共0篇 平均IF=NaN (-) 更多分析

    加载中

    logo
    Ostomy pouch wear time in the United States. Richbourg Leanne,Fellows Jane,Arroyave Whitney D Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to determine average pouch wear times of persons with an ostomy living in the United States. SUBJECTS AND SETTING:In this national survey, subjects were identified by ostomy nurses and through ostomy support groups in the United States. Participants responding to a survey represented all 6 geographic regions of the United States identified by US Bureau of Census. DESIGN AND PROCEDURE:Persons with colostomies, ileostomies, and urostomies were queried concerning their average pouch wear time. RESULTS:The mean wear time for ostomy pouches in the United States is 4.8 days. Persons with urostomies reported an average wear time of 5.02 days (SD = 1.74), those with ileostomies reported 5.01 days (SD = 2.25), and those with colostomies reported an average of 4.55 days (SD = 2.08). CONCLUSIONS:This study is the first of its kind to utilize a large, national sample to determine average wear time of ostomy pouches. Further research is needed to establish a benchmark for ostomy pouch wear time in the United States and to determine what factors affect wear time. 10.1097/01.WON.0000335962.75737.b3
    An update on stoma appliance flanges and base-plates. Burch Jennie British journal of community nursing Coping with a stoma can be difficult for many reasons; leakage and skin breakdown are two common problems faced by ostomates (people with a stoma). A flange or base-plate adheres to the patient's abdomen. A secure and well designed flange is essential to the ostomate when adjusting to their newly formed stoma. Selecting the correct type of appliance and flange is an important part of holistic assessment. This article is the second in a series of three and focuses on the newer flanges that are available. It can be difficult for community nurses to keep abreast of all the new developments within the stoma appliance field; therefore, this article aims to highlight some of the key aspects concerning the functionality of available flanges. 10.12968/bjcn.2009.14.8.43513
    Stoma complications: a literature overview. Shabbir J,Britton D C Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Stoma formation is a commonly performed procedure in colorectal surgery as a part of operations performed for malignant- and inflammatory bowel disease. Stoma formation is a simple, but not trivial, undertaking. When performed badly, it can leave the patients with a legacy of complications such as leakage, prolapse, parastomal hernia and retraction. Various studies have reported a complication rate of 21-70%. We performed a literature search using the Medline, Ovid and Google scholar database for all the articles published between January 1980 and December 2008. The search terms used were colostomy, ileostomy, stoma, parastomal hernia, stenosis, prolapse, necrosis and complications. The following article summarizes the common complications associated with stomas. 10.1111/j.1463-1318.2009.02006.x
    Clinically relevant leakage in percutaneous colostomy. Clark J A Journal of vascular and interventional radiology : JVIR
    Stoma-related complications and stoma size - a 2-year follow up. Persson E,Berndtsson I,Carlsson E,Hallén A-M,Lindholm E Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland AIM:The purpose of the study was to prospectively describe stoma configuration and evaluate stoma-related complications and their association with possible risk factors. METHOD:All elective patients (n = 180) operated on with a formation of colostomy, ileostomy or loop-ileostomy between 2003 and 2005 were included in the study. Follow up took place on the ward postoperatively and five times during 2 years after discharge. On these occasions the diameter and height of the stoma were recorded. Complications such as peristomal skin problems, necrosis, leakage caused by a low stoma, stenosis, granuloma formation, prolapse and peristomal hernia formation were evaluated. RESULTS:Most complications occurred 2 weeks after discharge; 53% of patients with colostomies, 79% with loop-ileostomies and 70% of patients with end-ileostomy had one or more complications. The most common complication was skin problems and it was most common in patients with end-ileostomies (60%) and loop-ileostomies (73%). Postoperatively at ward review, the most common complication was necrosis, which occurred in 20% of patients with a colostomy. Granuloma formation was most frequent in colostomies. Almost all patients with an end-ileostomy and loop-ileostomy with a height lower than 20 mm had leakage and skin problems as had half of the patients with a colostomy height lower than 5 mm. CONCLUSION:To prevent stoma-related complications, it is important to produce an adequate height of the stoma, with early and regular follow ups and adjustment of the appliance. To work closely in collaboration with the colorectal surgeons is of utmost important to provide feedback and in turn, to improve stoma outcome. 10.1111/j.1463-1318.2009.01941.x
    A novel use for botulinum toxin A in the management of ileostomy and urostomy leaks. Smith Vanessa M,Lyon Calum C Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:To assess the efficacy of Botulinum toxin A (BoNT-A) in the treatment of patients with hypercontractile stomas resulting in repeated pouching system failures and leaks. DESIGN:Prospective case series. SUBJECTS AND SETTING:Ten consecutive patients who presented to the outpatient stoma clinic with actively contractile stomas that shortened spasmodically resulting in leaks were offered treatment with BoNT-A if treatment with other measures had been unsuccessful. METHODS:Following an observed reduction in the peristalsic shortening of a stoma after intradermal injection of BoNT-A for hyperhidrosis, we conducted a prospective case series of 10 patients with pouch adhesive failures attributed to spasmodic shortening of the stoma. Ten patients, 3 with urostomies and 7 with ileostomies, were offered BoNT-A injection. The first was treated cautiously with 15 units of BoNT-A injected into the muscularis layer, followed by an additional 25 units injected 1 month later. Subsequent patients received doses varying from 50 to 100 units. Ongoing treatments ranged 50 to 100 units every 3 to 6 months. RESULTS:Seventy percent (n = 7) of patients reported a useful reduction in leakage and pouching system seal failures. In these 7 patients, the frequency of pouch changes changed from an average of 2.18 to 0.44 per day (over all 10 patients this was a change from an average of 2.35 per day to 1.16 per day). No adverse side effects were reported. CONCLUSION:Findings from this clinical case series suggest that BoNT-A may be a promising treatment in the management of patients with leaks caused by actively contracting stomas. 10.1097/WON.0000000000000076
    Predicting life with a permanent end colostomy: A prospective study on function, bother and acceptance. Sandberg Sofia,Asplund Dan,Bock David,Ehrencrona Carolina,Ohlsson Björn,Park Jennifer,Rosenberg Jacob,Smedh Kenneth,Walming Sofie,Angenete Eva Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland AIM:The factors that influence a patient's experience of a colostomy are not known. The aim of this study was to characterise stoma function, stoma-related bother and acceptance among patients operated for rectal cancer and to investigate if there were any preoperative personal factors with predictive impact on long-term stoma-related bother. METHODS:The QoLiRECT (Quality of Life in RECTal cancer) study is a prospective multicentre study of patients with rectal cancer. This was a subgroup analysis of patients with a permanent colostomy with a 2-year follow-up. Penalised regression models with shrinkage estimation were used to predict the 1-and 2-year bother using baseline data. The predictive value and the importance of the included variables were evaluated using bootstrap resampling techniques. RESULTS:A total of 379 patients were included. Overall stoma acceptance was high and a majority of patients were not bothered by their stoma; 77% and 83% at 1 and 2 years, respectively. The subgroup of patients with stoma-related bother had a high prevalence of difficulties, especially fear of leakage, and a low stoma acceptance in daily life. Both clinical and personal factors were associated with stoma-related bother. The most important factors were quality of life and physical health, but the prediction accuracy was low. CONCLUSIONS:Stoma-related bother was associated with overall stoma dysfunction. As stoma-related bother is a multifactorial problem, it was not possible to predict which patients will experience stoma-related bother. It is therefore of importance to prevent stoma-related symptoms and optimise stoma function to reduce long-term bother and increase stoma acceptance. 10.1111/codi.15842
