Effects of lavender oil on odor elimination, ostomy adjustment and quality of life in patients with permanent colostomy: A randomized controlled trial.

PURPOSE: The aim of this study is to assess the impact of lavender oil on odor elimination, ostomy adjustment and quality of life outcomes in patients with permanent colostomy. Specifically, the study aims to compare the outcomes of an experimental group receiving lavender oil intervention with those of a control group. METHODS: A randomized controlled trial design was employed, including an experimental group receiving lavender oil intervention and a control group receiving standard care. The study participants were patients with permanent colostomy. Various variables were assessed, including odor scale, work and social functioning, sexuality and body image, stoma function, financial concerns, acceptance, anxiety/preoccupation, social engagement and anger. RESULTS: The post-scores assessment showed significant differences between the experimental and control groups in all variables. The experimental group exhibited significantly more positive outcomes concerning the reduction of odor (p<0.001), performance in the workplace (p<0.001), body image connected to sexuality (p<0.001), stoma functionality (p<0.001), financial worries (p=0.005), acceptance levels (p<0.001), anxiety levels (p<0.001), social involvement (p<0.001), and irritability (p<0.001). Effect sizes were substantial (=0.88-0.98 in all variables but one), indicating significant differences in average scores before and after the intervention. CONCLUSION: The findings of this study suggest that lavender oil intervention effectively improved odor elimination, ostomy adjustment and quality of life outcomes in patients with permanent colostomy.

Perfil nutricional de pacientes ostomizados. Hospital General del segundo departamento de San Pedro Paraguay ­ Corea. 2022 / Nutritional profile of ostomized patients. General Hospital of the second department of San Pedro Paraguay ­ Korea. 2022

El perfil nutricional de los pacientes ostomizados adquiere especial atención debido a las condiciones que podrían predisponer a una malnutrición. El objetivo del estudio fue determinar el perfil nutricional de pacientes ostomizados que reciben atención ambulatoria en el Hospital General del Segundo Departamento de San Pedro-Paraguay - Corea, en el año 2022, se realizó un estudio observacional de corte transversal. Los datos obtenidos fueron cargados en una planilla electrónica Microsoft-Excel, para el análisis se utilizó estadística descriptiva. Para describir el estado nutricional de los pacientes se emplearon indicadores antropométricos y el Screening de Riesgo Nutricional (NRS-2002), aplicados mediante entrevista y evaluación clínica nutricional. El estudio tuvo una duración global de 9 meses, fueron incluidos 20 pacientes ostomizados atendidos en el Programa Nacional de Atención Integral al Paciente Ostomizado provisto por el Hospital General Paraguay-Corea que cumplieron con los criterios de inclusión. Se respetaron los principios éticos de investigación. El grupo etario más representativo fue el de 41 a 64 años o más, seguido del grupo etario de 20 a 40 años; mayor proporción de sexo masculino, procedencia rural. El tipo de ostomía más frecuente fue colostomía terminal seguido de colostomía laterales; enfermedad de base más frecuente fue el de tipo oncológico, seguida de obstrucción intestinal, trauma y por último fistulas y enfermedad diverticular. En conclusión, la apreciación global del estado nutricional evaluada mediante la herramienta NRS-2002 indicó que el perfil nutricional de los pacientes ostomizados presenta riesgo de malnutrición en todos los casos evaluados.

The nutritional profile of ostomized patients acquires special attention due to the conditions that could predispose to malnutrition. The objective of the study was to determine the nutritional profile of ostomized patients who receive outpatient care at the General Hospital of the Second Department of San Pedro-Paraguay Korea, in the year 2022, an observational study of a cross-section was conducted. The data obtained were loaded in an electronic form Microsoft-Excel, for the analysis was used descriptive statistics. To describe the nutritional status of patients, anthropometric indicators and nutritional risk screening (NRS-2002) were used, applied through nutritional clinical interview and evaluation. The study had a global duration of 9 months, 20 ostomized patients were included in the National Program for Comprehensive Care of the Ostomized Patient provided by the General Paraguay-Corea Hospital that complied with the inclusion criteria. Ethical research principles were respected. The most representative age group was 41 to 64 years or more, followed by the age group from 20 to 40 years; Greater proportion of male sex, rural origin. The most frequent type of ostomy was terminal colostomy followed by lateral colostomy; The most frequent base disease was the oncological type, followed by intestinal obstruction, trauma and finally fistulas and diverticular disease. In conclusion, the global appreciation of the nutritional status evaluated by the NRS-2002 tool indicated that the nutritional profile of ostomized patients has a risk of malnutrition in all cases evaluated.

