Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study.

BACKGROUND: Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. OBJECTIVE: To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain. DESIGN: Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019. SETTINGS AND PARTICIPANTS: The research sample consisted of a group of 39 nurses with expertise in the care of ostomates. METHODS: A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement. RESULTS: A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. CONCLUSIONS: The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.

Peristomal Pyoderma Gangrenosum in a Rectal Cancer Patient With an Ileostomy: A Case Study.

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a rare complication mainly associated with inflammatory bowel disease. Although it has also been found in patients with an ileostomy with rectal cancer, the best treatment options in this context have not been precisely elucidated. CASE: This case report describes the importance of a multidisciplinary treatment approach for a rare case of PPG around a protective ileostomy resulting from rectal cancer. CONCLUSIONS: Early diagnosis of PPG is imperative to avoid further extension of the lesion. Aggressive management with a multidrug treatment, both topical and systemic, is recommended in severe cases. Close monitoring of the response is necessary, given the variability in the effectiveness of the treatments.

Pioderma gangrenoso peri-ileostomía / Peri-ileostomy pyoderma gangrenosum. Case report

El pioderma gangrenoso es una de las complicaciones más graves que se pueden presentar tras la realización de un estoma. A pesar de los pocos casos descritos en la literatura, se considera que está infradiagnosticado. Se presenta un caso de pioderma gangrenoso peri-ileostomía en una paciente sometida a pancoloproctectomía e ileostomía definitiva por colitis ulcerosa. El tratamiento se basó en curas locales, adecuación de los dispositivos colectores, aplicación tópica de tacrolimus y administración sistémica de corticoides, adalimumab y antibióticos. La curación se produjo en ocho semanas de manera satisfactoria (AU)

Pyoderma gangrenosum is one of the most severe complications that can occur following stoma placement. Despite few cases reported in the literature, it is considered an underdiagnosed entity. We present a case of peri-ileostomy pyoderma gangrenosum (PPG) in a patient who underwent a pancoloproctectomy and permanent ileostomy due to ulcerative colitis (UC). Treatment was based on local cures, proper fitting of ostomy devices, topical tacrolimus and systemic corticosteroids, adalimumab and antibiotics. Satisfactory resolution was achieved in eight weeks (AU)

[To evaluate the quality of life and peristomal skin ostomy patient with the new device Sensura]. / Evaluación de la calidad de vida y de la piel periestomal del paciente ostomizado con el nuevo dispositivo SenSura.

UNLABELLED: In 2006, Coloplast launched in several European countries a new device for ostomy care called Sensura. This clinical research report includes only the results of the subpopulation included in Spain as a part of an international study involving many countries such as Denmark, United States, Canada, Australia, Poland, Netherlands, France, Slovakia, Germany, UK, Italy, Iceland, Japan, Czech Republic, Portugal, South Korea and Argentina. OBJECTIVES AND STUDY VARIABLES: The main purpose of the study is to evaluate the experience with Sensura, under normal conditions of use, with special attention to skin condition and quality of life. The main objective of the study is to evaluate the quality of life, through Quality of Life Questionnaire called "Stoma QoL". A secondary objective, is to study the correlation between quality of life and the peristomal skin condition. Other Secondary objectives include the evaluation of the patient's current device at the time of entering the study and by the other hand, the device Sensura and safety evaluation throughout the study. DESIGN STUDY: The study was designed as an open label non-comparative, multi-national Post Market study. The study period for each patient is 6 to 8 weeks +/- 4 days, which includes an initial visit and a final visit. The study population included people who carry a colostomy or ileostomy. METHODOLOGY: Regarding Spain, a total of 10 sites participated and included a total of 131 patients. This report only presents results for nine sites and a total of 123 patients. The reason is that the last participating site began the study with a considerable delay The remaining subjects included in this site together with the other centers in Spain and the other participating countries will be included in the final international report, that will present the overall results. MEASUREMENT TOOLS. Stoma-QoL (Quality of Life Questionnaire for people with an ostomy). OST (Ostomy Skin Tool) instrument for the assessment of peristomal skin. RESULTS: As for the quality of life, at baseline we found a mean of 59 out of 100 (SD = 8.8), while the final study visit, mean score was 59.6 out of 100 (SD = 9.3), although the final results on this variable will be presented in the global report, since it has not reached sufficient population in Spain for the analysis of this variable. The study revealed a significant improvement in the peristomal skin condition at the end of the study, measured by the tool OST (Ostomy Skin Tool). Regarding the evaluation of the SenSura device, there was a significant improvement related to the appearance of leakage of effluent, as well as other items evaluated in relation with the device.

