The psychometric properties of the Turkish version of the Ostomy Self-Care Index and the Caregiver Contribution to Self-Care in Ostomy Patient Index.

BACKGROUND: Living with an ostomy is a chronic condition, and self-care in such cases improves patient outcomes. PURPOSE: To adapt and test the psychometric properties of the Turkish version of the Ostomy Self-Care Index (T-OSCI) and the Turkish version of the Caregiver Contribution to Self-Care in Ostomy Patient Index (T-CC-OSCI). METHODS: A psychometric study was conducted on a convenience sample of 202 adult patients with an ostomy and their 165 caregivers. Translation and back translation, face and content validity, construct validation, and reliability assessment of the T-OSCI and the T-CC-OSCI were performed. Exploratory factor analysis was used to evaluate the construct validity. Reliability was established using Cronbach α coefficients, ceiling and floor effects, and the Hotelling T2 test, Wilcoxon signed rank test, and intraclass correlation coefficient. RESULTS: Content validity values were in the range of 0.85 to 1 for both the T-OSCI and the T-CC-OSCI. Exploratory factor analysis demonstrated generally acceptable factor loadings. The overall index revealed a high level of internal consistency (T-OSCI = 0.968, T-CC-OSCI = 0.862). No statistically significant difference was found between test-retest measurements. There was no indication of either ceiling or floor effects, or response bias. CONCLUSION: The T-OSCI and the T-CC-OSCI are valid and reliable indexes to measure the self-care of patients with an ostomy and their caregivers. These indexes may allow health care professionals to evaluate self-care in research and clinical settings, identify educational needs, and collaborate in developing and supporting appropriate self-care initiatives for patients with an ostomy and their caregivers.

The Effect of Pelvic Floor Muscle Exercises on Bowel Evacuation and Quality of Life in Following Intestinal Ostomy Closure: Randomized Controlled Trial.

PURPOSE: This purpose of this study was to evaluate the effect of pelvic floor muscle exercises (PFMEs) on bowel evacuation problems and health-related quality of life (HRQOL) following ostomy closure. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: Forty individuals following ostomy closure consented to participate in the study; 6 participants (15%) did not complete the trial (2 died and 2 required a second ostomy) yielding a study sample of 34. Participants were randomly allocated to an Exercise Group (EG, n = 17) and Control Group (CG, n = 17). The mean age of the EG was 55.7 (SD 12.6) years, whereas the mean age of the CG was 62.0 (SD 12.1) years. The study setting was the surgery clinic of 4 hospitals in Ankara, Turkey. Data were collected between December 2018 and May 2020. METHODS: The study intervention, PFME training by a clinician, was administered to participants in the EG; CG participants received no information regarding PFME. Data were collected during face-to-face interviews on the day before discharge and by phone at the first, second, third, and sixth months after surgery. A questionnaire was used for data collection that queried a demographic and pertinent clinical questions, along with the Assessment Form for Bowel Evacuation Habits and Psychosocial Problems, Wexner Scale, and the Short Form (SF-36) Health-related Quality of Life Scale. Descriptive statistics and Mann-Whitney U test, t-test, Pearson-χ2 test, Fisher's Exact test, Friedman test, and Cochran-Q test statistical analysis according to normal distribution were used in data evaluation. RESULTS: The number of defecations in the EG was statistically significantly lower than the CG at the second, third, and sixth months (P = .002, P = .002, P = .001, respectively). In addition, the number of individuals experiencing night defecation was statistically significantly less in the EG compared to the CG at the second-, third-, and sixth-month follow-ups (P = .001, P = .001, P = .028, respectively). HRQOL scores were also significantly higher in the EG. CONCLUSION: Pelvic floor exercises applied after ostomy closure are effective in reducing bowel evacuation and increasing quality of life. Given these findings, PFMEs are recommended for patients after ostomy closure.

The Lived Experience of Patients with an Ostomy: A Pilot Study on the Effect of Ostomy Pouch Opacity.

