1. DIAGNOSTIC PILOT STUDY OF AN EVALUATION SCALE OF THE REVERTION SYMPTOMS AFTER
AN ANTERIOR RESECTION OF THE RECTUM
Gaetano Militello (Ostomy Care Nurse, Wound Care Expert, U.S.L. 4, Misericordia e Dolce Hospital, Prato – Italy)
Mario Antonini (Ostomy Care Nurse, Wound Care Expert, U.S.L. 11, San Giuseppe Hospital, Empoli – Italy)
Sonia Fligor (Nurse, University of Florence – Italy)
Cristina Lippi (Nurse, U.S.L. 4, Misericordia e Dolce Hospital, Prato – Italy)
Giuliano Quaresimini (Surgeon Assistant, Misericordia e Dolce Hospital, Prato – Italy)
Drug treatment for fecal incontinence in • Numero di persone che non
INTRODUCTION adults By: Cheetam, Mark J, Brazzelli,
Miriam, Norton, Christine C, Glazener,
raggiungono una completa continenza
• Numero di persone che non migliora
The pilot study objective is to validate a scale for secondary symptoms of the revertion after the Cathryn MA, Cochrane Database of
systematic Reviews, Issue 4.
• Frequenza dell’incontinenza (diario o
self-report)
anterior rectum resection. As this problem seems to be scarcely evaluated in a correct scientific • Grado di incontinenza (ad esempio, il
peso delle feci)
way. A systematic bibliographical research highlighted that also the Cochrane shows two aspects: • Valutazione incontinenza
• Episodi di urgenza fecale
ano-rectal physiologic measurements are not directly comparable among different studies • Misurazioni fisiologiche anorettali
because of the huge variability of the technology and the evaluation methods of the ano-rectal
function used by different centers. Moreover they cannot be directly connected to the clinical Electrical stimulation for fecal SINTOMI DEL PAZIENTE:
incontinence in adults By: Hosker G, Cody - Incontinenza descrizione
outcomes. For these reasons such measurements should be considerate as substitute endpoints. JD, Norton CC, Cochrane Database of - Frequenza dell’incontinenza
Systematic Reviews, Issue 4. - Punteggio incontinenza (non viene
According to any research guidelines, indication from the research a standard related to the definito come misurarla)
- Verificarsi di effetti negativi
outcomes of the intestinal function should be defined to facilitate the comparison among Misurazioni della fisiologia anorettale.
different studies of different rehabilitation techniques.
Plugs for containing faecal incontinence SINTOMI DEL PAZIENTE:
By: Deutekom M, Dobben A, Cochrane - La frequenza di incontinenza delle feci
Database of Systematic Reviews, Issue 4. o flatus (diario o self-report)
- Grado di incontinenza (ad esempio, il
peso delle feci)
METHODS AND MATERIALS VALUTAZIONE INCONTINENZA:
- Episodi di urgenza anale.
A diagnostic blind research has been done to define the following essential data of the test: MISURE FISICHE:
- Realizzazione di pseudo-continenza
- Accuracy; (continenza solo mentre indossa un
tampone)
- Reproducibility. - Per quanto tempo lo indossa e
frequenza d’uso
In case of lack of any other bibliographical indications, the clinical evaluation should be considered - Tasso di perdita
- Controllo degli odori.
the gold standard.
Reconstructive Techniques after Rectal - Numero di movimenti intestinali al
Resection for Rectal Cancer By: Carl J, giorno.
Brown, Fenech, Darlene, McLeod, Robin S, - Urgenza, definita come l’incapacità di
Cochrane Database of Systematic Reviews. rimandare la defecazione.
- L’incontinenza fecale, misurata da uno
strumento adeguato (non vengono
definite le scare che possono essere
considerate adeguate.
Patients were selected from colo-proctological centers of Prato and Empoli USL (Local Sanitary - L’evacuazione incompleta, definita
dalla sensazione di tenesmo residua dopo
Units). la defecazione.
L’uso di farmaci anti-diarrea, definito
INCLUSION CRITERIA come la continua dipendenza da farmaci
costipativi.