Effect of Laughter Yoga on Sleep and Quality of Life in Individuals With Fecal Ostomies: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the effect of laughter yoga on the quality of life and sleep quality in individuals with fecal ostomies. DESIGN: This was randomized controlled trial. SUBJECTS AND SETTING: The sample comprised 55 individuals with an ostomy who received care at Ankara University's I˙bni Sina Hospital Stoma Therapy Unit in Ankara, Turkey. Data were collected over a 2-month period (January and February 2020). METHODS: Participants were allocated into an intervention group (n = 27) who received a yoga therapy intervention and a control group (n = 28) who received no intervention via simple randomization. Demographic and pertinent clinical variables were obtained during a baseline visit in both groups, along with the Pittsburgh Sleep Quality Index (PSQI) and Stoma-Quality of Life (Stoma-QOL) instruments. The intervention group received laughter yoga weekly over a period of 8 weeks. RESULTS: Mean scores on the PSQI and the Stoma-QOL at baseline were compared. Participants in the intervention had a significant decline in mean PSQI scores (6.85 vs 5.48, P = .044) indicating improvement in sleep quality following the intervention. Analysis revealed no significant difference in mean Stoma-QOL scores (P = .077). Control group participants had no significant difference in either mean PSQI or Stoma-QOL scores following data collection at the end of 8 weeks. CONCLUSIONS: Laughter yoga had a positive effect on the sleep quality in individuals with fecal ostomies. Further research is recommended to evaluate the effect of the number of laughter yoga sessions on the sleep quality and quality of life in individuals with ostomies.

Factors contributing to the quality of life among Thai patients diagnosed with colorectal cancer with a stoma: An integrative review.

AIM: To appraise and synthesize research investigating the factors contributing to the quality of life (QOL) among Thai patients diagnosed with colorectal cancer (CRC) with a stoma. DESIGN: An integrative review. DATA SOURCES: The scientific databases CINAHL, Medline, PubMed, Web of Science, Google Scholar and ThaiJO were queried for English or Thai research articles published between 2011 and 2021. REVIEW METHODS: Included studies were searched utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. The eligible studies were critically appraised by evaluating the study level and quality using the John Hopkins Research Evidence Appraisal Tool. Whittemore and Knafl's five-stage framework was used to guide this integrative review. Primary data from each suitable study were abstracted, coded and categorized into sub-themes. Finally, themes were identified based on the review question and objective. RESULTS: Eight articles met the inclusion criteria. Twelve sub-themes and five significant themes were identified: Sociodemographic and clinical, physiological, psychological, social and spiritual aspects. CONCLUSION: Factors contributing to QOL among Thai CRC ostomates can be categorized into five domains. The sociodemographic and clinical, physiological and psychological aspects are similar to those in other countries. In the meanwhile, the social and spiritual domains differ from those in other countries, particularly in extended family support and Buddhist belief. IMPACT: By providing the QOL contributing factors, nurses can investigate the significant QOL predictors and create the appropriate interventions for promoting QOL, specifically among Thai CRC adults with a stoma. Likewise, it will be helpful to integrate this result into the nursing curriculum in Thailand and other similar countries to teach nursing students who could give direct holistic care to CRC adults with a stoma. In addition, it will serve as the basis for healthcare policy regarding nursing practice guidelines for assessing the individuals' QOL factors and promoting QOL activities after ostomy surgery. Patient or Public contribution: The ostomy nurses in Thailand are involved in the data analysis stage. They read all the included studies before the meeting. They considered and commented on the generating and synthesizing of codes, subthemes and themes.

O enfermeiro como promotor do "empowerment" parental nos cuidados à criança com ostomia intestinal / The nurse as a promoter of parental empowerment in the care of children with intestinal ostomy

Os avanços da ciência na área da saúde, conduziram a um crescimento de crianças portadoras de doença crónica, com necessidades de cuidados de saúde diferenciados, como é o caso da presença de ostomia intestinal. Nestes casos, a família assume a responsabilidade pela manutenção dos cuidados necessários, muitos deles especializados. A preparação da alta deve ser um processo precoce, envolvendo a criança e família no planeamento e execução dos cuidados, promovendo a continuidade dos mesmos no domicílio. Torna-se, um desafio para o Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica (EEESIP) em corresponder com cuidados efetivos, através de intervenções direcionadas para a participação e capacitação, possibilitando momentos de educação para a saúde com a família, estimulando o empowerment parental, conceito tão importante na adaptação à ostomia intestinal. A necessidade da existência de intervenções de enfermagem adequadas e individualizadas à criança com ostomia intestinal, com foco na promoção do empowerment parental, surge como a problemática de enfermagem desenvolvida neste relatório. Este relatório retrata um percurso formativo operacionalizado em diferentes contextos de cuidados, abrangendo diferentes áreas de intervenção à criança e família, incorporando o paradigma em prática na enfermagem, que é o da transformação. A filosofia dos cuidados centrados na família, isto é, cuidado holístico e humanizado, são conceitos do cuidar em enfermagem pediátrica integrados neste relatório. Os referenciais teóricos que sustentam este percurso formativo são a Teoria do Cuidar de Jean Watson e o Modelo de empowerment para a enfermagem de Gibson. Para cada contexto de estágio foram desenvolvidas atividades que contribuíssem para o saber avançado da disciplina de Enfermagem, sustentada numa prática reflexiva.

