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The
prevalence and severity of constipation will vary in different
clinical populations. Several large, questionnaire-based epidemiological
surveys of constipation in healthy people exist (Connell
et al., 1965; Drossman
et al., 1982; Everhart
et al., 1989; Zuckerman
et al., 1995) and serve as a basis for comparison for results
obtained in groups with one or another type of pathology.
A
popular method of assessing the extent of constipation in a particular
clinical area is the retrospective chart review. This may look
at either:
- Recording
of complaints by patients and professionals’ impressions
of constipation, or
- Laxative
prescribing and the use of enemas and suppositories as
proxies respectively for the presence of constipation and
the success of treatment.
Such
an approach is simple to use but has evident difficulties of completeness
and interpretation that compromise its accuracy. It is, however,
considerably better than no audit at all of constipation and its
management.
For
example, Twycross has reported three reviews of constipation management
performed in the same palliative care unit.
Table
3.1
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| A
survey of 200 patients followed for six weeks or until
death looked at the requirement for rectal interventions
(suppository, enema or manual evacuation).
- 75%
of patients required such intervention during the
first week after admission, and
- 40%
continued to do so in subsequent weeks despite an
increasing rate of laxative prescription.
| The
laxative use of 260 patients was reviewed from admission
to death. To avoid a misleadingly low result because
of very ill individuals, those admitted less than
four days prior to death were excluded.
- 78%
received a regular laxative, and
- 4%
received an antidiarrheal.
| The
laxative use of 100 consecutive patients who had been
admitted for over 10 days was reviewed after stratification
for opioid use.
- 83%
of patients taking morphine or diamorphine received
laxatives, but so did
- 61%
of those on no opioids at all; they received laxatives.
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