Factors influencing inpatient bowel preparation: a scoping review.

Background And Aim: Inpatients undergoing colonoscopy experience a higher-than-average rate of inadequate bowel preparation (compared to outpatients) leading to canceled procedures, increased stress on the patient, increased time in hospital, and increased cost to the healthcare system. The aim of this scoping review was to identify research surrounding inpatient bowel preparation and to identify modifiable and non-modifiable factors that influence the adequacy of bowel preparation in hospitalized patients undergoing colonoscopy and establish areas where nursing interventions may help improve overall bowel preparation rates.

Methods: An initial search of MEDLINE, CINAHL, Scopus, and Embase was undertaken to identify seed articles, followed by a structured search using keywords and subject headings.

Pilot study using an Internet-based program in informed consent.

Purpose: To examine the effect of an internet-based aid to informed consent on parent recall of potential surgical complications.

Methods: Parents of children scheduled for elective inguinal hernia repair were assigned to a control group or were enrolled in an internet-based program designed to aid in the consent process. Nine potential surgical complications were presented to the parent(s) in the consent discussion and in the Internet program.

Developing a NSQIP module to measure outcomes in children's surgical care: opportunity and challenge.

Under the guidance of the American College of Surgeons (ACS) and in partnership with the US Department of Veterans Affairs (VA), the National Surgical Quality Improvement Program (NSQIP) has been developed to improve the quality of surgical care in adults on a national level. Its purpose is to provide reliable, risk-adjusted outcomes data so that surgical quality can be assessed and compared between institutions. Data analysis consists of reporting observed to expected ratios (O/E) for 30-day postoperative mortality and morbidity measurements.

Comparison of two neonatal intravenous amino acid formulations in preterm infants: a multicenter study.

Two neonatal intravenous amino acid solutions (Aminosyn-PF and Troph-Amine) were compared in 44 preterm infants. The rate of weight gain, nitrogen balance, and changes in plasma aminograms were determined over 7 days to ascertain whether different outcomes could be identified for the two solutions. At study entry, the infants received a minimum infusion of 2 g amino acid/kg/d with 50 or more nonprotein kcal/kg/d.

Mural thrombi in children: potentially lethal complication of central venous hyperalimentation.

While benefits of total parenteral nutrition (TPN) are well documented in a wide range of surgical conditions, deaths of two children secondary to mural thrombi from central venous catheters underscore the potential risks of such therapy. With the proven accuracy and widespread availability of echocardiography for diagnosis of mural thrombi, routine surveillance of all patients receiving TPN via central venous catheters is recommended, if fevers are present or if Candida is isolated on blood cultures. While treatment may involve surgical intervention, most mural thrombi will respond to thrombolytic agents.

Familial retroperitoneal fibrosis.

Retroperitoneal fibrosis is an unusual cause of obstructive uropathy in the pediatric population. The etiology is unknown although there are laboratory and clinical associations with various autoimmune diseases. Familial associations have not been reported in children.

Anterior cricoid split for subglottic stenosis.

Subglottic stenosis is a common problem that often results from ventilatory support necessary in the premature infant. Previous methods of treatment include tracheostomy with dilatation of the stenosis, steroid injections, and procedures to stent the trachea. Results of these methods have been unsatisfactory because of the multiple procedures needed to obtain an adequate airway as well as the high mortality from long-term tracheostomy in infants.

Hazards of splenic embolization.

Perceived high operative risk for splenectomy in children with hematologic disorders and hypersplenism has led to attempts at transcatheter splenic embolization (TSE) as a possibly safer alternative. A recent experience with a child who presented with an apparent acute subcapsular hematoma after TSE and who underwent complicated emergency splenectomy prompted review of the risks and complications of TSE. Although theoretically attractive in many respects, TSE is associated with significant morbidity.

Necrotizing enterocolitis in the unfed infant.

From 1974 to 1981, 139 infants with neonatal necrotizing enterocolitis (NEC) were treated at our institution. Fourteen of these infants had not been fed prior to development of NEC. The unfed infants who developed intestinal necrosis had lower birth weights, were less mature, and had lower Apgar scores.

Malignant hyperthermia. Current concepts.

At least three myopathies have been associated with malignant hyperthemia (MH). The clinical manifestations of MH are variable and depend on the nature of the underlying myopathy and the anesthetic agents administered. Unless muscle relaxants are used, fever and muscle rigidity may be delayed at onset.

Parenteral 20% safflower oil emulsion safety and effectiveness as a caloric source in newborn infants.

Five surgical infants, ages 3 to 30 days, were studied while receiving peripheral total parenteral nutrition for a period of 2 weeks. By a randomized sequence, either 10 or 20% safflower oil emulsion was infused the first week, followed by the alternate solution during the second week. Caloric intake was 80 to 100 cal/kg/day, of which lipids comprised one-third to one-half.

Inguinal hernia and hydrocele in infants and children.

Forty senior pediatric surgeons were surveyed regarding difficult decisions in the management of inguinal hernia. Areas covered were diagnosis, surgical techniques, hydrocele, incarceration, the contralateral side of a clinically apparent inguinal hernia, and inguinal hernia in the premature baby. The lack of agreement on many questions indicates that more than one approach may be effective in managing problems associated with hernia and that rigid policies are unwarranted.

A congenital abnormality in the arrangement of muscle bundles in a segment of the distal ileum, producing obstruction: a variant of the so-called "giant Meckel's diverticulum".

This 4-year-old male child was diagnosed at birth as having several minor congenital anomalies. X-rays taken during the first year of his life showed a single, massively dilated loop of bowel in the upper abdomen, not appreciated at the time. In 1980 he was admitted to Jackson Memorial Hospital with the diagnosis of small bowel obstruction.

A mixed hamartoma of the liver: light and electron microscopy.

The gross, microscopic, and ultrastructural features of a mixed liver hamartoma occurring in a three month old infant are reported. The differentiation from two solid liver masses, focal nodular hyperplasia and liver cell adenoma is emphasized. Mesenchymal hamartomas, though usually cystic rather than solid masses, share the histologic feature of fibroductular tissue with mixed liver hamartomas and focal nodular hyperplasia.

Gastrointestinal hemorrhage. An unusual complication of total anomalous pulmonary venous drainage.

A newborn boy had exsanguinating gastrointestinal hemorrhage in in the first week of life secondary to an unusual form of infradiaphragmatic pulmonary venous drainage. Autopsy and postmortem angiograms demonstrated huge esophageal varices as the course of the uncontrolled bleeding. The occurrence of massive gastrointestinal hemorrhage should be considered to be a rare but possibly lethal complication in patients with total anomalous pulmonary venous drainage (TAPVD) type III and IV.

Perforated appendicitis: current experience in a Childrens Hospital.

A review of 89 consecutive cases of perforated appendicitis recently treated surgically at Childrens Hospital of Los Angeles revealed no mortality and a complication rate of 17%. Significant factors in this low morbidity are: adequate preoperative resuscitation, routine administration of broad spectrum antibiotics pre and postoperatively, and attention to surgical detail. Anaerobic organisms were invariably present in cultures of the peritoneal fluid taken at operation.