Development of a leakage impact assessment for patients with a stoma, who may be impacted by leakage.

For people living with a stoma leakage is unpredictable. Despite advances in stoma products, leakage can lead to soiling and this, along with worrying about leakage, can significantly affect patients' everyday lives and impact their quality of life. It is also associated with excessive product use and increased healthcare resources. Leakage therefore remains a major unmet need for many people living with a stoma. To address this, Coloplast Ltd in collaboration with the authors and a broader group of stoma care nurses have worked together to develop a first version of the Leakage Impact Assessment. This assessment is intended to identify patients who struggle with leakage and leakage worry, and who might benefit from the reassurance that a new digital leakage notification system, Heylo™, can provide. This article reviews the evidence for leakage and its impact on people living with a stoma and outlines the development process for the assessment.

Protocol for the UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study).

AIM: Abdominal surgery sometimes necessitates the creation of a stoma, which can cause future complications including parastomal hernia (PSH), an incisional hernia adjacent to and related to the stoma. PSH affects approximately 40% of patients within 2 years of stoma formation. Complications of PSH reduce a patient's quality of life and can be severe (e.g. bowel obstruction). PSHs are difficult to manage and can recur after surgical repair. Therefore, it is very important to prevent a PSH. Surgeons create stomas in different ways and both patient and surgical factors are believed to influence the development of PSH. The aim of the CIPHER study is to investigate the influence of different surgical techniques on the development of PSH. METHOD: The UK cohort study to investigate the prevention of parastomal hernia (the CIPHER study) aims to recruit 4000 patients undergoing elective or expedited surgery with the intention of forming an ileostomy or colostomy, irrespective of the primary indication for the planned surgery. For each patient, surgeons will describe their methods of trephine formation, mesh reinforcement of the stoma trephine, use of the stoma as a specimen extraction site and wound closure. The primary outcome will be incident PSH during follow-up, defined as symptoms of PSH (custom-designed questionnaire) and anatomical PSH, ascertained by independent reading of usual care CT scans. Secondary outcomes will include surgical site infection, the Comprehensive Complication Index, quality of life (EQ-5D-5L and SF-12), PSH repair and use of NHS resources. RESULTS: Results of the study will be submitted for publication in peer-reviewed journals. All publications relating to the results of CIPHER will use a corporate authorship, 'The CIPHER Study Investigators' with named writing committee members. CONCLUSION: The CIPHER study will be the first to investigate detailed surgical methods of stoma formation in a large, representative cohort of patients with a range of primary indications, both cancer and noncancer.

Incorporating the Principles of Nursing Practice and the 6Cs.

This article will demonstrate how the Royal College of Nursing's (RCN's) Principles of Nursing Practice (2010) and the 6Cs (Cummings and Bennett, 2012a ; 2012b) can be applied to stoma care nursing. The multidimensional role of the stoma care nurse means that he or she is well placed to improve quality and standards in stoma nursing care. Stoma care nurses provide direct patient care and can play a vital part in helping patients with a stoma, a long-term condition, ensuring that their patients get the best possible care (RCN, 2010). The poster contained within this article was displayed at the Association of Stoma Care Nurses (ASCN) national conference in Harrogate in October 2014 and was voted the overall winner. The authors of the article and the poster are stoma care nurses working in the acute and community settings and, between 2013 and 2014, they completed the RCN's Clinical Leadership Programme (RCN, 2005). The NHS Plan (Department of Health, 2000) identified the importance of leadership and the necessity of remodelling the NHS around the needs of service users. With this in mind, using the Principles of Nursing Practice and the 6Cs within stoma care demonstrates development with a consistent focus on patient care.