Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese.

PURPOSE: To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN: Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING: Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS: The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS: The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION: This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.

Challenges faced by people with a stoma: peristomal body profile risk factors and leakage.

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 (n=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.

The Ostomy Skin Tool 2.0: a new instrument for assessing peristomal skin changes.

BACKGROUND: Peristomal skin complications (PSCs) are frequently reported postoperative complications. PSCs can present visibly or as symptoms such as pain, itching or burning sensations. AIM: To develop a new tool that can capture a range of sensation symptoms together with visible complications and an objective assessment of discolouration in the peristomal area. METHOD: Consensus from qualitative interviews with health professionals and people with an ostomy, and input from expert panels, formed the basis of a patient-reported outcome (PRO) questionnaire. A decision tree model was used to define a combined score including PRO and objectively assessed discolouration area. FINDINGS: Six elements were included in the PRO questionnaire and four health states representing different severity levels of the peristomal skin were defined. CONCLUSION: The Ostomy Skin Tool 2.0 is a sensitive tool that can be used to follow changes in the peristomal skin on a regular basis and thereby help prevent severe PSCs.

The Financial Impact of Living in Canada With an Ostomy: A Cross-sectional Survey.

PURPOSE: The aim of this study was to explore how living with an ostomy financially impacts Canadians. METHODS: A descriptive, pan-Canadian, cross-sectional online and paper-based survey was conducted using a convenience sample. RESULTS: Surveys were completed by 467 individuals. Seventy-six percent (n = 355) reported spending more than $1000 annually on ostomy supplies, with 58% (n = 271) paying partially out of pocket. Atlantic regions relied primarily on insurance (n = 81), and the central, prairies, and western regions used a combination of funding (provincial government funding and/or insurance) (n = 385) with no significant out-of-pocket funding differences between regions (χ = 18.267, P = .079). Fifteen percent (n = 70) reported frequent peristomal skin problems, and 19% (n = 89) indicated that having an ostomy negatively affected their ability to work. When experiencing ostomy-related problems, 60% (n = 280) sought assistance from a nurse specialized in wound, ostomy, and continence (NSWOC) and spent significantly less on ostomy supplies (χ = 231.267, P < .001). CONCLUSION: This study demonstrated that living with an ostomy may result in financial burden and that Canadian regional variations in funding and access to an NSWOC should be explored.

Differences in Ostomy Pouch Seal Leakage Occurrences Between North American and European Residents.

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.

Is Twice-Daily Skin Moisturizing More Effective Than Routine Care in the Prevention of Skin Tears in the Elderly Population?

BACKGROUND: Skin-moisturizing routines are part of a bundle of interventions designed to prevent skin tears. OBJECTIVE: This Evidence-Based Report Card reviews the effect of twice-daily moisturization of the skin on skin tear occurrence versus occurrence rates using routine skin care. SEARCH STRATEGY: The literature was systematically reviewed for studies that evaluated the use of standardized skin moisturizers on the rate of skin tears in the older adults (>60 years of age). A professional librarian performed the literature search, which yielded 446 articles. Following title and abstract reviews, we identified and retrieved 3 studies that met inclusion criteria. FINDINGS: Evidence concerning the effectiveness of routine twice-daily skin moisturizing reducing the rate of skin tears is mixed. Routine twice-daily skin moisturizing did not significantly result in a lower incidence of skin tears in long-term care residents compared to usual care in one study. However, the occurrence of skin tears per 1000 occupied beds was 50% lower when a moisturizer applied twice daily was compared to usual care. CONCLUSION: Routine skin moisturizing is recommended as one component of a prevention program for skin tears among aged adults residing in long-term care facilities.

Strategies to reduce treatment costs of peristomal skin complications.

Peristomal skin complications (PSCs) are common and troublesome and the consequences are substantial both for the patient and from a health-economic viewpoint. The purpose of this article is to demonstrate that early detection and treatment of PSCs, combined with the use of a correctly fitted and appropriate pouching system, can reduce treatment costs-in the UK, it is estimated to save £28.1m annually. A model for cost estimation of PSCs and a real-life global data set of people with stomas are used for the calculations. A high priority should be given to ensuring resources are available to provide education, guidance and assistance to people with a stoma. This would support increased awareness of the first signs of PSCs and enable self-management at an early stage.

Peristomal skin complications are common, expensive, and difficult to manage: a population based cost modeling study.

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.

The ostomy skin tool: tracking peristomal skin changes.

The Ostomy Skin Tool is a standardized measuring instrument for assessing the extent and severity of peristomal skin change in terms of discolouration (D), erosion (E), and tissue overgrowth (T) (DET). The reliability and validity of this tool has been determined in a previous study. The purpose of this article is to highlight the study's most important findings, and to demonstrate the usefulness of the DET score by evaluating three examples of peristomal skin changes. Additionally, a simplified categorical severity scale (defining 'mild', 'moderate', and 'severe' conditions) is introduced that may improve clinical interpretation of the DET score. It is reasonable to conclude that the DET score may empower the ostomy care nurse with an evidence-based platform to make qualified decisions on evaluation and treatment of peristomal skin disorders.

Summary of best practice recommendations for management of enterocutaneous fistulae from the Canadian Association for Enterostomal Therapy ECF Best Practice Recommendations Panel.

These recommendations are a comprehensive resource summarizing the current literature that supports the care of the person with an enterocutaneous fistula (ECF). They are the result of the decision of the Canadian Association for Enterostomal Therapy to provide an open-source guide to clinicians in the care of the person with ECF. It is intended as a tool for nurses to assist in decision making and priority setting when developing individualized care plans. It is not intended to be a clinical practice guideline but, like its progenitor the Canadian Association for Wound Care: Best Practice Recommendations for Wound Care, it is a distillation of existing research, expert opinion, and case studies intended to enable clinicians to determine their clinical practice based on the best available evidence. It is a living document and as such it is expected that having identified the gaps in knowledge and practice, clinicians will begin the research and publications necessary to fill in these gaps. Contributions to this body of knowledge are essential to an evolving improvement in care for patients living with ECF.