What is the diagnostic value of the history taking and the physical examination in diagnosing chronic idiopathic constipation in newborns, infants and children?
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PICO question:
What is the diagnostic value of the history taking and the physical examination in diagnosing chronic idiopathic constipation in newborns, infants and children? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday |
Intervention/Exposure
- -
History taking: passage of meconium, stool patterns, timing of onset of constipation & potential precipitating factors, growth and general well being, locomotor development, diet and fluid intake, social factors, abdominal distension, vomiting, retentive posturing, overflow soiling, straining, pain on defecation, bleeding with defecation, anal fissure, painful bowel movements, poor appetite - -
Physical examination: abdominal examination, abdominal mass, abdominal distension, spine/lumbosacral region/gluteal examination, perianal area inspection, anal fissure, height and weight, faltering growth, lower limb neuromuscular examination including tone, strength and reflexes
|
Control
Abdominal X-ray
Abdominal ultrasound
Colonic transit time
Gastrointestinal endoscopy
Anorectal manometry
Rectal biopsy |
Outcomes
Diagnosis of constipation
Accurate diagnosis of constipation
Differential diagnosis of constipation
Sensitivity, specificity
Diagnostic value
Diagnostic accuracy
Positive predictive value
Negative predictive value |
Study design
Diagnostic studies |
Ovid MEDLINE(R) 1950 to August Week 3 2009 IC_historytaking_medline_160709
EBM Reviews - Cochrane Central Register of Controlled Trials 3rd Quarter 2009 IC_historytaking_CCTR_170709
DARE, CDSR IC_historytaking_CSTRDARE_170709
EMBASE 1980 to 2009 Week 35 IC_historytaking_Embase_170709
CINAHL Ebsco IC_historytaking_Cinahl_170709
What is the diagnostic value of abdominal ultrasound in idiopathic constipation? What is the diagnostic value of abdominal x-ray in idiopathic constipation? What is the diagnostic value of transit time with radiological markers in idiopathic constipation?
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PICO question:
What is the diagnostic value of the abdominal ultrasound in diagnosing constipation in newborns, infants and children? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday |
Intervention/Exposure
Abdominal ultrasound |
Control
Digital rectal examination
Abdominal palpation
Abdominal X-ray
Transit time with radiological isotope markers |
Outcomes
Diagnosis of constipation
Accurate diagnosis of constipation
Differential diagnosis of constipation
Sensitivity, specificity
Diagnostic value
Diagnostic accuracy
Positive predictive value
Negative predictive value |
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PICO question:
What is the diagnostic value of the abdominal X-ray in diagnosing constipation in newborns, infants and children? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday |
Intervention/Exposure
Abdominal X-ray |
Control
Digital rectal examination
Abdominal palpation
Abdominal ultrasound
Transit time with radiological isotope markers |
Outcomes
Diagnosis of constipation
Accurate diagnosis of constipation
Differential diagnosis of constipation
Sensitivity, specificity
Diagnostic value
Diagnostic accuracy
Positive predictive value
Negative predictive value |
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PICO question:
What is the diagnostic value of the transit time with radiological isotope markers in diagnosing constipation in newborns, infants and children? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday |
Intervention/Exposure
Transit time with radiological isotope markers |
Control
Digital rectal examination
Abdominal palpation
Abdominal ultrasound
Abdominal X-ray |
Outcomes
Diagnosis of constipation
Accurate diagnosis of constipation
Differential diagnosis of constipation
Sensitivity, specificity
Diagnostic value
Diagnostic accuracy
Positive predictive value
Negative predictive value |
Ovid MEDLINE 1950 to June Week 1 2008 IC_ultrasound_radiography_transit_time_medline_130608
EBM Reviews - Cochrane Central Register of Controlled Trials 2nd Quarter 2008 IC_ultrasound_radiography_transit_time_cctr_130608
CDSR, DARE IC_ultrasound_radiography_transit_time_cdsrdare_130608
EMBASE 1980 to 2008 Week 24 IC_ultrasound_radiography_transit_time_embase_130608
CINAHL - Cumulative Index to Nursing & Allied Health Literature 1982 to June Week 1 2008 IC_ultrasound_radiography_transit_time_cinahl_130608
Cinahl Ebsco IC_ultrasound_radiography_transit_time_cinahl_130608
What is the effectiveness of pharmacological/surgical interventions in achieving disimpaction/maintenance in children with idiopathic constipation?