Advances in health science have led to an increase in the number of children with chronic illnesses, with different health care needs, such as the presence of an intestinal ostomy. In these cases, the family takes on the responsibility for maintaining the necessary care, many of which are specialized. Preparing for discharge should be an early process, involving the child and family in the planning and execution of care, promoting their continuity at home. It becomes a challenge for the Specialist Nurse in Child and Pediatric Health Nursing (SNCPHN) to provide effective care, through interventions aimed at participation and training, enabling moments of health education with the family, stimulating empowerment parenting, which is an important concept in adapting to intestinal ostomy. The topic developed in this report is the need for adequate and individualized nursing interventions for children with an intestinal ostomy, with a focus on promoting parental empowerment. This report portrays a training path operationalized in different contexts of care, covering different areas of intervention for children and families, incorporating in practice the paradigm of transformation in nursing. The philosophy of family-centered care, i.e. holistic and humanized care, are concepts of care in pediatric nursing integrated in this report. The theoretical references that support this training course are Jean Watson's Theory of Caring and Gibson's Model of Empowerment for Nursing. For each internship context, activities were developed that contributed to the advanced knowledge of the Nursing discipline, supported by a reflective practice.

It Has Become a Part of Me: Living With Low Anterior Resection Syndrome After Ostomy Reversal: A Phenomenological Study.

PURPOSE: The purpose of this study was to explore challenges of individuals living with low anterior resection syndrome (LARS) 1 year or more after ostomy reversal and formulate a greater understanding of their needs. DESIGN: Qualitative study with a phenomenological approach. SUBJECTS AND SETTING: The sample comprised 2 women and 5 men. All participants had undergone low anterior resection in the Comprehensive Cancer Center of a Swiss university hospital. The mean age of participants was 66 years (range, 61-71 years). METHODS: Interviews were conducted 12 to 42 months after ostomy reversal. Data were collected from one-on-one in-depth interviews using a standardized interview guide with open-ended questions. An interpretative phenomenological analysis was used to interpret data. RESULTS: Analysis revealed 3 central categories addressing the burden of living with LARS: "Internalizing new living conditions"; "Actively planning a new everyday life"; and "Knowing the body and controlling symptoms." "Unpredictability" emerged as the key challenge. Being informed in advance about the problems expected to arise, having the possibility to talk about problems, as well as receiving peer support and structured aftercare were identified as means to ease patients' challenges when living with LARS. CONCLUSIONS: Twelve to 42 months after stoma reversal, participants had internalized their new living conditions. Their level of acceptance of their situation was substantial. There are indications that a culture of open information before ostomy reversal contributed to being mentally prepared for the situation after surgery. Talking openly about their problems helped participants organize their everyday life.

Quality of life among ostomy patients: A narrative literature review.

AIM AND OBJECTIVE: This study aims to identify and summarise factors related to ostomy patients' experiences and how these impact the perceived quality of life for those patients. BACKGROUND: Ostomy formation is a common therapeutic technique used to treat different colorectal diseases such as colorectal cancer. Although surgical intervention and ostomy formation may prolong a patient's life, it may cause many problems in their daily lifestyle and affect their quality of life. The surgical creation of an ostomy has a significant impacts on a patient's quality of life from multiple perspectives, including physical, psychological, social and spiritual aspects. DESIGN: A narrative literature review, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline). METHODS: This review analysis of search filters was conducted in the following databases: PubMed (MEDLINE), CINAHL, Embase, ProQuest, Science Direct, Scopus, and PsycINFO. A validation data set of 283 research articles between January 2000 and December 2019 were used to identify the impact of stoma surgery on patients' quality of life. RESULT: Thirty-seven studies were identified as suitable for inclusion in this literature review. The results of the review indicate that quality of life (QoL) in patients who have an ostomy is influenced by many modifiable factors. Exercise, preoperative stoma site identification, family support, maintenance of social networks, education, spirituality and financial stability are all potentially modifiable factors that can improve the QOL for ostomy patients. CONCLUSION: This review has identified multiple challenges that ostomy patients experience, which were clustered according to physical, psychological, social and spiritual challenges. RELEVANCE TO CLINICAL PRACTICE: This study identifies issues associated with stoma creation and can help in planning and providing the required nursing care which may assist in the reduction of predictable challenges. Recommendations for future research related to nursing practice are stated.

