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Rationale and key points This article provides practitioners with information about how to perform digital removal of faeces in a safe, effective and patient-centred manner, promoting privacy and dignity. Passing faecal matter is essential to enable the elimination of waste. For some people, however, defecation is not possible without some form of intervention; this could be the administration of oral medication or an enema, insertion of suppositories or digital removal of faeces. ▶ Bowel care is a fundamental aspect of patient care. ▶ Digital removal of faeces should be performed by a practitioner competent in this skill. ▶ Digital removal of faeces is an invasive procedure and should only be carried out when necessary following holistic patient assessment. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will improve your practice. 2. How the patient receiving the care you delivered might have felt. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

This article describes the development of an evidence-based procedure for the digital removal of faeces (DRF) and the problems and barriers encountered--not least the absence of primary evidence. The procedure for DRF that evolved is based on the best evidence available. It sets out the criteria for performing DRF and directs the practitioner's actions, while still being adaptable to the individual patient's situation. It should help to ensure that nurses performing DRF do so within the remit of their professional and legal responsibilities, and that patients receive the most effective care grounded in the current state of knowledge.

Computed tomography colonography (CTC) enables evaluation of the colon with minimal invasiveness. In spite of advances in multidetector CT (MDCT) technology and advanced software features, including electronic bowel cleansing (digital removal and tagging of fluid and debris), a number of potential pitfalls in the evaluation of the 3D volumetric dataset persist. The purpose of this article is to illustrate the strengths and potential pitfalls in the detection of colorectal polyps using CTC via a primary three-dimensional (3D) approach for evaluation.

Human studies of haemodynamic factors in the pathogenesis of cerebral aneurysms require knowledge of the pre-aneurysmal vasculature. This paper presents an objective and automated technique to digitally remove an aneurysm and reconstruct the parent artery, based on lumen geometries segmented from angiographic images. Relying on robust computational geometry concepts, notably Voronoi diagrams of the digitised lumen surface, the aneurysm attachment region is first defined objectively using lumen centrelines. Centrelines within this region are replaced by smooth interpolations, which then guide the interpolation of Voronoi points within the attachment region. Combined with Voronoi points from outside the attachment region, the parent artery lumen, without the aneurysm, can be reconstructed. Plausible reconstructions were obtained, automatically, for a set of 10 side-wall or terminal aneurysms, of various sizes and shapes, from the ANEURISK project data set. Application of image-based computational fluid dynamics analysis to a five side-wall aneurysm cases data set revealed an association between the recently proposed gradient oscillatory number (GON) and the site of aneurysm formation in four of five cases; however, elevated GON was also evident at non-aneurysmal sites. A potential application to the automated delineation of aneurysms for morphological characterisations is also suggested. The proposed approach may serve as a broad platform for investigating haemodynamic and morphological factors in aneurysm initiation, rupture and therapy in a way amenable to large-scale clinical studies or routine clinical use. Nevertheless, while the parent artery reconstructions are plausible, it remains to be proven that they are faithful representations of the pre-aneurysmal artery.

A 2-year-old child was brought into the Accident Department with a history that he had swallowed his dummy. There were no direct witnesses to the injury. The child had come up to its mother salivating and pointing to its mouth. The initial incident happened approximately 20 min prior to presentation at the Accident Department after a 999 call. Attempts at digital removal of the dummy by ambulancemen had failed. The child was pink and quiet but responding to commands and cooperative. He had a small abrasion to his forehead presumably due to his initial fall when his dummy was forced into his mouth. The teat of the dummy was clearly visible in the pharynx. The child was able to breathe by virtue of the two air holes in the flange piece of the dummy.

Between 1973 and 1975, "early" operation with removal of necrotic tissue was performed on 15 patients with acute haemorrhagic-necrotizing pancreatitis. Partial necrotizing pancreatitis was found in ten patients, of whom seven survived. But all patients with total pancreatic necrosis died. Two early operations in patients with a necrotizing bout in the course of chronic recurrent pancreatitis were successful. The surgical procedure consisted of digital removal of necrotic tissue (greater than digitoclasia less than) and left-sided resection, combined with adequate drainage. Patients with acute, partial necrotizing pancreatitis can be saved by early operation, while those with total necrosis would require almost immediate surgical intervention, before the onset of lethal complications.