    The community nurse and stoma care. Burch Jennie British journal of community nursing Community nurses will have people with a stoma on their caseload, and a reminder about stoma and stoma care will hopefully increase confidence and, subsequently, care. There are approximately 205 000 people in the UK with a stoma; it is a common condition, with approximately one in every 340 people having a stoma. While quality of life with a stoma can be good, problems can occur, such as a leaking appliance that results in skin damage. Skin damage can occur for all people with a stoma, but is more common for people with an ileostomy. Appliance leakage can increase stoma care costs, time, financially as well as a decrease in quality of life, so it is important to be able to address issues when they arise or refer on as necessary. 10.12968/bjcn.2022.27.4.165
    Predischarge and postdischarge concerns of persons with an ostomy. Pieper B,Mikols C Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society This study examined the concerns of persons with ostomies before and after discharge from the hospital and attempted to determine whether these concerns were affected by the reason for stoma construction, temporary versus permanent status of the stoma, or the person's sex. Participants (N = 67) responded to a 46-item questionnaire titled "Perceived Effect of an Ostomy." Eight of the 46 items were common concerns affecting patients before and after discharge. These were fear of stool leakage, odor, ability to participate in sports, necessity for further treatment, wearing a pouch, changing the pouch, change in body appearance, and participating in sexual love play and intercourse. The total concern scores did not differ significantly with reason for stoma construction or temporary versus permanent ostomy status. Women had significantly higher concern scores than did men. Interviewing patients before and after discharge regarding their concerns may help to focus ostomy teaching and counseling. 10.1016/s1071-5754(96)90070-4
    Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies. Baldwin Carol M,Grant Marcia,Wendel Christopher,Hornbrook Mark C,Herrinton Lisa J,McMullen Carmit,Krouse Robert S Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine STUDY OBJECTIVES:The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL). METHODS:Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p < 0.05. RESULTS:On the ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p < 0.01), adjusted for age, and greater levels of fatigue (p < 0.01), adjusted for time since surgery. Women's PCS and MCS scores indicated poorer HR-QOL compared to men, and differences were clinically meaningful. Qualitative narrative comments suggested that sleep disruption could stem from ostomy-associated fear of or actual leakage during sleep. CONCLUSION:Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.
    Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study. Meisner Søren,Lehur Paul-Antoine,Moran Brendan,Martins Lina,Jemec Gregor Borut Ernst PloS one BACKGROUND:Peristomal skin complications (PSCs) are the most common post-operative complications following creation of a stoma. Living with a stoma is a challenge, not only for the patient and their carers, but also for society as a whole. Due to methodological problems of PSC assessment, the associated health-economic burden of medium to longterm complications has been poorly described. AIM:The aim of the present study was to create a model to estimate treatment costs of PSCs using the standardized assessment Ostomy Skin Tool as a reference. The resultant model was applied to a real-life global data set of stoma patients (n = 3017) to determine the prevalence and financial burden of PSCs. METHODS:Eleven experienced stoma care nurses were interviewed to get a global understanding of a treatment algorithm that formed the basis of the cost analysis. The estimated costs were based on a seven week treatment period. PSC costs were estimated for five underlying diagnostic categories and three levels of severity. The estimated treatment costs of severe cases of PSCs were increased 2-5 fold for the different diagnostic categories of PSCs compared with mild cases. French unit costs were applied to the global data set. RESULTS:The estimated total average cost for a seven week treatment period (including appliances and accessories) was 263€ for those with PSCs (n = 1742) compared to 215€ for those without PSCs (n = 1172). A co-variance analysis showed that leakage level had a significant impact on PSC cost from 'rarely/never' to 'always/often' p<0.00001 and from 'rarely/never' to 'sometimes' p = 0.0115. CONCLUSION:PSCs are common and troublesome and the consequences are substantial, both for the patient and from a health economic viewpoint. PSCs should be diagnosed and treated at an early stage to prevent long term, debilitating and expensive complications. 10.1371/journal.pone.0037813
    Difficulties experienced by the ostomate after hospital discharge. Richbourg Leanne,Thorpe Joshua M,Rapp Carla Gene Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:This descriptive study used a mailed survey to identify difficulties related to the stoma that ostomates experience after discharge from the hospital, who they sought help from, and if the advice was perceived as helpful. SUBJECTS AND SETTING:Ostomates who are 18 years or older and have undergone a urinary or fecal diversion at a North Carolina hospital between January 1, 2003 and June 30, 2005, were asked to respond to a survey about the difficulties related to their ostomy. INSTRUMENT:The survey gathered demographic and anthropometric data, information regarding stomal complications, self-evaluation of emotional state, and contact with clinicians and support groups. RESULTS:Of the 140 surveys mailed, 43 were returned, demonstrating a return rate of 31%. Thirty-four returned surveys were useable for statistical analysis. The top 5 difficulties experienced by the respondents were peristomal skin irritation (76%), pouch leakage (62%), odor (59%), reduction in previously enjoyed activities (54%), and depression/anxiety (53%). Twenty percent of the ostomates who experienced difficulties after surgery did not seek help. Ostomates primarily sought help from nurses when they experienced problems related to the stoma and its maintenance. For mental health, sleep, and sexual problems, a medical doctor was the practitioner of choice. Ostomates were satisfied with most of the help they received from an ostomy nurse; satisfaction was lower for home health nurses and surgeon or primary care physician practices. Average wear time for a stoma pouch was 4 days. CONCLUSION:The majority of the ostomates experienced difficulty with pouch leakage, skin irritation, odor, depression or anxiety, and uneven pouching surfaces. Ostomates desire assistance with these problems and will benefit from long-term follow-up by an ostomy nurse. 10.1097/00152192-200701000-00011
    Considering the benefits of a new stoma appliance: a clinical trial. Kruse Trine Møller,Størling Zenia Marian British journal of nursing (Mark Allen Publishing) For people living with a stoma, leakage is one of the main problems compromising quality of life. The right choice of stoma appliance is therefore of utmost importance. This randomised, controlled clinical trial investigated the benefits of a new stoma appliance, SenSura Mio Convex Soft, specifically for people who experience leakage using a flat stoma appliance. The degree of leakage under the baseplate was measured using a new objective method. The study included 38 participants with an ileostomy or colostomy. Results showed that while being flexible and comfortable, the new appliance reduced leakage significantly and provided a better feeling of security when compared with the participants' own flat stoma appliance. The product was the preferred of the convex stoma appliances in the study. This study demonstrated that it may be a solution for people with a stoma challenged by leakage using flat stoma appliances. 10.12968/bjon.2015.24.Sup22.S12
