Crohn's Disease-Related Stoma Complications and Their Impact on Postsurgical Course.

INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. The diversion through a colostomy or an ileostomy is sometimes required for disease control. In these patients, common stoma-related complications sum up with CD-related complications and often require revisional surgery. METHODS: The aim of the study was to assess stoma morbidity after surgery for CD and to identify the burden of CD-related or CD-associated complications. Thus, details of past medical history, surgery, and follow-up of 54 consecutive patients operated on for CD with any sort of stoma were retrieved from the stoma therapist prospectively maintained database. RESULTS: In our series, 23 patients had a colostomy, and 31 patients had an ileostomy. Complications occurred after stoma creation in 38 patients (70%) at a median of 1.3 months (interquartile range 0.6-7.2). CD-related complications arose in 8 patients (including pyoderma gangrenosum in 3 patients, peristomal fistulae in 2, granulomas in 2, and peristomal abscess in 1). Patients with CD-related complications tended to have a shorter disease duration (p = 0.07) and higher occurrence of CD-related complications was associated with end-stoma (p = 0.006). In this cohort, 11 cases had to be surgically treated for peristomal fistulae or abscess, parastomal hernia, prolapse, pyoderma gangrenosum, and recurrent CD. DISCUSSION/CONCLUSIONS: In patients with CD, stoma creation is burdened by a high rate of postoperative complication and a relevant rate is specifically related to CD. Often these patients are required to be reoperated on to redo the stoma. Moreover, end-stoma configuration and aggressive CD phenotype are associated to a higher rate of complications.

Surgical management of urinary diversion and stomas in adults: multidisciplinary Italian panel guidelines.

INTRODUCTION: Urinary stomas represent a worldwide medical and social problem. Data from literature about stoma management are extensive, but inhomogeneous. No guidelines exist about this topic. Therefore, clear, and comprehensive clinical guidelines based on evidence-based data and best practice are needed. The aim of this article was to elaborate guidelines for practice management of urinary stomas in adults. EVIDENCE ACQUISITION: Experts guided review of the literature was performed in PubMed, National Guideline Clearing-house and other databases (updated March 31, 2018). The research included guidelines, systematic reviews, meta-analysis, randomized clinical trials, cohort studies and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care" and "stoma reversal." The systematic review was performed for each topic and studies were evaluated according to the GRADE system, AGREE II tool. Recommendations were elaborated in the form of statements with an established grade of recommendation for each statement. For low level of scientific evidence statements a consensus conference composed by expert members of the major Italian scientific societies in the field of stoma management and care was performed. EVIDENCE SYNTHESIS: After discussing, correcting, validating, or eliminating the statements by the experts, the final version of the guidelines with definitive recommendations was elaborated and prepared for publication. This manuscript is focused on statements about surgical management of urinary stomas. These guidelines include recommendations for adult patients only, articles published in English or Italian and with complete text available. CONCLUSIONS: These guidelines represent the first Italian guidelines about urinary stoma multidisciplinary management with the aim to assist urologists and stoma specialized nurses during the urinary stoma management and care.

Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary.

PURPOSE: This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. METHODS: Scoping review and generation of evidence and consensus-based clinical guidelines. SEARCH STRATEGY: The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. FINDINGS/CONCLUSIONS: This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Patient flow for the management of ostomy patients.

Subjects undergoing ostomy are increasing and share a reduced quality of life. The patient flow (PF) is the pathway of a patient from hospital admission to discharge and should provide care appropriateness to the patient himself. In the recent literature no paper exists regarding the PF of the patient undergoing (intestinal or urinary) ostomy, which is the objective of the present article. This paper stems from the work done during the Educational Camp entitled "The Patient Flow in Stoma Care," which took place on three separate days (27th May, 18th September, and 21st November 2019) at B. Braun Milano S.p.A. and regarded 33 stomatherapy nurses from all over Italy supervised by the authors. The participants, divided into heterogeneous groups, developed the PF by means of three specific work methodologies: mental maps, timeline and appreciative inquiry. The elaborated PF was inspired to the International Charter of the Ostomates' Rights. The efficacious and empathic communication and the role of the patient and/or the caregiver as the main characters are transversal to every step and must be always pursued. The PF is developed in eight macro-areas: diagnosis; pre-admission; admission and preoperative phase; surgical operation; awakening; postoperative phase; discharge; follow-up. In agreement with the recent literature, this systematic approach will give benefits to the patients in terms of outcome and perception of taking charge before, during and after the ostomy. At the same time the performances, the therapeutic appropriateness, the optimization of technology and healthcare resources and the staff satisfaction will equally be guaranteed.

Ostomy Adjustment Inventory-23 (OAI-23): Development and Testing of the Italian Version.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Italian version of the Ostomy Adjustment Inventory-23 (OAI-23). DESIGN: This is a methodological study evaluated psychometric properties of the OAI-23. SUBJECTS AND SETTING: A sample of 230 patients with an ostomy was enrolled in an Italian university hospital from May to September 2017. METHODS: This study comprised two phases; during phase 1, the cultural-linguistic translation of the OAI-23 into Italian was completed. In addition, content and face validity were tested. In phase 2, psychometric testing of the OAI-23 was conducted in a cross-section sample of 258 Italian patients with a fecal ostomy. RESULTS: The Italian version of the OAI-23 presents 23 items giving a 3-dimensional structure: acceptance, negative feelings, and social engagement. Accordingly, this 3-dimensional structure arise from an exploratory factorial analysis with the maximum likelihood robust estimator (RMSEA = 0.089 [95% CI = 0.063-0.113; P = .05], and CFI = 0.901, explaining 44% of the total variance). The internal consistency of the OAI-23 was good (Cronbach α for acceptance = 0.91; for negative feelings = 0.87; for social engagement = 0.93; for overall scale = 0.91). CONCLUSIONS: The OAI-23 provides a valid and reliable assessment of patients' psychosocial adjustment to an ostomy. It provides important resource for clinical decision-making; for example, it may be used to design or tailor educational strategies to enhance psychosocial adjustment following creation of an ostomy.