The patients involved have had a revertion surgery after anterior resection of the rectum and they Bilateral sacral spinal nerve rectum - Frequenza episodi di
were all out-patients. resection . Matzel KE, Stadelmaier U,
Bittorf B, Hohenefellner, Hohenfellner -
inocntinenza
Soddisfazione del paziente (non
EXCLUSION CRITERIA -
specificato come valutata)
Manometria (pressione di
Patients that had a different type of resection; patients that were not reversed, patients that had compressione, pressione a riposo,
soglie per la prima percezione,
not been followed by the mentioned centers, patients with privious fecal incontinence for -
massimo volume tollerabile
Cleveland Clinic Continence
different reasons than the ones takent into consideration in this study;, patients that used drugs Score.
that can cause fecal incontinence or severe disorders of the intestinal alvum. Sample units: 20
patients. Kaspar Z’graggen, Christoph A. Maurer, - Frequenza dei movimenti intestinali
Stefan Birrer, Daniel Giachinoi, Beatrice nelle 24 ore (range)
Kem MD, Markus W, Buchler, A new - Urgenza
surgical Concept for Rectal Replacement - Frammentazione delle feci
aftewr low anterior resection. The - Incontinenza (non viene indicata la
transverse Coloplasty Pouch Annals of modalità di valutazione.
Surgery Vol. 234, N. 6, 780-2001 Lippicott
Williams & Williams % Wilins, Inc.
RESULTS
In order to evaluate the validiy of the scale we firstly gave a definition of Cut-off levels by
comparing the evaluation results of the scale with the data of the clinical evaluation done by the PRATO EVALUATION SCALE
clinician and by elaborating matrix tables regarding to each cut-off value. The scale presented INCONTINENCE OTHER SYMPTOMS
two Cut-Offs: the first (light-medium) the second (medium-severe). Then sensitivity, specificity,
DATE
Vp+, Vp-, LR+, LR- have been evaluated. The evaluation of the Cut-Off was done using the Flatulence Liquid Stools Solid Stools Bloating Bleeding Rectal Pain Perineal
Youden Index. spasm Lesions
The evaluation of the reproducibility was done through the K of Choen. K of Choen of 92% shoul SF R SF R SF R Trace True Weak Strong
be considered as remarkable reproducibility. SOMETIME 1 2 3 5 6 8 1 1 2 2 1 2 Present
As there are several other scales to measure incontinence, the values of their validation have 4
been searched in order to compare them with the section of the Prato scale section regarding DAILY 6 5 7 9 10 12 2 3 5 5 3 5 No
the incontinence. This was done to understand if the use of a single scale is correct or if it’s lesion
better to evaluate the incontinence with another scale and the other symptoms with this scale if 0
we should use this scale only. ABSENT 0 0 0 0 0 0 0
A systematic bibliographical research has given unexpeted results, as the validation of the TOTAL
above-mentioned scales was done just for some of them; moreover, in those cases, only the
Signature
agreement among helth care professionals was considered.
No data about sensitivity and specificity were.
In a study R of Parson was evaluated to demonstrate a connection between scale values and
clinical data, but the same Chocrane stated that this index tent to overestimate the real value.
Cut-off
VN VP
DISCUSSION lieve media VP
The pilot study seems to show positive results but reproducibility must be held under control in grave
case of:
- Other valuators will be involved
- The sample selection includes more patients with light symptomatology.
This research is also oriented to start the validation of the scale about to the incontinence, as it’s
the only study conducted with a methodology suggested by Cochrane, also for this the preliminary
results are good. 0 7 16 38
valore di cut-off
cut-
Cut-off 16 Valore I.C. 95% Cut-off 7 Valore I.C. 95%
Sensibility 0,83 0,661 1,005 Sensibility 1,000 1,000 1,000
Specificity 0,91 0,788 1,029 Specificity 0,94 0,849 1,02196623
VPP 0,88 0,729 1,035 VPP 0,82 0,59025087 1,04611277
VPN 0,87 0,731 1,007 VPN 1,00 1,00000000 1,00000000
LR + 9,17 2,406 34,919 LR + 15,50 4,05667414 59,22339135
LR - 0,18 0,064 0,369 LR - 0,00
Accuracy 0,450 Accuracy 0,95
Prob. Pre-test 0,818 Prob. Pre-test 0,225
(prevalence) (prevalence)
Pre-test odds 7,500 Pre-test odds 0,290
Post –test odds 0,882 Post –test odds 4,500
Prob. Post-test 0,450 Prob. Post-test 0,818