Dialogue study. Evaluación de la calidad de vida y de la piel periestomal del paciente ostomizado con el nuevo dispositivo SenSura / Dialogue study. To evaluate the quality of life and peristomal skin ostomy patient with the new device Sensura

En el año 2006, Coloplast comercializó en distintos países europeos un nuevo dispositivo para ostomías llamado SenSura. El presente informe de la investigación clínica incluye exclusivamente los resultados de la subpoblación incluida en España, como parte de un estudio internacional, en el que participaron numerosos países como Dinamarca, Estados Unidos, Canadá, Australia, Polonia, Países Bajos, Francia, Eslovaquia, Alemania, Reino Unido, Italia, Islandia, Japón, República Checa, Portugal, España, Corea del Sur y Argentina. Objetivos y variables de estudio. El propósito principal es evaluar la experiencia práctica con este dispositivo, en condiciones normales de uso, con especial atención al estado de la piel y a la calidad de vida. El objetivo principal es la evaluación de la calidad de vida a través del Cuestionario de Calidad de Vida llamado «Stoma QoL». En cuanto a los objetivos secundarios encontramos el estudio de la correlación entre calidad de vida y el estado de la piel periestomal. Otros son la evaluación del dispositivo utilizado habitualmente por el paciente en el momento de entrar en el estudio, así como el dispositivo SenSura y el registro de acontecimientos adversos a lo largo de todo el proceso. Diseño del estudio. Se trata de un estudio abierto, longitudinal, internacional, no comparativo y post-comercialización. El período de estudio para cada paciente es de seis a ocho semanas +/– cuatro días, incluyendo una visita inicial y otra final. La población del estudio consiste en personas portadoras de una colostomía o una ileostomía. Metodología. En España participaron un total de 10 centros, para un total de 131 pacientes. En el presente informe únicamente se presentan resultados correspondientes a nueve centros y un total de 123 pacientes. El motivo es que el último centro comenzó el estudio con un retraso considerable. Los pacientes correspondientes a éste, junto con el resto de centros en España, serán incluidos en el próximo informe de investigación clínica internacional. Herramientas de medición. Stoma-QoL (Cuestionario de calidad de vida para personas ostomizadas). OST (Ostomy Skin Tool) Instrumento para la evaluación de la piel periestomal. Resultados. En cuanto a la calidad de vida, en la visita basal nos encontramos con una media de 59 sobre 100 (SD= 8,8), mientras que en la visita final del estudio, la puntuación media obtenida ha sido de 59,6 sobre 100 (SD= 9,3), aunque los resultados definitivos con respecto a esta variable se presentarán en el informe global, dado que no se ha alcanzado población suficiente en España para el análisis de esta variable. El estudio reveló una mejora significativa en el estado de la piel periestomal al final del mismo, medida a través de la herramienta OST (Ostomy Skin Tool). En cuanto a la evaluación del dispositivo SenSura, se registró una mejora significativa con respecto a la aparición de fugas de efluente, así como del resto de ítems evaluados en relación con el dispositivo(AU)

In 2006, Coloplast launched in several European countries a new device for ostomy care called Sensura. This clinical research report includes only the results of the subpopulation included in Spain as a part of an international study, involving many countries such as Denmark, United States, Canada, Australia, Poland, Netherlands, France, Slovakia, Germany, UK, Italy, Iceland, Japan, Czech Republic, Portugal, South Korea and Argentina. Objectives and study variables. The main purpose of the study is to evaluate the experience with Sensura, under normal conditions of use, with special attention to skin condition and quality of life. The main objective of the study is to evaluate the quality of life, through Quality of Life Questionnaire called «Stoma QoL». A secondary objective, is to study the correlation between quality of life and the peristomal skin condition. Other Secondary objectives include the evaluation of the patient's current device at the time of entering the study, and by the other hand, the device Sensura and safety evaluation throughout the study. Design study. The study was designed as an open label, non-comparative, multi-national Post Market study. The study period for each patient is 6 to 8 weeks +/– 4 days, which includes an initial visit and a final visit. The study population included people who carry a colostomy or ileostomy. Methodology. Regarding Spain, a total of 10 sites participated and included a total of 131 patients. This report only presents results for nine sites and a total of 123 patients. The reason is that the last participating site began the study with a considerable delay. The remaining subjects included in this site together with the other centers in Spain and the other participating countries will be included in the final international report, that will present the overall results. Measurement tools. Stoma-QoL (Quality of Life Questionnaire for people with an ostomy). OST (Ostomy Skin Tool) instrument for the assessment of peristomal skin. Results. As for the quality of life, at baseline we found a mean of 59 out of 100 (SD = 8.8), while the final study visit, mean score was 59.6 out of 100 (SD = 9.3), although the final results on this variable will be presented in the global report, since since it has not reached sufficient population in Spain for the analysis of this variable. The study revealed a significant improvement in the peristomal skin condition at the end of the study, measured by the tool OST (Ostomy Skin Tool). Regarding the evaluation of the SenSura device, there was a significant improvement related to the appearance of leakage of effluent, as well as other items evaluated in relation with the device(AU)