autonomic function after SCI. To improve understanding of the Bowel subsection, illustrative cases are presented. Three cases are presented which illustrate differences in presentation and scoring of the elements in the data set based upon varying injury severity and location. Determination of neurologic level of injury is insufficient for assessment of autonomic function and there is no direct method of assessment. Hence, surrogate makers are needed. The Bowel subsection of the International standards to document remaining autonomic function in persons with SCI is an easy-to-use tool for this purpose.

  • a comparison of patient outcomes and quality of life in persons with Neurogenic Bowel standard Bowel care program vs colostomy
    Journal of Spinal Cord Medicine, 2005
    Co-Authors: Stephen L Luther, Audrey Nelson, Jeffrey J Harrow, Fangfei Chen, Lance L Goetz
    Abstract:

    Background/Objective: The purpose of this study was to compare patient outcomes and quality of life for people with Neurogenic Bowel using either a standard Bowel care program or colostomy.Methods:...

  • provider adherence to implementation of clinical practice guidelines for Neurogenic Bowel in adults with spinal cord injury
    Journal of Spinal Cord Medicine, 2005
    Co-Authors: Lance L Goetz, Jeffrey J Harrow, Audrey L Nelson, Marylou Guihan, Helen T Bosshart, Kevin D Gerhart, Barbara Krasnicka, Stephen P Burns
    Abstract:

    Background/Objectives: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the “Neurogenic Bowel Management in Adults with Spinal Cord Injury” Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine

  • Neurogenic Bowel dysfunction after spinal cord injury clinical evaluation and rehabilitative management
    Archives of Physical Medicine and Rehabilitation, 1997
    Co-Authors: Steven A Stiens, Susan Biener Bergman, Lance L Goetz
    Abstract:

    Neurogenic Bowel dysfunction (NBD) is one of many impairments that result from spinal cord injury (SCI). The experience of persons with SCI reveals that the risk and occurrence of fecal incontinence and difficulty with evacuation are particularly significant life-limiting problems. This review relates the anatomy and physiology of colon function to the specific pathophysiology that detracts from the quality of life of persons after SCI. There are two patterns of NBD after SCI: the upper motor neuron Bowel, which results from a spinal cord lesion above the sacral level, and the lower motor neuron Bowel, which results from a lesion to the sacral spinal cord, roots, or peripheral nerve innervation of the colon. Rehabilitation evaluation consists of a comprehensive history and examination to define impairments, disabilities, and handicaps pertinent to NBD. Rehabilitation goals include continence of stool, simple willful independent defecation, and prevention of gastrointestinal complications. Intervention consists of derivation and implementation of an individualized person-centered Bowel program, which may include diet, oral/rectal medications, equipment, and scheduling of Bowel care. Bowel care is a procedure devised to initiate defecation and accomplish fecal evacuation. Digital-rectal stimulation is a technique utilized during Bowel care to open the anal sphincter and facilitate reflex peristalsis. Recent advances in rehabilitation practices, equipment, pharmacology, and surgery have offered patients new Bowel program alternatives. Interdisciplinary development of solutions for problems of NBD are evolving rapidly.

F Bieringsorensen - One of the best experts on this subject based on the ideXlab platform.