Practice Implications from the WCET® International Ostomy Guideline 2020.

GENERAL PURPOSE: To introduce the 15 recommendations of the International Ostomy Guideline (IOG) 2020, covering the four key arenas of education, holistic aspects, and pre- and postoperative care; and to summarize key concepts for clinicians to customize for translation into their practice. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Analyze supporting evidence for the education recommendations in the IOG 2020.2. Identify a benefit of the International Charter of Ostomate Rights.3. Distinguish concepts related to pre- and postoperative ostomy-related care.4. Select a potential barrier to IOG 2020 guideline implementation.

The second edition of the WCET ® International Ostomy Guideline (IOG) was launched in December 2020 as an update to the original guideline published in 2014. The purpose of this article is to introduce the 15 recommendations covering four key arenas (education, holistic aspects, and pre- and postoperative care) and summarize key concepts for clinicians to customize for translation into their practice. The article also includes information about the impact of the novel coronavirus 2019 on ostomy care.

Self-care of people with intestinal ostomy: beyond the procedural towards rehabilitation.

OBJECTIVES: to interpret the self-care experience of people with intestinal ostomy registered in an ostomy program, based on the framework of the Social Model of Disability. METHODS: qualitative exploratory research, with the participation of nine people with intestinal ostomy, based on the Social Model of Disability. RESULTS: majority were elderly, married, male with colostomy due to colorectal neoplasia. The self-care of these people was analyzed in two thematic groups: "Interdisciplinary assistance needed for people with intestinal ostomy" and "Self-care for the rehabilitation of the person with intestinal ostomy". It was proved that there was a need for a specialized health team, offering information on disabilities, teaching self-care and perioperative follow-up. FINAL CONSIDERATIONS: when the social barriers of physical disabilities are overcome in the context of assistance for health and life, self-care will go beyond the reductionist vision of procedural care, towards comprehensive care, favoring the achievement of rehabilitation and the quality of survival.

Spiritual care needs and associated factors among patients with ostomy: A Cross-Sectional Study.

AIMS AND OBJECTIVES: To investigate the spiritual care needs and associated factors in patients with ostomy. BACKGROUND: The significance of the spiritual care needs of the patients has been emphasised across countries and cultures in the literature. DESIGN: A descriptive, cross-sectional study. METHODS: Outpatients with an ostomy (n = 127) were recruited from proctology, wound and stoma therapy unit and general surgery clinics between January and 28 March 2020. The data were collected using the Socio-demographic Characteristics Form and Spiritual Care Needs Inventory (SCNI). SCNI has two components, namely 'meaning and hope' and 'caring and respect'. Descriptive statistics, correlation, Student's t test, ANOVA and multiple linear regression analyses were used to analyse the data. The STROBE checklist was used to report the study. RESULTS: The mean scores of the spiritual care needs (65.31 ± 12.83), meaning and hope (37.35 ± 9.37), and caring and respect (27.96 ± 5.63) of the patients with ostomy were found to be moderate. The most significant factors affecting the meaning and hope component were the age, being female and decreases in the level of income. Scores of the patients who perceived the severity of the disease seriously and who practiced religious ritual regularly had more spiritual care needs for the component of caring and respect. Patients with ostomy needed interaction, respect for their privacy and dignity, to be shown concern and to be respected for their religious and cultural beliefs, which were the most salient needs. CONCLUSIONS: There is an unambiguous requirement for nurses to ensure spiritual care for patients with ostomy. Showing interest and spending time for the interaction with patients with ostomy, need-based spiritual practices and life review are key elements of spiritual care. RELEVANCE TO CLINICAL PRACTICE: Evaluating patients with ostomy spiritually requires information about how spiritual needs may arise and how to talk about spiritual needs. The result of the present study may help nurses to begin the process of maintaining spiritual care for patients with ostomy.