    A Descriptive, Cross-sectional Study Among Chinese Patients to Identify Factors that Affect Psychosocial Adjustment to an Enterostomy. Xian Hongtao,Zhang Yu,Yang Yang,Zhang Xiaoxue,Wang Xinran Ostomy/wound management Physiological, psychological, and social problems may affect adaptation to living with a stoma. A descriptive, cross-sectional study was conducted between March 2017 and June 2017 among patients culled from a manufacturer's database to identify factors that influence psychosocial adjustment in Chinese patients with an enterostoma. Patients with a history of ostomy surgery ≥1 month prior and who were ≥18 years of age, completed a primary school education, and able to communicate in Chinese were eligible to participate unless they had a history of psychosis, cognitive impairment, or participation in other research programs. After providing informed consent, participants completed a questionnaire that addressed demographic (age, gender, employment, educational level, marital status, medical payment method, living status, and area of residence) and stoma-related (date of surgery, preoperative stoma siting, ostomy appliance type, peristomal complications, regular defecation, stoma self-care ability, stoma-related communication with medical staff, level of understanding regarding stoma knowledge and care skills, appliance change knowledge/experience, and leakage history) factors. Social support was assessed using the 10-item Social Support Revalued Scale (SSRS), and 3 dimensions of adjustment (acceptance, continuous worry, and positive life attitude) were assessed using the 20-item Chinese version of the Ostomy Adjustment Inventory (OAI). Questionnaires were administered via an online survey platform. Data were analyzed descriptively, and single-factor analysis and stepwise multiple linear regression were applied to identify the factors that influenced the adjustment level. Incomplete (missing >2 questions), incorrect, or hastily completed (within 600 seconds) records were excluded from analysis. Of the 1109 persons who returned the questionnaire, 1010 (91.1%) completed the entire survey (564 men [55.8%] and 446 women [44.2%], mean age 56.62 ± 15.62 years); 823 (81.5%) had a colostomy and 187 (18.5%) had an ileostomy. The OAI dimension continuous worry was negatively and significantly associated with all 3 dimensions of the SSRS, including subjective support (r = 0.259), objective support (r = 0.259), and utilization of support (r = 0.289), while the dimension acceptance was positively associated with both subjective support (r = 0.082) and objective support (r = 0.074) (all P values <.05). Using multiple linear regression, residence area, peristomal complication, regular defecation, leaking, self-care ability, communication with medical staff regarding ostomy, understanding knowledge or skill needed for stoma care, utilization of social support, and total score of social support were found to be significantly associated with ostomy adjustment level (all P values <.05). Patients living in an urban area, with no history of peristomal complications, who had regular defecation, had not experienced leaking, had better self-care ability, frequently communicated with medical staff, had a high level understanding about knowledge or skill of stoma, and had higher social support scores had higher adjustment scores. Knowledge of the factors that enhance or hinder adaptation of the patient to the ostomy is an important tool in the clinician's care armamentarium.
    Research and expert opinion on siting a stoma: a review of the literature. Burch Jennie British journal of nursing (Mark Allen Publishing) Marking the optimal position for a stoma on the patient's body before an operation is likely to result in fewer postoperative problems such as appliance leakage. A literature search was undertaken to examine and evaluate current practice internationally. Four recent articles describe the procedure; these articles were consensus documents or expert opinion, with limited robust research to support the statements made. Despite some variations in techniques, there was general agreement within the articles. Interestingly, when comparing recent and historical information on stoma siting, there were reassuringly few changes. Thus, in practice, although poorly researched, it is considered essential for people to have their stoma site marked as part of their preoperative preparation before elective stoma-forming surgery. 10.12968/bjon.2018.27.16.S4
    Gaining consensus: the challenges of living with a stoma and the impact of stoma leakage. Aibibula Miriayi,Burry Gill,Gagen Hannah,Osborne Wendy,Lewis Harry,Bramwell Caroline,Pixley Hazel,Cinque Giovanni British journal of nursing (Mark Allen Publishing) BACKGROUND:People with a stoma face many unique challenges. Leakage is a significant one but is not sufficiently discussed within the wider area of health and social care. AIMS:This study aimed to articulate and achieve consensus on the problems experienced by people with a stoma, particularly leakage, in the hope of encouraging conversations among patients, clinicians and policymakers on how to solve them. METHODS:Output from a modified Delphi panel, consisting of patient groups, was used to create a set of calls to action, with a particular focus on the issue of leakage. FINDINGS:Leakage has a large impact on daily life and can cause both physical and mental health difficulties. Peer support and specialist care can be offer considerable benefits in dealing with these. CONCLUSIONS:There are significant unmet needs for equitable access to specialist stoma care and peer support, as well as information provision for non-specialist healthcare providers. The calls to action should be implemented. 10.12968/bjon.2022.31.6.S30
    Convexity in stoma care: developing a new ASCN UK guideline on the appropriate use of convex products. Perrin Angie,White Maddie,Burch Jennie British journal of nursing (Mark Allen Publishing) One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year (https://ascnuk.com/). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care. 10.12968/bjon.2021.30.16.S12
    Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients. Stokes Audrey L,Tice Shelly,Follett Suzi,Paskey Diane,Abraham Lini,Bealer Cheryl,Keister Holly,Koltun Walter,Puleo Frances J Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to compare selected postoperative complications (including stomal and peristomal complications), hospital length of stay, and readmission rates in a group of patients who attended a preoperative educational intervention to a retrospective group of patients who did not receive the intervention. DESIGN:Retrospective, comparison cohort study. SUBJECTS AND SETTING:The intervention group comprised 124 patients who attended an educational session for persons with fecal ostomies at a single tertiary care center in the Northeastern United States. They were compared to findings from a group of 94 individuals who underwent ostomy surgery during a 1-year period before initiation of the class. Patients undergoing emergent procedures or who had previous stomas were excluded. We found no significant differences between the 2 cohorts with respect to age, gender, comorbidities, open versus minimally invasive procedures, or colorectal diagnoses. METHODS:A preoperative 2-hour stoma education class was led by certified WOC nurses for all patients undergoing colorectal surgeries in which the creation of a stoma was anticipated. This session included a didactic portion outlining postoperative expectations in the management of new ostomies (including dietary changes, prevention of dehydration, and an overview of ostomy supplies), as well as a hands-on portion to practice stoma care skills. We compared postoperative complications within 30 days (particularly stoma-related complications, including pouch leakage due to loss of seal, and peristomal skin irritation) between the group attending the education session and the control group. We also compared length of stay and 30-day readmission rates. RESULTS:Patients who participated in the educational intervention experienced significantly fewer peristomal complications than did patients in the historic control group (44.7% vs 20.2%, P = .002). Logistic regression analysis revealed that participation in the group was associated with a lower likelihood of peristomal skin complications (odds ratio = 0.35; 95% confidence interval, 0.18-0.67). Their length of stay (median 6 days vs 5 days, P = NS), and the proportion who experienced 30-day readmission (20.2% vs 15.3%, P = NS), did not significantly differ. CONCLUSIONS:A preoperative stoma education group class significantly reduced the likelihood of frequent leakage from the ostomy pouching system and peristomal skin irritation. 10.1097/WON.0000000000000338