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PICO question:
What is the effectiveness of pharmacological/surgical interventions in achieving disimpaction/maintenance in children with constipation? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday with constipation |
Intervention/Exposure
Stimulant laxatives: Sodium picosulphate: elixir, perles, bowel cleansing solutions, oral powder (Laxoberal, Dulco-lax Liquid/Perles, Picolax) Bisacodyl: tablets, suppositories (Dulco-lax) Senna: tablets, granules, syrup (Manevac, Senokot) Glycerol: suppositories (Glycerin) Dantron: suspension, capsules. With poloxamer ‘188’ as co-danthramer, with docusate sodium as co-danthrusate (Capsuvac, Normax, Codalax, Danlax, CodalaxForte) Docusate Sodium: paediatric/adult solution, rectal preparations, capsules (Dioctyl, Docusol, Norgalax Micro-enema)
Osmotic laxatives: Magnesium salts: suspension, bowel cleansing solution (Magnesium Hydroxide, Citramag) Lactulose: solution (Duphalac, Lactugal, Regulose) Phosphates: suppositories, enema, bowel cleansing solution (Carbalax, Fleet, Fletcher's) Sodium citrate: enema (Micolette, Microlax, Relaxit)
Macrogols (Polyethylene glycols): oral powder, bowel cleansing solution (Idrolax, Movicol, Klean-Prep) Faecal softeners: enema, emulsion (arachis oil, liquid paraffin) Bulk forming laxatives: Ispaghula husk: granules, sachets, powder (Fibrelief, Fybogel, Isogel, Ispagel Orange, Regulan) Methylcellulose: tablets, extemporaneous preparations (Celevac) Sterculia: granules, sachets (Normacol, Normacol Plus)
Manual evacuation of the bowel under general anaesthetic ACE procedure: antegrade colonic enema
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Control
Any of the previous |
Outcomes:
Changes in frequency of bowel movements Changes in stools consistency/appearance Changes in pain/difficulty on passing stools Changes in frequency of episodes of soiling Reduction in laxative Parent/child views/satisfaction or Quality of Life
|
Ovid MEDLINE(R) 1950 to July Week 4 2008 IC_disimpaction_maintain_pharm_surg_medline_050808
EBM Reviews - Cochrane Central Register of Controlled Trials 3rd Quarter 2008 IC_disimpaction_maintain_pharm_surg_cctr_050808
CDSR, DARE IC_disimpaction_maintain_pharm_surg_cdsrdare_050808
EMBASE 1980 to 2008 Week 31 IC_disimpaction_maintain_pharm_surg_embase_050808
CINAHL - Cumulative Index to Nursing & Allied Health Literature 1982 to August Week 1 2008 IC_disimpaction_maintain_pharm_surg_cinahl_050808
Cinahl Ebsco IC_disimpaction_maintain_pharm_surg_cinahl_050808_8
What is the effectiveness of dietary and lifestyle modifications in improving constipation in neonates, infants and all children up to their 18th birthday diagnosed with idiopathic constipation?
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PICO question:
What is the effectiveness of dietary and lifestyle modifications in improving constipation in neonates, infants and all children up to their 18th birthday diagnosed with idiopathic constipation? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday diagnosed with idiopathic constipation |
Intervention/Exposure
Increasing fluids intake Increasing physical activity/exercise Increasing fibre intake: Dried or fresh fruits, fruit juices, vegetables, cereals, bran, dihydroxyphenyl isatin (laxating part of prunes), prebiotics, oligosaccharides, fructooligosaccarides (FOS) (found in garlic, leek and onion), Inulin (found in bananas, onions, garlic, asparagus and tomatoes.) Supplements: Benefiber (partially hydrolysed guar gum), glucomannan, iron, pectin Infant's formulas: Prebiotics, oligosaccharides, partially hydrolysed whey protein, casein, whey hydrolysates Omega 3 fish oils Chocolate Low fat / high fat diet Dairy free diet Soy milk Sheep milk
|
Control
Usual / “normal” fluids intake
Usual/ “normal” physical activity
Usual / “normal” diet |
Outcomes
Changes in frequency of bowel movements Changes in stools consistency/appearance Changes in pain/difficulty on passing stools Changes in frequency of episodes of soiling Reduction in laxative Parent/child views/satisfaction or Quality of Life
|
Ovid MEDLINE(R) 1950 to September Week 2 2008 IC_Q8_dietlife_medline_220908
EBM Reviews - Cochrane Central Register of Controlled Trials 3rd Quarter 2008 IC_Q8_dietlife_cctr_220908
DARE, CDSR IC_Q8_dietlife_cdsrdare_220908
EMBASE 1980 to 2008 Week 38 IC_Q8_dietlife_embase_220908
CINAHL - Cumulative Index to Nursing & Allied Health Literature 1982 to September Week 3 2008 IC_Q8_dietlife_cinahl_220908
Cinahl Ebsco IC_Q8_dietlife_cinahl_ebsco_220908
What is the effectiveness of behavioural interventions in improving constipation in neonates, infants and all children up to their 18th birthday diagnosed with idiopathic constipation?