Design and validation of a "Peristomal Lesion Scale" for peristomal skin assessment.

Many people in Italy undergo ostomy because of illness, and this can have negative psychological and physical effects. It is estimated that 15%-43% of ostomates suffer from skin complications in the peristomal area. During their life, many ostomates experience at least one peristomal lesion, and they turn to stomal therapy centres where trained nurses provide patient care and manage skin complications. To ensure a good quality of life for patients, and to take prompt action for the prevention and treatment of stomal lesions, it is essential to use appropriate assessment tools. The aim of this study was to develop a reliable peristomal skin assessment tool (Peristomal Lesion Scale [PLS]) for classifying lesions based on their severity; and to compare its validity with the most widely used peristomal tool in Italy, SACS. The new tool was designed by a team of experts, focusing on patients' demographics, clinical characteristics, and classification of the lesions by severity and topography. The results of this comparative validation study indicate that the PLS better discriminates lesions by their severity because of its level of detail, using a standardised terminology, and its completeness. The PLS is a valid tool for use in the daily work of stomal therapists.

Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients: An Executive Summary.

Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN, and gastrointestinal complications.

[Medicine wards of Local Health Authority 18 of Rovigo - Prospective Survey]. / Score (BRASS) nei reparti di Geriatria e Medicina dell'Azienda Ulss 18 di Rovigo - Studio prospettico.

AIM: The primary objective of the study is to measure the phenomenon of the difficult discharge through the implementation and use of a validated instrument that can support later the nurse in planning the discharge of patients hospitalized in the departments of Medi- cine and Geriatrics. SECONDARY OBJECTIVES: - Experience using the index of BRASS - To study the characteristics of the population at risk of difficult discharge METHOD: prospective observational study to measure the phenomenon of the difficult discharge through the implementation of the index of BRASS in the Medicine and Geriatrics wards of Hospital of Rovigo Ulss 18, in order to study the characteristics of the population at risk of discharge difficult. RESULTS: In a sample of 165 patients, 42.4% (70) respectively at risk was high and medium discharge difficult, while 15.2% (25) were at low risk. The average score was 18.76 BRASS. 37.6% of high-risk patients were hospitalized in Geriatrics, while in Medicine patients are more concentrated in the middle class risk. CONCLUSIONS: The study made it possible to measure the phenomenon of the difficult discharge classifying patients into risk groups. The analysis of the resignation protected revealed the congruence between score BRASS and sample characteristics. The instrument does not require long compile times, is to support decision-making because of the nurse notes the need to create a structured on the discharge of the patient, in a systematic and planned, avoi- ding the dispersion of important information to the right to ensure continuity welfare.

Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs.

Changes in decision-making among Italian nurses and nursing students over the last 15 years.

AIMS AND OBJECTIVES: The study aimed at identifying the cognitive strategies used by nurses and nursing students in using information for clinical decision-making and comparing such abilities retrospectively, over the past 15 years. BACKGROUND: Within the context of Italian healthcare professions, a process of cultural role development has been ongoing for several years, in the wake of normative and institutional changes. However, the ability to use information for clinical nursing decision-making has been little studied. DESIGN: Three independent observational studies, with convenience samples of Italian clinical nurses and nursing students recruited at three time-points (1997, 2007, 2012). METHODS: The total sample consisted of 2855 subjects (1406 Nurses and 1449 Nursing Students). Nurses from various clinical realities were subdivided into two classes (less or more than 10 years of experience). Data were collected according to Jenkins' 'Clinical Decision Making in Nursing Scale'. RESULTS: A trend of decreasing skills in information strategies emerged in both nurses and nursing students from 1997-2012. All subjects totalled values in the lowest class (0-130) of the Clinical Decision Making in Nursing Scale of final scoring. Particularly evident were the decreased scores for nursing students from 1997 to 2007-2012. Comparing nurses with nursing students, the former had significantly higher scores. Comparing experienced nurses with novices, the former again had significantly higher scores. Interestingly, in 1997, nursing students had higher scores than nurses, although this result was not confirmed for the other 2 years. CONCLUSIONS: Results showed consistently decreased competence in the use of information skills, particularly among nursing students. RELEVANCE TO CLINICAL PRACTICE: All transformations in training in university-level teaching of nursing show that decision-making skills are continually and significantly worsening. These results are of special interest in view of changes in professional and educational systems.

[Tables of Moses: nursing research project]. / Mosè--le tavole, progetto di ricerca infermieristica.

UNLABELLED: A review of literature and in others realities of our country has been done to verify the existence of welfare procedure in stomatherapy. It has been pointed out that the behaviours are not supported by evidence and that the given performances are not measurable. It borns the idea to start a nursing research finalized to define care standards procedures supported by evidence. MATERIALS AND METHOD: Once the project group is formed with nurses, ET nurses and surgeons, the research is structured in the following points: predisposition of nursing protocols; predisposition of evaluation tools for each protocol; experimentation of the tools with 150 national investigators specifically trained; gathering, elaboration and interpretation of the data; on 13.172 forms picked up, 2.034 has been regularly fulfilled; distribution of the knowledge through a text, the associative magazine, presentation at courses and associative congresses; Research development: the critic results analysis has permitted to recognize areas on which continue the research. CONCLUSION: Data confirms the validity of specifics check-lists and protocols even if the research says the achievement of care standards results through codified performances, to disadvantage of a case-control way for example.