    Skin problems in ostomy patients: a case-control study of risk factors. Nybaek Hanne,Bang Knudsen Dorte,Nørgaard Laursen Troels,Karlsmark Tonny,Jemec Gregor B E Acta dermato-venereologica Skin complications are frequent in ostomy patients and a number of risk factors have been suggested. The data on risk factors have, however, been documented mainly in single-centre studies and the actual importance of the suggested risk factors should therefore be verified in a group of ostomy patients broadly selected from the gene-ral population. All patients with permanent ostomies living in Roskilde County, Denmark, were invited to participate in the study. A total of 338 responded and 199 agreed to participate. Forty-five percent of all patients presented a skin problem. Less than half (43%) of patients with a skin problem were aware of the skin problems, and less than 1 in 5 (16%) had sought treatment for their skin problem. Ileostomies, ostomies with leakage and ostomies in patients with body mass index >30 were associated with skin problems. In conclusion, ileostomy, leakage and obesity predisposed patients to peristomal skin problems. Other suggested risk factors appear to be weak or insignificant. Patients under-report the presence of peristomal skin problems and therefore it is suggested that they need to be assessed by a professional on a routine basis in order to avoid or better manage peristomal skin complications. 10.2340/00015555-0536
    Stoma-Related Complications Following Ostomy Surgery in 3 Acute Care Hospitals: A Cohort Study. Pearson Robert,Knight Stephen R,Ng James C K,Robertson Isabell,McKenzie Clare,Macdonald Angus M Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The aim of this study was to evaluate both surgical and patient-centered stomal complications after stoma formation, with emphasis on underreported symptoms and complaints. DESIGN:Prospective, single-group study. SUBJECTS AND SETTING:Patients undergoing emergency and elective ostomy surgery between January 1, 1999, and June 1, 2016, in 3 acute care hospitals were followed up by stoma care nurse specialists in NHS Lanarkshire, Scotland. METHODS:Data were collected on surgery type (emergency or elective), stoma type (ileostomy or colostomy), stoma-related complications including surgical complications (stenosis, retractions, hernia, and prolapse) and so-called "patient-centered" complications (skin changes, odor, leakage, soiling, and nighttime emptying) at 5 time points: 10 days, 3 months, 6 months, 1 year, and 2 years postoperatively. For this study, we report comparisons at 10 days and 2 years, using frequencies reported as percentages. RESULTS:Data from 3509 consecutive stoma surgeries were analyzed. Complication rates were similar in both emergency and elective cases. The nighttime symptoms of leakage and soiling were significantly greater in the ileostomy group and worsened over the 2-year period. The parastomal hernia rate was 34.5% at 2 years, a finding more common in the colostomy group (46.4% vs 20.1%, P < .001). However, the rate of clinically significant hernia was similar when comparing the colostomy group with the ileostomy group (3.6% vs 2.2%, P = .38). Emergency stoma surgeries (40.2%) were preoperatively sited compared with 95.9% of elective cases. CONCLUSIONS:Our prospective multicenter study demonstrated that stoma-related complications are similar irrespective of whether the stoma was formed via an elective surgery or emergency surgery. Nighttime symptoms of leakage, soiling, and emptying were high post-stoma formation, particularly in the ileostomy group, and worsened over the 2-year period. Findings from our study highlight the presence and persistence of complications. We believe our work highlights the importance of having frequent discussions with patients about making decisions about approaches to reduce complications to enhance patient outcomes. 10.1097/WON.0000000000000605
    A Cost-Utility Model of Care for Peristomal Skin Complications. Neil Nancy,Inglese Gary,Manson Andrea,Townshend Arden Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The aim of this study was to evaluate the economic and humanistic implications of using ostomy components to prevent subsequent peristomal skin complications (PSCs) in individuals who experience an initial, leakage-related PSC event. DESIGN:Cost-utility analysis. METHODS:We developed a simple decision model to consider, from a payer's perspective, PSCs managed with and without the use of ostomy components over 1 year. The model evaluated the extent to which outcomes associated with the use of ostomy components (PSC events avoided; quality-adjusted life days gained) offset the costs associated with their use. RESULTS:Our base case analysis of 1000 hypothetical individuals over 1 year assumes that using ostomy components following a first PSC reduces recurrent events versus PSC management without components. In this analysis, component acquisition costs were largely offset by lower resource use for ostomy supplies (barriers; pouches) and lower clinical utilization to manage PSCs. The overall annual average resource use for individuals using components was about 6.3% ($139) higher versus individuals not using components. Each PSC event avoided yielded, on average, 8 additional quality-adjusted life days over 1 year. CONCLUSIONS:In our analysis, (1) acquisition costs for ostomy components were offset in whole or in part by the use of fewer ostomy supplies to manage PSCs and (2) use of ostomy components to prevent PSCs produced better outcomes (fewer repeat PSC events; more health-related quality-adjusted life days) over 1 year compared to not using components. 10.1097/WON.0000000000000194
    The Application of a Moldable Skin Barrier in the Self-Care of Elderly Ostomy Patients. Liu Gaoming,Chen Yongyi,Luo Jiayou,Liu Aizhong,Tang Xinghui Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates The quality of ostomy directly affects the stoma patient's quality of life. This study investigated the application of a moldable skin barrier in the self-care of elderly stoma patients after colostomy for colorectal cancer. A total of 104 elderly stoma patients (65-79 years) who underwent colostomy because of colorectal cancer were randomly divided into an experimental group (56 cases) receiving a moldable skin barrier and a control group (48 cases) receiving a conventional skin barrier. The information on peristomal irritant dermatitis occurrence, the satisfaction of self-care, and related care costs were collected 1 month after patients were discharged from the hospital. The overall incidence of irritant dermatitis was significantly lower (p = .01), the self-care satisfaction score was significantly higher (p = .02), and the cost for leakage-proof cream (p < .001) was significantly lower in the experimental group than in the control group. In contrast, no significant differences in the cost of ostomy equipment and the barrier replacement interval were observed. In conclusion, a moldable skin barrier can reduce the incidence of irritant dermatitis in elderly stoma patients, improve their self-care satisfaction, and reduce the cost of leakage-proof cream use compared with the conventional stoma skin barrier. 10.1097/SGA.0000000000000143
    Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. Pittman Joyce,Rawl Susan M,Schmidt C Max,Grant Marcia,Ko Clifford Y,Wendel Christopher,Krouse Robert S Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study is to describe demographic, clinical, and quality-of-life variables related to ostomy complications (skin irritation, leakage, and difficulty adjusting to an ostomy) in a veteran population in the United States. DESIGN:The original study employed a descriptive crosssectional study using a mixed method design. This secondary analysis used the quantitative data collected. SAMPLE AND SETTING:Two hundred thirty-nine veterans with intestinal ostomies from 3 Veteran's Administration hospitals participated in the study. METHODS:Instruments used for this investigation included the City of Hope Quality of Life: Ostomy Instrument. Demographic and medical history data were collected from the survey, the Veteran's Administration health information system, and the Tumor Registry database. A self-administered survey questionnaire (mCOH-QOL-Ostomy) was mailed to each participant. RESULTS:The severity of skin irritation, problems with leakage, and difficulty adjusting were significantly related to demographic, clinical, and quality-of-life domains. Univariate analyses showed that age, income, employment, preoperative care (stoma site marking and education), having a partner, ostomy type, reason for ostomy, time since surgery, total quality-of-life scores and scores on all 4 domains of quality of life were related to the severity of these ostomy complications. Age was inversely related to severity of all 3 ostomy complications (skin irritation, leakage, and difficulty adjusting). Having an ileostomy, rather than a colostomy, was associated with higher severity of skin irritation. Having had the stoma site marked preoperatively was associated with less difficulty adjusting to an ostomy, and having had preoperative ostomy education was associated with less severe problems with skin irritation and leakage. Severity of each ostomy complication predicted total quality-of-life scores. Difficulty adjusting to the ostomy was related to all 4 quality-of-life domains (physical, psychological, social, and spiritual). CONCLUSIONS:This study found important relationships between demographic and clinical factors and ostomy complications. Skin problems, leakage, and difficulty adjusting predicted total quality of life scores and domains. Establishing relationships among ostomy complications and demographic, clinical factors, and quality of life can enhance identification of patients at risk for the development of complications and is an important first step in identifying the development of effective interventions to reduce the negative impact of complications for people with ostomies. Further study of predictors and outcomes of ostomy complications is needed to improve care. 10.1097/01.WON.0000335961.68113.cb
    The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Ambe Peter C,Kugler Charlotte Mareike,Breuing Jessica,Grohmann Erich,Friedel Julia,Hess Simone,Pieper Dawid Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland AIM:This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. METHODS:MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. RESULTS:This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. CONCLUSION:Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients. 10.1111/codi.16118
    Use of a Convex Pouching System in the Postoperative Period: A National Consensus. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society Convex pouching systems have been available for ostomy patients for decades; however, controversy remains over the use of convexity in the postoperative period. A group of 10 nurses and physicians with expertise caring for patients with an ostomy completed a scoping review identifying research-based evidence and gaps in our knowledge of the safety and effectiveness related to the use of a convex pouching system following ostomy surgery. Results of this scoping review demonstrated the need for a structured consensus to define best practices when selecting a pouching system that provides a secure and reliable seal around the stoma, avoids undermining and leakage of effluent from the pouching system, and contributes to optimal health-related quality of life for patients following ostomy surgery. The expert panel reached consensus on 8 statements for the use of convex products immediately after surgery and throughout the first 6 months after stoma creation, as well as describing goals in choosing the best pouching system for the patient with an ostomy. 10.1097/WON.0000000000000874
    Factors impacting the quality of life of people with an ostomy in North America: results from the Dialogue Study. Erwin-Toth Paula,Thompson Sally J,Davis Janet Stoia Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to evaluate skin condition and quality of life following the use of a double-layer adhesive pouching system. This article reports results from North American participants. DESIGN:The study was an open-label, noncomparative, multicenter study. SUBJECTS AND SETTING:Seven hundred forty-three persons with ostomies who reside in North America participated in the study. INSTRUMENTS:A stoma-quality of life (QOL) questionnaire consisting of 20 questions was used to measure health-related quality of life. The Ostomy Skin Tool was used to assess peristomal skin condition. METHODS:Peristomal skin and health-related quality of life were assessed by WOC nurses at baseline and again after 6 to 8 weeks following the use of a double-layer adhesive ostomy pouching system. The participants recorded self-reported leakage level, presence of peristomal skin disorder, use of appliance type (e.g., convex, 1- or 2-piece), and frequency of consultation with the WOC nurse. RESULTS:Participants experienced a significant decrease in frequency of pouch leakage (P < .0001) and accessory use, improvement of skin condition, and overall significant improvement in mean quality of life score (56.8 vs. 58.9, P < .0001). The greatest change on the Stoma-QOL scores was observed in the quartile of participants with the lowest QOL at baseline. Their QOL scores rose from a mean 43.8 at visit 1 to 50.1 at visit 2 (P < .0001). CONCLUSION:The combination of a regular contact with a WOC nurse and the use of a double-layer adhesive appliance led to a significant reduction in leakage and accessory use, improved skin condition, and significant improvement in health-related quality of life. 10.1097/WON.0b013e318259c441
    Evaluation of a one-piece soft convex ostomy appliance: a prospective, multicentre, open-label pilot study. Rat Patrick,Robert Nathalie,Fernandes Isabelle,Edmond Delphine,Mauvais François British journal of nursing (Mark Allen Publishing) Leakage of stomal effluent is considered by people living with a stoma to be the key factor that negatively impacts their quality of life (QoL). This non-randomised pilot study evaluated the performance of a new stoma appliance, Flexima Active O Convex in 40 ostomy patients with a flat, flush or slightly retracted stoma over a 14-day period. Leakage was reported for the wear time of each pouch by the patients. On 79% of occasions, the patient reported no leakage under the skin protector. The appliance was very well tolerated and the condition of the patients' peristomal skin was maintained throughout the study. The performance was rated as 'good' or 'very good' by most of the patients. The results of this study have shown that the design of this one-piece soft convex appliance can prevent leakage and protect peristomal skin by providing a safe seal around the stoma. It was also reported as being flexible and comfortable to wear. 10.12968/bjon.2018.27.16.S20
    Fat Grafting for Improved Ileostomy Ostomy Device Fit: A Case Report. Czerniak Sharona,Gusenoff Jeffrey A,MacIsaac Zoe M,CBram Ryan P,Amar Dalit,Seynnaeve Carl,Medich David,Coleman Sydney,Rubin J Peter Wound management & prevention For patients with an ostomy, a poor fitting appliance may cause leakage, peristomal dermatitis, and frequent appliance changes. PURPOSE:The purpose of this case study was to report the outcome of fat grafting to augment peristomal soft tissue and improve appliance fit. CASE STUDY:A 57-year-old woman with a history of Crohn's disease presented with soft-tissue deficiency and uneven contour around her ileostomy site. She was unable to properly fit an ostomy appliance, which resulted in leakage, chronic skin irritation, and frequent appliance changes. The patient underwent 2 rounds of fat grafting using fat harvested from her medial thighs and knees infused with dilute lidocaine with epinephrine. The patient noted immediate improvement after 34 cc of processed fat was injected in the first round. Appliance change frequency decreased from daily to every 3 to 4 days. A second graft of 32 cc provided 3 months later further improved appliance fit, reducing appliance change frequency to every 5 to 7 days and obviating the need to use adjustment rings and glue. Pre- and postoperative computed tomography showed increased thickness of abdominal wall subcutaneous tissues. CONCLUSION:Fat grafting around an ostomy site presents a viable option to improve contour and appliance fit with reduced skin irritation and leakage.