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PICO question:
What is the effectiveness of psychological/behavioural interventions in improving constipation in neonates, infants and all children up to their 18th birthday diagnosed with chronic idiopathic constipation? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday diagnosed with chronic idiopathic constipation |
Intervention/Exposure
Toilet /bowel / habit training and retraining Behavioural modification: 'chaining' and 'shaping' programmes Maintaining toilet diaries Rewarding, positive reinforcement, incentive/reward charts, star charts, reward systems Psychosocial counselling Psychoeducation Biofeedback therapy Intense psychotherapy: Cognitive behavioural therapy (CBT), Systemic/family therapy and psychodynamic psychotherapy. Parent involvement, parent participation, parents as therapists, parents as mediators Minimal intervention models using parents in behaviour therapy or behaviour modification The Portage project Mediational models in cognitive or behavioural therapy The consultative triad (consultant-parent-patient) Clinical hypnosis
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Control
Any of previous interventions compared with each other
Laxatives |
Outcomes
Changes in frequency of bowel movements Changes in stools consistency/appearance Changes in pain/difficulty on passing stools Changes in frequency of episodes of soiling Reduction in laxatives use Parent/child views/satisfaction or Quality of Life
|
Ovid MEDLINE(R) 1950 to January Week 2 2009 IC_Q14_behavioural_MEDLINE_160109
EBM Reviews - Cochrane Central Register of Controlled Trials 4th Quarter 2008 IC_Q14_behavioural_CCTR_160109
DARE, CDSR IC_Q14_behavioural_CDSRDARE_160109
EMBASE 1980 to 2009 Week 03 IC_Q14_behavioural_EMBASE_160109
Cinahl Ebsco IC_Q14_behavioural_CINAHL_160109
PsycINFO 1967 to January Week 3 2009 IC_Q14_behavioural_PSYCINFO_160109
What is the effectiveness of offering information and support in addition to usual care in improving constipation in children up to their 18th birthday diagnosed with chronic idiopathic constipation?
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PICO question:
What is the effectiveness of offering information and support in addition to “usual care” in improving constipation in neonates, infants and all children up to their 18th birthday diagnosed with chronic idiopathic constipation? |
Patients/Population
Neonates (newborns), infants and all children up to their 18th birthday diagnosed with chronic idiopathic constipation |
Intervention/Exposure
health information or health education advice or information or education support or regular support or follow-up
the previous can be combined with the following terms
nurse led clinics written information or handout/leaflet help-line web based intervention or internet intervention telephone support face to face / additional appointments
|
Control
“Usual care” alone i.e. Without additional support or information |
Outcomes
Changes in frequency of bowel movements Changes in stools consistency/appearance Changes in pain/difficulty on passing stools Changes in frequency of episodes of soiling Reduction in laxatives use Parent/child views/satisfaction or Quality of Life Adherence to management programme Reduced A+E attendance / inappropriate medical attendance /utilisation e.g. reduced manual evacuation, investigations, etc.
|
Ovid MEDLINE(R) 1950 to March Week 3 2009 IC_infosupport_medline_260309
EBM Reviews - Cochrane Central Register of Controlled Trials 1st Quarter 2009 IC_infosupport_cctr_260309
DARE, CDSR IC_infosupport_CDSRDARE_260309
EMBASE 1980 to 2009 Week 12 IC_infosupport_embase_260309
Cinahl Ebsco IC_infosupport_cinahlebsco_260309_2