Self-care of people with intestinal ostomy: beyond the procedural towards rehabilitation / Autocuidado de personas con estoma intestinal: para además del procedimental rumbo al alcance de la rehabilitación / Autocuidado de pessoas com estomia intestinal: para além do procedimental rumo ao alcance da reabilitação

ABSTRACT Objectives: to interpret the self-care experience of people with intestinal ostomy registered in an ostomy program, based on the framework of the Social Model of Disability. Methods: qualitative exploratory research, with the participation of nine people with intestinal ostomy, based on the Social Model of Disability. Results: majority were elderly, married, male with colostomy due to colorectal neoplasia. The self-care of these people was analyzed in two thematic groups: "Interdisciplinary assistance needed for people with intestinal ostomy" and "Self-care for the rehabilitation of the person with intestinal ostomy". It was proved that there was a need for a specialized health team, offering information on disabilities, teaching self-care and perioperative follow-up. Final Considerations: when the social barriers of physical disabilities are overcome in the context of assistance for health and life, self-care will go beyond the reductionist vision of procedural care, towards comprehensive care, favoring the achievement of rehabilitation and the quality of survival.

RESUMEN Objetivos: interpretar la experiencia de autocuidado de personas con estoma intestinal registradas en un programa de ostomizados, fundamentándose en Modelo Social de la Discapacidad. Métodos: estudio exploratorio cualitativo, con participación de nueve personas con estoma intestinal, pautándose en Modelo Social de la Discapacidad. Resultados: mayoría anciana, casada, sexo masculino y con colostomía por neoplasia colorrectal. Analizado autocuidado de esas personas en dos núcleos temáticos: "Asistencia interdisciplinar necesaria a las personas con estoma intestinal" y "Autocuidado para la rehabilitación de persona con estoma intestinal". Mostrada necesidad del equipo de salud especializada, con ofrecimiento de informaciones sobre discapacidad, enseñanza del autocuidado y seguimiento perioperatorio. Consideraciones Finales: cuando las barreras sociales de la discapacidad física se rebasen en el contexto de la asistencia de salud y de vida, el autocuidado extrapolará la visión reduccionista del cuidado procedimental, rumbo al cuidado integral, favoreciendo el alcance de la rehabilitación y de la calidad de supervivencia.

RESUMO Objetivos: interpretar a experiência de autocuidado de pessoas com estomia intestinal cadastradas em um programa de ostomizados, fundamentando-se no referencial do Modelo Social da Deficiência. Métodos: estudo exploratório qualitativo, com participação de nove pessoas com estomia intestinal, pautando-se no Modelo Social da Deficiência. Resultados: maioria idosa, casada, do sexo masculino e com colostomia por neoplasia colorretal. Analisou-se o autocuidado dessas pessoas em dois núcleos temáticos: "Assistência interdisciplinar necessária às pessoas com estomia intestinal" e "Autocuidado para a reabilitação da pessoa com estomia intestinal". Mostrouse a necessidade de equipe de saúde especializada, com oferecimento de informações sobre deficiência, ensino do autocuidado e seguimento perioperatório. Considerações Finais: quando as barreiras sociais da deficiência física forem superadas no contexto da assistência à saúde e de vida, o autocuidado extrapolará a visão reducionista do cuidado procedimental, rumo ao cuidado integral, favorecendo o alcance da reabilitação e da qualidade de sobrevivência.

Estrategias de educación en Salud Sexual a personas con estomas de eliminación con el enfoque de la Teoría de Cuidados de Kristen Swanson. "Scoping Review" / Sexual Health education strategies for people with removal stomata with the Kristen Swanson Theory of Care approach. "Scoping Review"

Objetivo: Proponer estrategias de educación en salud sexual a personas con estomas de eliminación con el enfoque de la teoría de Cuidados de Kristen Swanson. Método: El presente estudio, se realizó con la metodología "Scoping Review", en 2 etapas: la etapa 1 se dividió en 5 fases para la obtención y análisis de los resultados obtenidos en la revisión; en la etapa 2 se planteó la elaboración de la propuesta de cuidado a través de 3 fases con los momentos del cuidado propuesto por Kristen Swanson. Resultados: Se seleccionaron 21 artículos, entre los año 2010 al 2020. Se realiza la caracterización de los artículos, se evidenció que los estudios cuantitativos aportaron el 57% de los hallazgos y el 43% corresponde a estudios cualitativos. Luego de la saturación de los contenidos de la información se obtuvieron 3 categorías: Estrategias de Educación en Salud Sexual, Mi Estoma Opción de Vida y Cuidado de Enfermeria para el Bienestar. Estas fueron usadas para la construcción de la propuesta de cuidado planteado en 6 fases durante el preoperatorio y posoperatorio. Conclusiones: Generar una propuesta de cuidado, basado en el modelo de Kristen Swanson adaptado a las necesidades de salud sexual a las personas con estomas de eliminación, se considera esencial para un abordaje y evaluación integral en el preoperatorio y posoperatorio, que permitió plantear 6 fases de la intervención educativa propuesta, como indicador empírico facilitará a enfermería brindar un cuidado holístico en este tipo de pacientes

