3D printing and intelligent technology increase convenience, reliability, and patient acceptance of ostomy nursing: a randomized controlled trial.

Traditional ostomy bags commonly cause skin allergy and inflammation around the stoma, as well as leakage. This study aimed to examine the effect of a 3D-printed ostomy bag with sensors and stimulators on stoma nursing. This is a randomized controlled trial. This trial involved 113 distinct individuals who undergo colorectal cancer surgery and intestinal obstruction surgery, with resulting stoma. The date of trial registration was January 17, 2019, and the date of first recruitment was May 1, 2019. Patients were randomized into two groups: intelligent 3D-printed ostomy bag (3D group, n = 57) and Coloplast one-piece pouching systems (control group, n = 56). The shape of ostomy and the surrounding skin of all the 57 patients of the 3D group was scanned by a handheld 3D scanner. Then, the ostomy bag chassis (also known as skin barrier) was 3D printed and an intelligent device adhered to the ostomy bag. The wearing time, leakage rate, the Discoloration, Erosion, and Tissue Overgrowth (DET) score, and the Acceptance of Illness Scale (AIS) were observed. In the 3D-printed bag group, the time to wear (0.7 ± 0.4 m) was significantly shorter than that of the control group (9.1 ± 3.5 m). The leakage rate of 3D-printed bag (1.75%) was significantly lower than that of the control group (16.1%). The DET score for the 3D-printed bag group was also lower than that of the control group, and the AIS score for the 3D-printed bag group was higher than that of the control group. The 3D-printed ostomy bags and the linked computer program can significantly reduce wearing time, leakage rate, and stoma complications. This may improve the quality of home ostomy care for patients and reduce the incidence of skin complications around the stoma.Registration number: ChiCTR1900020752.

Impact of Stoma Baseplate Convexity on Tension and Compression Around the Stoma Site: A Finite Element Analysis.

For patients living with intestinal or urinary stomas, skin barriers play an essential role in protecting the peristomal skin and preventing peristomal complications. Convex baseplates press into the peristomal skin and are suitable for retracted stomas that do not protrude, peristomal skin with creases, folds, or dips, and stomas where frequent leaking can occur with flat pouching systems. However, there is a lack of data on the magnitude and location of tension applied to the abdomen by convex baseplates. We evaluated the impact of a range of convex baseplates applied to a simulated stoma site. A comparative finite element analysis investigation was conducted to evaluate the impact of eight different convex stoma system baseplates applied to an idealised flat abdomen, representing skin, subcutaneous tissue, and musculature layers. The baseplates considered had varying convexity with depths of 3.5 mm and 7 mm and internal structural diameters between ~30 mm and ~60 mm. The convex product range provided tension in the skin (maximum principal strain) and compression through the fat layer (minimum principal strain). Large differences in the locations and magnitudes of skin tension and fat layer compression were seen between the baseplates under analysis, with both the depth and diameter of convexity influencing the strain experienced across the abdominal topography. The results generated highlight the importance of having an appropriate range of convexity products available and selecting an appropriate option for use based on the stoma type and condition of the peristomal skin.

Incontinências urinária e fecal e constipação intestinal em pacientes hospitalizados: prevalência e fatores associados / Urinary and fecal incontinence and intestinal constipation in hospitalized patients: prevalence and associated factors