    Psychometric evaluation of the ostomy complication severity index. Pittman Joyce,Bakas Tamilyn,Ellett Marsha,Sloan Rebecca,Rawl Susan M Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to evaluate the psychometric properties of a new instrument to measure incidence and severity of ostomy complications early in the postoperative period. SUBJECTS AND SETTINGS:71 participants were enrolled, most were men (52%), white (96%), and married or partnered (55%). The mean age of participants was 57 ± 15.09 years (mean ± SD). Fifty-two participants (84%) experienced at least 1 ostomy complication in the 60-day postoperative period. The research setting was 3 acute care settings within a large healthcare system in the Midwestern United States. INSTRUMENT:We developed an evidence-based conceptual model to guide development and evaluation of a new instrument, the Pittman Ostomy Complication Severity Index (OCSI). The OCSI format includes Likert-like scale with 9 individual items scored 0 to 3 and a total score computed by summing the individual items. Higher scores indicate more severe ostomy complications. METHOD:This study consisted of 2 phases: (1) an expert review, conducted to establish content validity; and (2) a prospective, longitudinal study design, to examine psychometric properties of the instrument. A convenience sample of 71 adult patients who underwent surgery to create a new fecal ostomy was recruited from 3 hospitals. Descriptive analyses, content validity indices, interrater reliability testing, and construct validity testing were employed. RESULTS:Common complications included leakage (60%), peristomal moisture-associated dermatitis (50%), stomal pain (42%), retraction (39%), and bleeding (32%). The OCSI demonstrated acceptable evidence of content validity index (CVI = 0.9) and interrater reliability for individual items (k = 0.71-1.0), as well as almost perfect agreement for total scores among raters (ICC = 0.991, P ≤ .001). Construct validity of the OCSI was supported by significant correlations among variables in the conceptual model (complications, risk factors, stoma care self-efficacy, and ostomy adjustment). CONCLUSION:OCSI demonstrated acceptable validity and reliability and can be used to assess incidence and severity of ostomy complications in the early postoperative period. We found the OCSI to be brief, easy-to-use, and clinically practical. It can be used to (a) identify priority areas for nursing intervention related to the ostomy, (b) determine appropriate interventions to prevent or treat complications, and (c) evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies. 10.1097/WON.0000000000000008
    A Randomized Controlled Trial Determining Variances in Ostomy Skin Conditions and the Economic Impact (ADVOCATE Trial). Colwell Janice C,Pittman Joyce,Raizman Rose,Salvadalena Ginger Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers. DESIGN:The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design. SUBJECTS AND SETTING:The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings. METHODS:Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifically for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specific questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered. RESULTS:Use of the ceramide-infused barrier significantly reduced stoma-related cost of care over a 12-week period, resulting in a $36.46 decrease in cost (14% relative decrease). The adjusted average costs were $223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confidence interval of the difference: -1.2 to 30.4). Significantly more participants using the ceramide-infused skin barrier were "very satisfied" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was noted in both groups. CONCLUSIONS:The use of a ceramide-infused barrier significantly decreased cost and increased satisfaction with patient-reported outcomes. 10.1097/WON.0000000000000389
    Context for Practice: Leakage From the Ostomy Pouch, Constipation in Patients With Colostomies. Gray Mikel Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society 10.1097/WON.0000000000000316
    Challenges faced by people with a stoma: peristomal body profile risk factors and leakage. British journal of nursing (Mark Allen Publishing) AIM:The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma. METHODS:Online survey with participants from 17 countries. FINDINGS:Of the 54 614 individuals invited to take part, 5187 responded; 62% of the respondents avoided physical and social activities because of their stoma and 37% had never consulted their stoma care nurse to have the fit of their stoma product checked. In a subgroup receiving questions on leakage (=4209), output under the baseplate and leakage onto clothes were experienced within the previous month by 76% and 26% of respondents, respectively. Higher chance of leakage was associated with an irregular stoma shape and peristomal body profile; a stoma level at or below the skin surface; and the presence of creases, folds and other changes in the peristomal area. CONCLUSION:Leakage and access to a stoma care nurse to provide the necessary care and guidance remain important concerns for individuals with a stoma. 10.12968/bjon.2022.31.7.376
    Validation and Clinical Experience With a Turkish Language Version of the Pittman Ostomy Complication and Severity Index. Sayar Serap,Vural Fatma Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to evaluate the content validity and interrater reliability of a Turkish language version of the Pittman Ostomy Complication and Severity Index (OCSI). DESIGN:Psychometric evaluation of instrument. SUBJECTS AND SETTING:The sample comprised 90 individuals living with an ostomy for 2 to 6 months. Their mean age was 59.48 years (SD 13.292); 52.2% were female. Almost two-thirds (73.3%, n = 66) had experienced at least 1 ostomy complication. The study was conducted in the Wound and Stoma Therapy Unit of the Dokuz Eylül University Hospital General Surgery Clinic and Polyclinic in Izmir, Turkey. METHODS:A Turkish language version of the OCSI was created using a translation, back-translation technique. The instrument's content validity was analyzed by 26 experts. Interrater reliability test was evaluated using Cohen's κ and intraclass correlation coefficients. Data were collected between January 15, 2017 and July 30, 2017 through face-to-face interviews conducted in our Wound and Stoma Therapy Unit. RESULTS:The overall content validity index was 0.95. Cohen's κ coefficient varied from 0.70 and 1.0 for all items. The Pearson correlation coefficient and intraclass correlation coefficient were 0.982 (P = .000) and 0.986 (P = .000), respectively, indicating good internal consistency. The most prevalent complications were leakage (41.1%), peristomal moisture-associated skin damage (42.2%), and stomal retraction (27.7%). CONCLUSIONS:Findings indicate that the Turkish language version of the Pittman OCSI is a reliable and valid instrument for assessment of presence and severity of early postoperative complications in individuals with an ostomy. We found the instrument parsimonious, easy-to-use, and clinically practical. It can be used to determine appropriate interventions to prevent or treat complications and evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies. 10.1097/WON.0000000000000600
    Ongoing ostomy self-care challenges of long-term rectal cancer survivors. Bulkley Joanna E,McMullen Carmit K,Grant Marcia,Wendel Christopher,Hornbrook Mark C,Krouse Robert S Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:Surgical treatment for rectal cancer (RC) can result in an intestinal ostomy that requires lifelong adaptation and investment of physical, cognitive, and financial resources. However, little is known about the extent of ongoing challenges related to ostomy self-care among long-term RC survivors. We analyzed the prevalence of self-reported ostomy self-care challenges and the physical and environmental factors that can support or undermine ostomy self-care. METHODS:We mailed surveys to long-term (≥ 5 years post-diagnosis) RC survivors, including 177 adults with ostomies who were members of integrated health systems in northern California, Oregon, and Washington State. Potential participants were identified through tumor registries. Data were also extracted from electronic health records. RESULTS:The response rate was 65%. The majority of respondents were male (67%), and the mean age was 75 years. Sixty-three percent of respondents reported at least one ostomy self-care challenge. The most common challenges were leakage or skin problems around the ostomy and needing to change the pouching system too frequently. Twenty-two percent reported difficulty caring for their ostomy. Younger age and higher BMI were consistently related to ostomy self-care challenges. CONCLUSIONS:The majority of RC survivors reported ostomy-related self-care challenges, and 31% experienced problems across multiple domains of ostomy self-care. In addition, most survivors reported significant physical challenges that could lead to ostomy-related disability. Although the participants surveyed had access to ostomy care nurses, the care gaps we found suggest that additional work is needed to understand barriers to ostomy care, reduce unmet needs, and improve well-being among this group. 10.1007/s00520-018-4268-0