Objective: To propose strategies of education in sexual health to people with stomata of modification with the focus of the theory of Care of Kristen Swanson. Method: The present study will be carried out with the "Scoping Review" methodology, which is divided into 2 stages: in stage 1 it is divided into 5 phases to obtain the results; in stage 2 the preparation of the care proposal through 3 phases contemplating the moments of care. Results: 21 articles were selected, between the years 2010 to 2020. The characterization of the articles was carried out, it was evidenced that quantitative studies contributed 57% of the findings and 43% correspond to qualitative studies. After saturating the information contents, 3 categories were obtained: sexual health education strategies, my stoma life option and nursing care for well-being. These were used for the construction of the care proposal proposed in 6 phases during the preoperative and postoperative periods. Conclusions: Generating a care proposal, based on Kristen Swanson's model adapted to the sexual health needs of people with removal stomata, is considered essential for a comprehensive approach and evaluation in the preoperative and postoperative period, which allowed to propose 6 phases of the proposed educational intervention, as an empirical indicator, will facilitate nursing to provide holistic care in this type of patient

Treatment of Peristomal granulomatosis with a Neem and Red Hypericum Oil application: Case studies.

BACKGROUND: Peristomal granulomatosis is a chronic inflammatory disease of uncertain aetiology, and a high recurrence rate. It frequently occurs in patients with enterostomy and urostomy. The most frequent type affects the mucocutaneous junction, causing bleeding and painful nodular lesions, which complicate management of the ostomy pouching system. Currently, only invasive treatments are available, consisting in cauterisation or surgical removal of the granuloma. Our objective was to evaluate efficacy of a topic mixture oil, composed by a 1:1 of extracts of Neem and Red Hypericum; amongst its many therapeutical properties, it is proven to inhibit the over-granulation process. METHOD: Two clinical cases presenting typical peristomal granulomatosis were selected. On first access after recruitment, the patients underwent an accurate nursing anamnesis, a global assessment was carried out according to the Toven Method and an assessment of peristomal sore skin according to SACS 2.0. Granulomatosis wounds were treated with the oil mixture, applied on a hydrofiber pad, secured over the wound site by means of a transparent film. This allowed the release of active ingredients while ensuring the pouching system secure adhesion. The chosen protocol consisted in 2 dressing changes per week, while monitoring the granulomatosis wound evolution by means of a TOR Form validated data form and documenting progress by taking photographs. RESULTS: Initially a regression of the inflammatory process was observed, with significant decrease of bleeding and pain. Gradually, the proliferating lesions reduced in size (both width and extent), and eventually healed completely. The product was very well tolerated, even when in contact with the stoma mucous membrane. No recurrence signs were observed either at the follow up visit 15 days from end of treatment, and in clinical case N.2 equally none were present two months after treatment. CONCLUSIONS: Compared to conventional methods which are invasive, not resolving, and not tolerated by patients, the product was demonstrated to be an innovative therapeutical solution, easy to apply, with no side effects and well-liked by patients. The excellent results obtained require further confirmation and validation through new studies on a statistically significant number of cases.

Custos de equipamentos coletores e adjuvantes em pacientes com estomias de eliminação / Collection and adjuvant equipment costs in patients with elimination ostomy / Costos de equipos colectores y adicionales en pacientes con estomas de eliminación

Objetivo: avaliar os custos de equipamentos coletores e adjuvantes dispensados pelo serviço público para pacientes com estomias de eliminação. Método: estudo transversal analítico realizado em um centro integrado de saúde em Teresina-PI, com 115 pacientes que receberam equipamentos e/ou adjuvantes para estomia. Os dados foram coletados nos meses de abril e maio de 2017, mediante entrevista e revisão de prontuário, utilizando formulário semiestruturado. A análise foi desenvolvida a partir de estatística descritiva e inferencial. Resultados: a maioria dos pacientes era do sexo masculino (59,1%), casado (59,1%), possuía ensino fundamental (55,7%), residia em Teresina (53,1%) e com idade média de 58,41 anos. As estomias decorrentes de trauma (R$ 302,50), as provisórias (R$ 293,75), as inferiores a três anos (R$ 289,84) e a colostomia (R$ 306,29) apresentaram maior custo médio mensal, sendo que a herniação foi a complicação com maior custo (R$ 326,70). Os pacientes que utilizaram bolsa de duas peças (R$ 317,50) e pasta (R$ 324,00) tiveram maior custo médio mensal. Ademais, aqueles com retração (R$ 53,40) e estenose (R$ 20,67) tiveram maior custo médio com adjuvantes. Houve associação significativa entre o custo mensal e o tipo de estomia (p<0,001), as complicações (p=0,011), o tipo de bolsa (p<0,001) e os adjuvantes (p=0,020). Conclusão: observou-se que numerosas variáveis relacionadas às estomias, aos equipamentos coletores e aos adjuvantes apresentaram associação significativa com os custos mensais. Diante disso, espera-se contribuir para melhoria da prática assistencial de Enfermagem na dispensação de materiais e no gerenciamento da assistência às pessoas com estomias.(AU)

