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Inpatient colonoscopy bowel preparation quality is frequently suboptimal. This quality improvement (QI) intervention is focused on regimenting this process to impact important outcomes.

Define, Measure, Analyze, Improve and Control (DMAIC) methodology was employed, including generating a root-cause analysis to identify factors associated with inpatient bowel quality. These findings motivated the creation of a standardized electronic health record (EHR)-based order set with consistent instructions and anticipatory guidance for administering providers.

There were 264 inpatient colonoscopies evaluated, including 198 procedures pre-intervention and 66 post-intervention. The intervention significantly improved the adequacy of right colon bowel preparations (75.0 percent vs 86.9 percent, p = 0.04) but not overall preparation quality (73.7 percent vs 80.3 percent, p = 0.22). The intervention led to numerical improvement in the proportion of procedures in which the preparation quality interfered with making a diagnosis (10 percent–6 percent, p = 0.29) or resulted in an aborted procedure (3.5 percent–1.5 percent, p = 0.39). After the intervention, provider satisfaction with the ordering process significantly increased (23.3 percent vs 61.1 percent, p < 0.001).

The QI intervention significantly reduced the number of inpatient colonoscopies with inadequate preparation in the right colon, while also modestly improving the diagnostic yield and proportion of aborted procedures. Importantly, the standardized EHR order set substantially improved provider satisfaction, which should justify broader use of such tools.

Novel clinical outcomes such as ability to answer diagnostic questions were improved using this intervention. The results align with strategic goals to enhance provider experience and continuously improve quality of patient care.

The purpose of this paper is to investigate the presence of bladder and bowel symptoms in women recently imprisoned in Western Australian prisons, specifically; stress, urge and mixed urinary incontinence, faecal incontinence, nocturia, nocturnal enuresis and constipation and the impact on the quality of life (QOL).

Over a 12-month period 29 women, recently released from Western Australia’s female prisons, were surveyed using a questionnaire previously validated for the prison population. The Short Form King’s Health Questionnaire and a modified version of the Manchester Health Questionnaire were used to assess the effects of these symptoms on QOL.

Of those surveyed only one respondent reported having no bladder or bowel symptoms following release from prison. Trends assessed by Chi-square analysis suggest women imprisoned for any period of time are more likely to develop both bladder and bowel symptoms which persist after release back into the community. A history of substance or alcohol abuse is often concurrent with the presence of symptoms. QOL scores are also lower for those reporting either bladder or bowel symptoms affecting total scores and the domains of both activities of daily living and mental health.

Women imprisoned for any length of time developed bladder and bowel symptoms which had a negative impact on their QOL. Larger studies need to be conducted to investigate these trends and whether small changes in conservative measures can influence outcomes.

This condition is very common but can diet help? Jill Davies PhD reports

Chronic illnesses often go unnoticed mainly due to their invisibility and lack of understanding both at home and in the workplace. In this chapter, I use an autoethnographic approach to engage with my “emotionally charged” lived experiences of living and working with a stigmatized chronic illness – irritable bowel syndrome (IBS) – in a highly patriarchal Pashtun society where women are expected to perform various social roles despite of illness and are often silenced to male domination. IBS is a functional gastrointestinal disorder characterized by abdominal pain, abnormal bowel function, and bloating, in the absence of any structural abnormalities, and has a significant impact on one’s life. As I navigate through my experiences of suffering from a chronic illness and the emotional labor involved therein, I shed light on the challenges I face as a woman in managing work and life and as I silence my pain and emotions to fit into the roles of a “professional” academic, a “good” wife, a “good” daughter, a “good” sister-in-law, a “good” daughter-in-law, and so forth. I have used both the lens of stigma to reflect my sufferings and normalization to demonstrate my resilience and (re)adjustment to the new life. In doing so, pain and emotions do leak out during intense situations but silencing chronic illness is mostly strategic as it protects us from being excluded, marginalized, and stigmatzed both at work and home.

This paper aims to investigate the concept of value self-creation and provides a formal definition for this concept. The paper suggests that it sits within an overall continuum of value creation that includes value delivery and value co-creation.

A proposed model of value self-creation was developed and empirically tested in a health care self-service, bowel screening. An online, self-completion survey was administered to Australian men and women aged 50 years and above, as this represents the primary target population for bowel screening.

The results of the structural equation modelling in AMOS suggest that consumers can self-create value, leading to desired outcomes of satisfaction with the consumption experience and behavioural intentions to engage with the self-service again in the future. The findings provide empirical evidence to suggest that consumers’ behavioural contributions represent the most important consumer contributions in self-service, followed by cognitive contributions.

The study provides an empirically validated model of value self-creation in health care self-service. Much of the existing research on value co-creation has concentrated on traditional service types and is ill-placed to explain the value creation processes in self-services. This study offers originality by addressing this gap and demonstrating to service managers how they can manage consumer contributions towards a self-service and facilitate value-self creation, even though they are not present during the consumption stage of the consumption process.