    Cancer survivors' challenges with ostomy appliances and self-management: a qualitative analysis. Sun Virginia,Bojorquez Octavio,Grant Marcia,Wendel Christopher S,Weinstein Ronald,Krouse Robert S Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer PURPOSE:An ostomy poses significant health-related quality of life (HRQOL) issues for cancer survivors. Survivors must learn to manage pouching appliances and adjust to the psychosocial consequences of living with an ostomy. We explored, through qualitative analysis, the challenges with self-management and ostomy appliances reported by cancer survivors. METHODS:Pooled data from two studies with a question on the greatest challenge of living with an ostomy and intervention session notes were analyzed using content analysis approach. The themes were reviewed and agreed upon by the research team, and counts were tallied for each theme based on the number of times they were mentioned by participants. RESULTS:Of the 928 greatest challenge responses and session notes, a total of 106 mentions (11%) were focused on ostomy appliances, associated repercussions, and time taken for ostomy care. Eight themes emerged: bleeding, pain, leakage, skin problems/irritation/rash, wafer-related issues, materials getting under the wafer, time to care for ostomy, and solutions to clean the stoma. Challenges described included poor wafer adherence, allergic reactions to adhesives, and pain around the stoma site. These challenges resulted in anxiety related to leakage, odor, and/or skin irritation, which negatively impacted on participation in social activities and self-confidence with ostomy care. CONCLUSIONS:Cancer survivors living with an ostomy experience multiple obstacles with ostomy appliances and caring for their ostomy. Continued innovation in ostomy appliance design and technology is needed to help cancer survivors with successfully managing ostomy care. 10.1007/s00520-019-05156-7
    Ostomy 101 for dermatologists: Managing peristomal skin diseases. Morss-Walton Peyton C,Yi Julie Z,Gunning Mary-Ellen,McGee Jean S Dermatologic therapy An estimated 1 million North Americans live with ostomies, with up to 80% of ostomy patients developing stoma-related skin morbidities. While ostomy nurses are often the first line of management, dermatologists may be involved in the care of ostomy patients with complex or persistent peristomal skin complications. Therefore, an understanding of the ostomy apparatus and possible peristomal skin conditions that may arise allows dermatologists to identify skin complications early and work effectively with a multidisciplinary team. In this article, we aim to review the ostomy apparatus, discuss the differential diagnoses, and provide practical guidelines for the management of peristomal skin conditions. Pubmed, Ovid Medline, and Google Scholar were searched for relevant articles assessing peristomal skin complications and their management. Peristomal skin complications may be local (e.g., contact dermatitis, infection, fistula, and mechanical trauma) or secondary to systemic disease (e.g., inflammatory bowel disease, pyoderma gangrenosum, and psoriasis). Ensuring appropriate ostomy fit and proper use of ostomy accessory products helps to reduce effluent leakage and prevent damage to the peristomal skin. For persistent peristomal skin conditions, corticosteroid sprays, systemic therapies, and surgical interventions may be warranted. 10.1111/dth.15069
    Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis. González Eugenia Rodriguez,Zurita Carmen Del Pino,Caballero Gemma Arrontes,Rodríguez Araceli Hoyo,Rodríguez Eugenia Zapatero,Blázquez Eduardo García British journal of community nursing Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care. 10.12968/bjcn.2021.26.Sup12.S24
    Factors related to ostomy leakage in the community setting. Ratliff Catherine R Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to describe demographic and clinical variables related to ostomy pouch leakage from those discharged from a major medical center during a 2-year period. SUBJECTS AND SETTINGS:A convenience sample of 198 persons with an ostomy was obtained using the ICD-9 (International Classification of Diseases, Ninth Revision) codes for colostomy, ileostomy, and ileal conduit for patients who were discharged from the medical center within the time frame of July 2009 to July 2011. One hundred seven participants (55%) returned a completed survey. Respondents included 57 men (53%) and 50 women (47%). The mean age was 60 years with age range from 23 to 91 years. Fecal ostomies made up the majority of the stomas representing 71 patients (66%). METHODS:A descriptive, cross-sectional research design was used to describe clinical variables related to ostomy pouch leakage for those discharged from a major academic medical center over a 2-year period of time. Participants were mailed an introductory letter from the principal investigator, a self-administered questionnaire, and a prepaid return envelope. RESULTS:Ninety-three patients (87%) reported leakage; however, 48 patients (45%) stated that they did not leak often. A logistic regression was estimated to determine which variables were significant predictors of the dependent variable of leaking status (no/seldom leaking vs more frequent leaking). Two variables were individually significant predictors, sex (P = .021) and 2-piece pouch (P = .015). Women were 4 times more likely to be in the more frequent leaking group than were men. Those who were wearing 2-piece pouches were 78% less likely to be in the more frequent leaking group. Participants with ileostomies or urostomies were more likely to be in the more frequent leaking group and those with peristomal skin irritation were more likely to be in the more frequent leaking group. CONCLUSION:Findings from this study reveal that women were more likely to experience leakage than men and that wearing a 2-piece pouch was associated with no leakage or seldom leakage group. Additional studies looking at specific characteristics of patients with ostomy leakage are needed to validate these results. 10.1097/WON.0000000000000017
    Ostomy Complications and Quality of Life of Ostomy Support Belt/Garment Wearers: A Web-Based Survey. Pittman Joyce,Colwell Janice,Mulekar Madhuri S Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to examine ostomy complications and health-related quality of life (QOL) in individuals with an ostomy who wear an ostomy support belt/garment. DESIGN:A mixed-methods descriptive study. SUBJECTS AND SETTING:Two hundred two community-living adults with an ostomy were recruited using an industry distribution list. The target sample had no geographic restrictions. METHODS:Descriptive analysis was conducted for all outcomes. Participants were separated into groups depending on type of ostomy belt or belt/garment worn or none. All categorical data were summarized using percentages and numerical data using mean ± standard deviation. Association between categorical factors was evaluated using a χ2 test and proportions of occurrences from 2 groups were compared using a 2-proportion z-test. The mean outcomes for 2 or more groups were compared using t tests or analysis of variance (ANOVA), respectively. If ANOVA showed difference among groups, post hoc analysis of group means was conducted using Tukey's Honestly Significant Difference (HSD) test. RESULTS:Two hundred two respondents completed the survey. Of the 174 participants who responded to the survey question on leakage, 157 (90%) reported experiencing leakage and 135 (77.59%) reported rash or skin irritation. Comparison of whether participants had ever experienced a leakage event was not significantly different across groups (P = .3663). Those who wore an ostomy support belt/garment reported leakage less often (less than once a month) versus respondents who wore other types of belts or no belt (n = 49, 73.13% vs n = 53, 59.55%; P = .0388). Of the 174 participants who responded to the peristomal skin question, 135 (77.59%) participants reported peristomal skin complications. Significantly fewer participants who wore an ostomy support belt/garment reported having peristomal skin irritation compared to those who wore other types of belts or no belt (69.01% vs 84.16%; P = .0080). The mean cumulative total City of Hope Quality of Life (COH QOL) Ostomy score for all participants was 6.45 ± 1.36 out of 10, with the psychosocial domain scoring the lowest at 5.67 ± 1.30 out of 10. No significant differences were observed in mean QOL domain and total scores by those who wore an ostomy support belt/garment, other type of belt/garment, and none. When comparing COH QOL mean scores and leakage frequency of more/less once a month, those who reported leakage more often had significantly worse QOL scores in all 4 domains as well as total scores: physical (P = .0008), psychological (P = .0154), social (P = .0056), spiritual (P = .0376), and total COH QOL score (P = .0018). CONCLUSION:This study provides important information related to ostomy complications and QOL associated with wearing an ostomy belt or belt/garment. The use of an ostomy support belt/garment may offer an additional intervention to decrease frequency of leakage and peristomal skin irritation and improve QOL. 10.1097/WON.0000000000000843