Objective: to evaluate the costs of collecting equipment and adjuvants dispensed by the public service for patients with elimination ostomies. Method: an analytical cross-sectional study performed at an integrated health center in Teresina-PI, with 115 patients who received equipment and / or adjuvants for the ostomy. The data were collected in April and May of 2017, through an interview and review of medical records, using semi-structured form. The analysis was developed from descriptive and inferential statistics. Results: most of the patients were male (59.1%), married (59.1%), had primary education (55.7%), resided in Teresina (53.1%) and had a mean age of 58.41 years old. Trauma (R$ 302.50), provisional (R$ 293.75), lower than three years (R$ 289.84) and colostomy (R$ 306.29) had a higher average monthly cost, and herniation was the costliest complication (R$ 326.70). Patients who used a two-piece bag (R$ 317.50) and paste (R$ 324.00) had a higher average monthly cost. In addition, those with retraction (R$ 53.40) and stenosis (R$ 20.67) had higher average cost with adjuvants. There was a significant association between monthly cost and type of stoma (p <0.001), complications (p = 0.011), type of pouch (p <0.001) and adjuvants...(AU)

Objetivo: evaluar costos de los equipos colectores y adicionales suministrados por servicios públicos para pacientes con estoma de eliminación. Método: estudio transversal analítico realizado en un centro integrado de salud de Teresina (PI) con 115 pacientes que recibieron equipos y/ o adicionales para estoma. Los datos se recogieron en abril y mayo de 2017 a través de entrevistas y revisión de expedientes, con cuestionario semiestructurado. El análisis se efectuó en base a estadística descriptiva e inferencial. Resultados: la mayoría de los pacientes era del sexo masculino (59,1%), casada (59,1%) con instrucción básica (55,7%), domiciliada en Teresina (53,1%) y edad promedio de 58, 41 años. Los estomas resultantes del trauma (R$ 302,50), los provisionales (R$ 293, 75), los inferiores a 3 años (R$ 289,84) y la colostomía (R$ 306,29) presentaron un costo superior al promedio mensual; la herniación fue la complicación de mayor costo (R$ 326,70). El costo promedio mensual de los pacientes que usaron bolsas de dos piezas (R$ 317,50) y pasta (R$ 324,00) fue mayor. Aquéllos con retracción (R$ 53,40) y estenosis (R$ 20,67) presentaron mayor costo promedio mensual con adicionales. Asociación significativa entre costo mensual y tipo de estoma (p<0,001), complicaciones (p=0,011), tipo de bolsa p<0,001 ) y adicionales (p=0,020). Conclusión: variables vinculadas con estomas, equipos colectores y adicionales presentaron asociación significativa con costos mensuales. Se espera poder contribuir a mejorar la práctica asistencial de enfermería en el suministro de material y en gestión de la atención de personas con estoma.(AU)

Nutritional Management of a Patient with a High-Output Stoma after Extensive Small Bowel Resection to Treat Crohn's Disease

For patients with short bowel syndrome who undergo ileostomy, nutritional management is essential to prevent complications associated with a high-output stoma (HOS). We report a practical example of ostomic, medical nutrition therapy provided by an intensive nutritional support team (NST). A 42-year-old male with a history of Crohn's disease visited Seoul National University Hospital for treatment of mechanical ileus. He underwent loop ileostomy after extensive small bowel resection. As his remaining small bowel was only 160 cm in length, the stomal output was about 3,000 mL/day and his body weight fell from 52.4 to 40.3 kg. Given his clinical condition, continuous tube feeding for 24 h was used to promote adaptation of the remnant bowel. Thereafter, an oral diet was initiated and multiple, nutritional educational sessions were offered by dietitians. Constant infusion therapy was prescribed and included in the discharge plan. Two months after discharge, his body weight had increased to 46.6 kg and his hydration status was appropriately maintained. This case suggests that the critical features of medical nutritional therapy for ostomy management are frequent assessments of fluid balance, weight history, and laboratory data and after nutritional interventions.