Introdução: A ocorrência das diferentes incontinências e da constipação intestinal (CI), de forma isolada ou concomitante, não é pouco frequente no ambiente hospitalar. Esses problemas de saúde ainda são pouco investigados e os estudos com pacientes hospitalizados são escassos. Conhecer sua prevalência e fatores associados em pacientes hospitalizados é necessário para promover a sensibilização dos profissionais de saúde sobre a importância dessas necessidades passíveis de intervenções durante o período da internação. Objetivo: Identificar e analisar a prevalência das incontinências urinária (IU) e fecal (IF), de forma isolada e combinada, e da CI e as variáveis sociodemográficas e clínicas associadas às suas ocorrências em pacientes hospitalizados. Métodos: Trata-se de um estudo epidemiológico, observacional, transversal, analítico e descritivo, onde a amostra do estudo foi composta de 345 pacientes adultos e idosos hospitalizados no Hospital Universitário da USP. Os dados foram coletados por meio de entrevista, exame físico e registros de prontuários, utilizando-se os seguintes instrumentos: questionário de dados Sociodemograficos e Clínicos, Características das Perdas Urinárias, International Consultation on Incontinence Questionnaire - ICIQ-SF, Hábito Intestinal na População Geral e o Índice de Incontinência Anal IIA. A prevalência dos eventos estudados foi levantada quatro vezes (prevalência-ponto), em um único dia, nos meses de março, abril, maio e junho, sempre no mesmo dia do mês, de forma a atender o tamanho amostral para a análise dos fatores associados. Os dados foram analisados utilizando-se os testes qui-quadrado e Fisher para as variáveis categóricas, os testes t-student e Mann-Whitney para as variáveis numéricas, além de regressão logística (forward stepwise) para a identificação de fatores associados. Resultados: Obtiveram-se as seguintes prevalências: 22,9% para IU (28% para mulheres e 16,1% para homens); 7,9% para IF (9,4% para mulheres e 6% para homens); 4,7% para incontinência combinada (IC) (7,3% para mulheres e 1,4% para homens) e 14,9% para CI (15% para mulheres e 14,7% para homens). Dentre as incontinências, conseguiu-se detectar fatores associados somente para a IU: sexo feminino (OR=3,89; IC95% 1,899-7,991); idade (OR=1,03; IC95% 1,019-1,054); asma (OR=3,66; IC95% 1,302-10,290); estar em uso de laxantes (OR=3,26; IC95% 1,085-9,811); o uso de fralda no momento da avaliação (OR=2,75; IC95% 1,096-6,908); o uso de fralda em casa (OR=10,29; IC95% 1,839-57,606) e o uso de fralda em algum momento da internação (OR=6,74; IC95% 0,496-91,834). Especificamente para o sexo feminino, as variáveis associadas à IU foram: idade (OR=1,03; IC95% 1,017-1056); Diabetes Mellitus (OR=2,59; IC95% 1,039-6,489); asma (OR=4,92; IC95% 1,460-16,588) e número de partos (OR=1,27; IC95% 1,064-1,522). Os fatores que apresentaram associação com a CI foram: anos de estudo (OR=0,91; IC95% 0,856-0,985) e estar em uso de laxantes (OR=8,08; IC95% 3,387-19,282). Conclusão: Os valores de prevalência encontrados no presente estudo, assim como os fatores associados, foram similares aos achados de estudos epidemiológicos nacionais e internacionais realizados com população geral, porém distintos daqueles oriundos da escassa literatura internacional existente sobre o tema para adultos e idosos hospitalizados. Estudos longitudinais fazem-se necessários para a confirmação das relações encontradas entre as variáveis estudadas, contribuindo para o diagnóstico mais acurado da causalidade dessas condições e, portanto, o estabelecimento de medidas mais eficazes de prevenção e tratamento das incontinências e da CI no cenário hospitalar.

Introduction: The occurrence of different incontinences and intestinal constipation (IC), alone or concomitantly, is not uncommon in the hospital setting. These health problems are still poorly investigated and studies of inpatients are scarce. Knowing their prevalence and associated factors in hospitalized patients is necessary to promote the awareness of health professionals about the importance of these possible interventional needs during the period of hospitalization. Objective: To identify and to analyze the prevalence of urinary (UI) and fecal incontinence (FI), in an isolated and combined manner, and IC, and sociodemographic and clinical variables associated with their occurrences in hospitalized patients. Methods: This is an observational, cross-sectional, analytical and descriptive epidemiological study, where the study sample consisted of 345 adult and elderly patients hospitalized at University Hospital of USP. The data were collected through interviews, physical examination and medical records, using the following instruments: Sociodemographic and Clinical Data, Characteristics of Urinary Loss, International Consultation on Incontinence Questionnaire - ICIQ-SF, Intestinal Habit of the General Population and the Anal Incontinence Index - IIA. The prevalence of the events studied was raised four times (point-prevalence) in a single day in March, April, May and June, always on the same day of each month, in order to meet the sample size for the analysis of the factors associated. Data were analyzed using chi-square and Fisher tests for categorical variables, t-student and Mann-Whitney tests for numerical variables, and logistic regression for the identification of associated factors. Results: The following prevalences were obtained: 22.9% for UI (28% for women and 16.1% for men); 7.9% for FI (9.4% for women and 6% for men); 4.7% for combined incontinence (CI) (7.3% for women and 1.4% for men) and 14.9% for IC (15% for women and 14.7% for men). Among the incontinences, it was possible to detect factors associated only for UI: female gender (OR=3.89; IC95% 1,899- 7,991); age (OR=1.03; IC95% 1.019-1.054); asthma (OR=3.66; IC95% 1.302-10.290); being in use of laxatives (OR=3.26; IC95% 1.085-9.811); The use of the diaper at the time of evaluation (OR=2.75; IC95% 1.096-6.908); The use of diapers at home (OR=10.29; IC95% 1,839-57,606) and the use of diapers at some time of hospitalization (OR=6.74; IC95% 0.496- 91.834). Specifically for females, the variables associated with UI were: age (OR=1.03; IC95% 1.017-1056); Diabetes Mellitus (OR=2.59; IC95% 1.039-6.489); asthma (OR=4.92; IC95% 1,460-16,588) and number of deliveries (OR=1.27; IC95% 1.064-1.522). The factors that showed association with IC were: years of study (OR=0,91; IC95% 0,856-0,985) and being in use of laxatives (OR=8,08; IC95% 3,387-19,282). Conclusion: The prevalence values found in the present study as well as the associated factors were similar to the findings of National and International epidemiological studies conducted with the general population. But they were quite different from those of the scarce existing International literature for hospitalized adults and elderly people. Longitudinal studies are necessary to confirm the relationships found between the studied variables, contributing to a more accurate diagnosis of the causality of these conditions and, therefore, the establishment of more effective measures of prevention and treatment of incontinence and IC in the hospital setting.