    Differences in Ostomy Pouch Seal Leakage Occurrences Between North American and European Residents. Fellows Jane,Forest Lalande Louise,Martins Lina,Steen Anne,Størling Zenia M Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society PURPOSE:The purpose of this study was to compare experiences and concerns about pouch seal leakage between persons with ostomies residing in North America (Canada and the United States) and Europe (United Kingdom, Netherlands, Sweden, Germany, Belgium, France, and Italy). Differences in reported pouch wear time and accessories used between the 2 groups were also examined. DESIGN:Secondary analysis of data from a cross-sectional study (Ostomy Life Study). SUBJECTS AND SETTINGS:Responses from persons residing in European countries (n = 1939) were compared with responses of 1387 individuals residing in North American countries. METHODS:Persons with an ostomy completed a questionnaire that focused on 4 topics related to the daily use of an ostomy pouching system (pouch seal leakage, ballooning, appearance of pouching system such as color and size of the pouch and whether it is discrete under clothing, and coupling failure of 2-piece pouching systems). Pouch seal leakage was defined as stomal effluent seeping between the skin and the wafer of the ostomy pouching system. Statistical analysis was performed using a proportional odds model including various variable effects. Special attention was given to frequency of pouch seal leakage occurrences. All tests were 2-sided; P values ≤.05 were deemed statistically significant. RESULTS:Participants living in the North American countries indicated they were more likely to experience leakage from the ostomy (odds ratio = 2.610, 95% CI 2.187-3.115; P < .0001). Findings also indicated they were more likely to worry about pouch seal leakage than those in the European countries' data set (odds ratio = 2.722, 95% CI 2.283-3.246; P < .0001). Participants residing in the North American countries had significantly longer wear times than those participants in the European countries (P < .0001, χ test). The use of accessories was associated with a longer pouching system wear time. CONCLUSION:Study results suggest that participants from the North American countries indicated significantly more experience with and worries about leakage and longer wear time than the participants from the European population. Additional research is needed to determine the reasons for these differences. 10.1097/WON.0000000000000312
    The ostomy leak impact tool: development and validation of a new patient-reported tool to measure the burden of leakage in ostomy device users. Nafees Beenish,Størling Zenia M,Hindsberger Charlotte,Lloyd Andrew Health and quality of life outcomes BACKGROUND:Leakage is a major concern for people who use a stoma, but people's experience and its impact is not well understood. This study aimed to establish a definition of leakage through clinical and user input. This information was used to develop and validate a new measurement tool to understand the impact of leakage for people using a stoma appliance, in the UK, US, France, and Denmark. METHODS:Participants were recruited from a panel of users, hosted by Coloplast, that includes people who currently use Coloplast products. Six clinicians and 41 users took part in concept elicitation interviews. The qualitative findings were used to draft items. A panel of clinical experts was organized to develop and validate items (N = 6). Cognitive debrief interviews were conducted with five users in each country, which resulted in removing some items and revising the measure. A psychometric validation was conducted with 340 people in four countries whereby participants were asked to complete a series of measures online. Full psychometric analyses including validity and reliability were conducted. RESULTS:A final tool was established consisting of three domains related to the burden of leakage: "Emotional impact," "Usual and social activities," and "Coping and control." Convergent validity was evaluated by benchmarking to existing health-related quality of life instruments (domains of SF-36 and Ostomy-Q). This showed high correlation between domains of the leakage tool and other measures, in particular for the Emotional impact domain when compared with SF-36 Emotional well-being and Ostomy-Q Confidence domain (p < 0.001). Coping and control correlated moderately well with most PROs tested for except the physical functioning domains, which showed only modest correlation (p < 0.001). Usual and social activities correlated equally well with all domains. Internal consistency was high for Emotional impact and Usual and social activities (> 0.92). CONCLUSION:The study highlights how users define leakage and its impact in a way that is meaningful to them. This information has been used to develop an instrument to measure leakage which can potentially be used by clinicians and researchers. The instrument demonstrated evidence supporting its reliability and validity as an outcome measure to assess the impact of leakage in stoma care. 10.1186/s12955-018-1054-0
    Impact of stoma leakage in everyday life: data from the Ostomy Life Study 2019. Jeppesen Palle Bekker,Vestergaard Martin,Boisen Esben Bo,Ajslev Teresa Adeltoft British journal of nursing (Mark Allen Publishing) BACKGROUND:Many people with a stoma experience leakage of stomal effluent. AIM:To investigate the impact of leakage on individuals with a stoma. METHODS:The Ostomy Life Study 2019 included a survey concerning experiences with stomal effluent leakage and the validated Ostomy Leak Impact tool. FINDINGS:Respondents with frequent leakage episodes were significantly more affected emotionally and they were feeling less in control than those who rarely or never experienced leakage. The emotional impact of experiencing leakage onto clothes appeared to last up to 1 year after the last leakage incidence. Because of worrying about leakage users increased their product usage and, of those who were in employment, 65% reported that leakage and the related worry influenced their ability to work. CONCLUSION:Most people with a stoma were emotionally impacted by experiencing leakage, especially by leakage outside the baseplate (resulting in soiled clothes). New solutions are warranted that can help reduce the impact of leakage. 10.12968/bjon.2022.31.6.S48
    Perception of leakage: data from the Ostomy Life Study 2019. British journal of nursing (Mark Allen Publishing) BACKGROUND:Leakage is a common problem for people with a stoma. AIM:To investigate how people with a stoma and stoma care nurses perceive different patterns of effluent under the baseplate. METHODS:The Ostomy Life Study 2019 included a user survey and a nurse survey covering experiences of leakage and the perception of leakage. FINDINGS:Most people with a stoma perceived effluent reaching outside the baseplate as leakage (88-90%), whereas effluent close to the stoma only was not perceived as leakage by the majority (81-91%). Effluent covering major parts of the baseplate was perceived as leakage by most respondents with a colostomy or ileostomy (83%), whereas fewer respondents with a urostomy perceived this as leakage (57%). Most of the nurses (70%) did not perceive effluent close to the stoma as leakage. CONCLUSION:This study revealed that effluent confined to the area next to the stoma is generally not perceived as leakage. 10.12968/bjon.2021.30.22.S4