The Impact of Ostomy Creation after Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in a Newly Established Peritoneal Malignancy Program.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes for selected patients with peritoneal carcinomatosis and often requires ostomy creation. We examined the impact of ostomy creation in a newly established peritoneal malignancy program. A retrospective review was performed of CRS-HIPEC procedures from 2011 to 2016. Those who did and did not receive an ostomy were compared. Fifty-eight patients underwent CRS-HIPEC and an ostomy was created in 25.9 per cent. Median peritoneal cancer index (14 vs 16, P = 0.63) and multivisceral resection rates (87.9 vs 100.0%, P = 0.17) were similar between groups. Multivariable analysis revealed that bowel resection (OR 210.65, P = 0.02) was significantly associated with ostomy creation. Advanced age was noted to be inversely associated with stoma formation (OR 0.04, P = 0.04). Progression-free survival was significantly lower in the ostomy group (18 vs 23 months, P = 0.03). Those with an ostomy experienced prolonged length of stay (13.3 ± 7.4 vs 9.5 ± 3.7, P = 0.01). At follow-up, 6/10 temporary ostomies had undergone reversal and three patients experienced morbidity after reversal. Ostomy creation may occur during CRS-HIPEC and carries potential for morbidity. Ostomy creation may contribute to postoperative length of stay. Patients should be counseled preoperatively on the potential impact of ostomy placement during CRS-HIPEC.

Ongoing ostomy self-care challenges of long-term rectal cancer survivors.

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.

Laparoscopic Appendicostomy Low-Profile Balloon Button for Antegrade Enemas in Children.

INTRODUCTION: The Malone appendicostomy is a continent channel used for antegrade enemas. It requires daily cannulation and is susceptible to stenosis. We use an indwelling low-profile balloon button tube inserted through the appendix into the cecum for antegrade enemas. We hypothesized that this method is effective at managing constipation or fecal incontinence and is associated with a low rate of stenosis. METHODS: Children who underwent laparoscopic appendicostomy balloon button placement at our institution from January 2011 to April 2017 were identified. The primary outcome was success in managing constipation or fecal continence as measured by the Malone continence scale. Postoperative complications were analyzed. RESULTS: Thirty-six children underwent the procedure, 35 of which met the inclusion criteria. Thirty-one patients (88.5%) underwent the operation for idiopathic constipation, 3 patients (8.6%) for anorectal malformation, and 1 patient (2.9%) for hypermobility. Rate of open conversion was 3%. A full response was obtained in 24 patients (68.6%), partial response in 9 patients (25.7%), and 2 patients failed (5.7%). One patient developed an internal hernia requiring laparotomy and later developed mucosal prolapse. One patient developed a stricture noted at button change. Seven patients (20%) underwent reversal of their appendicostomy tube: 5 due to return of normal bowel function and 2 due to discomfort with flushes. CONCLUSION: A laparoscopic appendicostomy with a balloon button tube is an effective means of addressing chronic constipation or fecal incontinence. The stenosis rate associated with tube appendicostomy may be lower than those reported for Malone antegrade continence enema procedures.

Factors Associated with 60-Day Readmission Following Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy.

INTRODUCTION: Readmission rates following surgery are subject to scrutiny in efforts to control health care costs. This study was designed to define the 60-day readmission rate following cytoreduction and HIPEC at a high-volume center and to identify factors associated with readmission. METHODS: Patients who underwent complete cytoreduction and HIPEC at a single institution from August 2007 through June 2014 were identified from a prospectively maintained database. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day readmission following surgery. RESULTS: A total of 250 patients were identified. Forty patients (17%) experienced readmission within 60 days of surgery. The most common reasons for readmission were ileus/dehydration (12, 31%), deep space infection (8, 21%), and DVT/PE (6, 15%). Initial postoperative length of stay was longer for patients readmitted within 60 days (median 12 vs. 9 days, p = 0.013). Of categorical variables analyzed, including gender, histology, HIPEC agent, intraoperative transfusion, and individual procedures performed during cytoreduction, adjuvant systemic therapy, and postoperative morbidity, only Charlson comorbidity index CCI (odds ratio (OR) = 3.80 [1.68-8.60]) and stoma creation (OR = 6.04 [1.56-12.14]) were associated with 60-day readmission. CONCLUSIONS: Few measurable variables are associated with readmission following cytoreduction and HIPEC. Patients with high CCI and those with stomas created at the time of CRS/HIPEC may be at increased risk of readmission within 60 days. Earlier or more frequent follow-up for high-risk patients should be considered as a strategy to reduce readmissions.