The purpose of this paper is to present information from the Joint Health and Social Care Self-Assessment Framework (JHSCSAF) on reported rates of cervical cancer, breast cancer and bowel cancer screening for eligible people with learning disabilities in England in 2012/2013 compared to screening rates for the general population.

Between 94 and 101 Learning Disability Partnership Boards, as part of the JHSCSAF, provided information to allow the calculation of rates of cervical cancer, breast cancer and bowel cancer screening in their locality, for eligible people with learning disabilities and for the population as a whole.

At a national level, reported cancer screening coverage for eligible people with learning disabilities was substantially lower than for the population as a whole (cervical cancer screening 27.6 per cent of people with learning disabilities vs 70 per cent of total population; breast cancer screening 36.8 per cent of people with learning disabilities vs 57.8 per cent of total population; bowel cancer screening 28.1 per cent of people with learning disabilities vs 40.5 per cent of the general population). There were considerable geographical variations in reported coverage for all three screening programmes.

Consistent with previous research, localities in England report cancer screening rates for eligible people with learning disabilities considerably below those of the general population. There is an urgent need to address data availability and quality issues, as well as reasonable adjustments to cancer screening programmes to ensure uniformly high rates of cancer screening for people with learning disabilities across England.

The purpose of this paper is to explore the use of qualitative approaches to add depth and insight to understanding concerning the issues involved when consumers try to make changes in their behaviour. The context of this study is people trying to make and sustain changes to their dietary behaviour. Taking Prochaska and Di Clemente's Stages of Change model as the starting point, this paper marks a departure from other work in the behavioural change area in so far as a qualitative approach is adopted rather than a quantitative perspective.

This study was longitudinal in design and the data presented concern groups of people who were categorized as belonging to stages of change and who followed a similar stage of change pattern over a period of 18 months (according to the Stage of Change algorithm described by Curry et al.).

By examining peoples' behaviour changes in depth, the similarities and differences in their attitudes and motivations are revealed in terms of their dietary behaviour change and maintenance of change. This provides a more refined understanding of how people make changes and maintain them over time.

While focusing only on a small number of people, the weaknesses of the Stages of Change model is demonstrated and how qualitative research approaches can be used to add depth and meaning to quantitative methodologies popular in the social marketing domain.

This paper demonstrates that the Stages of Change model has value in categorizing people into stages of change and measuring these changes over time but is limited in its ability to develop understanding of the lived experience of trying to change behaviour.

Addresses the problem of defining the term “constipation”. Briefly discusses the role of dietary fibre as a cause for concern in the aetiology of the disorder and highlights the importance of “other” factors that may influence bowel habits. Makes specific reference to: the amount of food eaten; fluid intake; exercise; delay in responding to the call to stool; establishment of a bowel routine; psychological factor; sex hormones (female); pharmacological preparations and health status. States the prevalence of constipation in the UK and places emphasis throughout on objective measurements of bowel function, including stool frequency, weight and transit time. Emphasizes the fact that fibre is just one consideration in the constipation scenario. Fibre is not the panacea for this condition.

The purpose of this paper is to investigate the role of masculine identity in generating value destruction and diminished well-being in a preventative health service.

This research used five focus groups with 39 Australian men aged between 50 and 74 years. Men’s participation in the National Bowel Cancer Screening Program informed the sample frame. In total, 12 Jungian male archetypes were used to identify different masculine identities.

Thematic analysis of the data revealed three themes of masculinity that explain why men destroy value by avoiding the use of a preventative health services including: rejection of the service reduces consumer disempowerment and emasculation, active rejection of resources creates positive agency and suppressing negative self-conscious emotions protects the self.

Limitations include the single context of bowel cancer screening. Future research could investigate value destruction in other preventative health contexts such as testicular cancer screening, sexual health screening and drug abuse.

Practical implications include fostering consumer empowerment when accessing services, developing consumer resources to create positive agency and boosting positive self-conscious emotions by promoting positive social norms.

This research is the first known study to explore how value is destroyed in men’s preventative health using the perspective of gender identity. This research also is the first to explore value destruction as an emotion regulation strategy.

Black metal has the power to stimulate the mind, to bring the listener to the very edge of an intellectual nihilistic abyss. While the experience of black metal can be one of transcendence and annihilation, it is nevertheless rooted in the embodiment of the listener. Black metal’s primal sound and aesthetic are closely associated with the chaotic lower abdomen, including the generative organs and the bowels, which in medieval cosmology represented torment, melancholia, and demonic forces. Black metal bowellism translates this medieval visceral inversion into an expression of the Bakhtian Grotesque, a gleeful and anarchic rejection of the hierarchical order. This chapter connects this metaphysical inversion to a desire to return to an imagined medieval world, but one of dissolution and decay rather than a reconstitution of older hierarchies.