OBJECTIVE: To explore the effects of ostomy pouch opacity on the lived experience of patients with ostomies in the postoperative period. METHODS: This qualitative, descriptive phenomenology study used purposive sampling to recruit seven participants who were inpatients in an acute care facility in Central Ontario, Canada, after their first ostomy surgery. Face-to-face, audio-recorded, semistructured interviews were used to collect data regarding patient experience with either a transparent or opaque ostomy pouch. Data were collected between August and November 2019. Audio tapes were transcribed verbatim and analyzed using a thematic analysis technique focused on describing patient lived experience. RESULTS: Five themes were discovered: "undercover," "fiscal consideration," "past medical experience," "self-esteem," and "functionality." Most participants focused on appliance functionality over pouch opacity in the immediate postoperative period. However, participants did describe difficulties adjusting to their new stoma and noted that an opaque pouch can improve postoperative comfort. Past exposure to medical devices, particularly in terms of their cost, may impact the decision to use a transparent or opaque pouching system. CONCLUSIONS: Pouching systems that are opaque while still allowing for assessment of the pouching contents and stoma are ideal. When this is not available, providers should consider the patient's wishes to alleviate any psychosocial effects the opacity of the pouching system may have.

Effectiveness of Semiocclusive Sodium Carboxymethyl Cellulose Fibers and Hydrocolloid Dressings for Irritant Peristomal Dermatitis: A Case Series.

ABSTRACT: The most common complication in individuals with ostomies is irritant contact dermatitis from the acidic stoma effluent coming into contact with the peristomal skin. Although protective powders are widely used for the treatment of peristomal skin, there is little scientific evidence to justify their use. The combined use of sodium carboxymethylcellulose cellulose fibers (SCCFs) together with a hydrocolloid dressing for fixation is an effective alternative in the management of these wounds. Here, the authors report a case series of three patients presenting at a stoma therapy clinic with peristomal skin lesions because of severe irritant contact dermatitis. Patients were men aged between 70 and 81 years, had been diagnosed with colon cancer (n = 2) or bladder cancer (n = 1), and had undergone a colostomy (n = 1), ileostomy (n = 1), or Bricker-type ureteroileostomy (n = 1). A semiocclusive care protocol was applied in a moist environment using SCCF and an extrathin hydrocolloid adhesive dressing, and the collection device was secured using adhesive resin and an ostomy belt. The combined use of SCCF and hydrocolloid dressings provided beneficial results to treat the dermatitis, with reduced discomfort after 7 days and lesions healing within 4 weeks.

Usability of a Novel Instrument to Measure Damaged Peristomal Skin in Patients with an Ostomy.

OBJECTIVE: To evaluate the usability of a novel instrument (stoma ruler) to measure damaged peristomal skin in patients with an ostomy. METHODS: A wound ostomy and continence nurse used both the stoma ruler and a linear ruler to assess DET (discoloration, erosion, tissue overgrowth) scores and the height of protrusion above the skin of 10 patients with ileostomies and took photographs. The photographs were presented to five ostomy care nurses for reliability testing. The difference between the two methods was determined using paired Wilcoxon signed ranks test. PRIMARY OUTCOME MEASURE: Interrater reliability of the linear versus stoma ruler. RESULTS: The interrater reliabilities of the stoma ruler versus the linear ruler for the domain-area DET score were 0.95 (95% confidence interval, 0.89-0.99) and 0.68 (95% confidence interval, 0.42-0.89), respectively. Only nurse 5 reported a significant difference between the two rulers (z = -2.24, P = .03). CONCLUSIONS: In busy clinical settings, the stoma ruler is easy for ostomy care nurses to use to obtain accurate DET scores and the height of stoma protrusion above the skin. Observing the position of damaged skin using the clock marks on the stoma ruler enhance clinical description and reduce assessment variation among professionals.

Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings.

OBJECTIVE: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. METHOD: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. RESULTS: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). CONCLUSIONS: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings / Trinta anos do serviço de atenção à saúde da pessoa ostomizada de Juiz de Fora e região

ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

RESUMO Objetivo: elaborar o perfil epidemiológico dos pacientes estomizados atendidos no Serviço de Atenção à Saúde da Pessoa Ostomizada de Juiz de Fora e região (SASPO/JF) e quantificar tanto as patologias que levaram à confecção, quanto as complicações presentes nas estomias. Método: realizado estudo retrospectivo com análise de 496 prontuários de pacientes cadastrados no SASPO/JF ao longo de 30 anos e que permaneciam em atendimento no serviço em junho de 2018. Foram consideradas as seguintes variáveis: idade, sexo, patologia que levou à confecção do estoma, tipo, caráter temporal, localização e complicações das estomias. Resultados: 53,43% dos pacientes eram do sexo masculino e 46,57% do sexo feminino. A média de idade entre os homens foi de 56,24 anos e entre as mulheres foi de 58,40 anos. Oito pacientes apresentaram dois tipos de estomias simultaneamente e o total de 504 estomias foi distribuído da seguinte forma: 340 colostomias (67,46%), 117 ileostomias (23,21%) e 47 urostomias (9,33%). Além disso, 47,65% das colostomias e 76,92% das ileostomias foram temporárias, enquanto todas as urostomias foram permanentes. Em 70,24% dos casos, o motivo para confecção do estoma foi a neoplasia maligna. Foram encontrados 277 estomas com uma ou mais complicações (54,96%). Conclusão: as estomias predominaram em pacientes com mais de 50 anos e o principal diagnóstico que levou à confecção dos estomas foi a neoplasia maligna. As ileostomias apresentaram maior percentual de complicações do que as colostomias e urostomias e, para todos os tipos de estomas, a complicação mais frequente foi a dermatite.

Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study.

BACKGROUND: In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants' expectations regarding services and counselling. METHODS: This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. RESULTS: Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. CONCLUSION: This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants' perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.

The Lived Experiences of Persons With Ostomies Attending a Support Group: A Qualitative Study.

PURPOSE: The purpose of this study was to describe the lived experiences of patients with ostomies participating in a support group. DESIGN: Qualitative, descriptive, phenomenological study. SUBJECT AND SETTING: Fifteen adults with different types of ostomies were recruited from support groups in the state of Georgia. METHODS: Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analyses of data were performed using Parse's 5-step thematic analysis. RESULTS: Four major themes and 10 subthemes emerged from the interviews: (1) theme 1-support group gives hope and changes lives, with 2 subthemes of increased knowledge and provided new knowledge and allows open communication; (2) theme 2-changes in body image had 2 subthemes, some things are different and everyone is the same; (3) theme 3-I am not alone resulted in 4 subthemes of feeling of belonging, willingness to be helped, being supported, and developing lifelong relationships; and (4) theme 4-being independent manifested 2 subthemes including confidence in rejoining society, and building confidence and decreased shame. CONCLUSION: We found that participation in an ostomy support group allowed individuals with ostomies to function at more advanced levels than they were before participating in the support group. The lived experiences were characterized by hope, willingness to live fully again, participating in different activities, and making new friends. Participants shared their positive experiences with others who were experiencing the same problems they once experienced. These findings add to and support the body of knowledge related to the interactions between nurses and individuals with ostomies as well as the care needed to ensure a safe discharge from the acute care facility. New knowledge gained may help in the improvement of the education provided during hospitalization. Providing this information will equip patients and families with a better understanding of and methods to care for their new ostomies and develop an acceptance of their new health status.

Ostomy Complications, Risk Factors, and Applied Nursing Care: A Retrospective, Descriptive Study.

PURPOSE: This study aimed to describe the frequency of colostomy and ileostomy complications and types of nursing interventions as well as to examine patient and ostomy variables associated with early and late complications. METHODS: The records of 572 patients who received ostomy care from a wound ostomy care (WOC) nurse between 2013 and 2017 were abstracted. Patient demographic and ostomy variables, early period (< 30 days after surgery) and late period (> 30 days after surgery) complications, as well as documented nursing interventions were retrieved. Percentages and rates, chi-square statistics, and logistic regression were used to analyze the data. RESULTS: The mean patient age was 59.1 years (standard deviation [SD], 13.86), and the majority of patients were male (302 patients; 52.8%), married (454; 79.4%), and had a temporary (438; 76.6%) end colostomy (253; 44.2%). One (1) or more complications developed in 323 patients (56.5%) in the early period and in 207 patients (36.2%) in the late period. The most common complications in the early period were peristomal irritant contact dermatitis (PICD) (181; 31.6%) and mucocutaneous separation (135; 23.6%). PICD was also the most common complication in the late period (149; 26%). The risk of PICD was significantly higher in patients with a body mass index > 24.9 kg/m2 (odds ratio [OR] = 1.547), who had an ileostomy (OR = 1.654), or a temporary ostomy (OR = 1.728). Variables associated with an increased risk of mucocutaneous separation included obstacles to ostomy care (OR = 2.222), having an end ostomy (OR = 2.171), and ostomy height < 10 mm (OR = 1.964). Complications were treated by the WOC nurse in 67.5% of patients, and the most common intervention was application of skin barrier powder and wipe layers. CONCLUSIONS: The rate of ostomy complications, especially PICD and mucocutaneous separation, in this study was high. Results confirm that patient and ostomy characteristics might significantly affect the risk of complications. The findings support the importance of outpatient follow-up by a WOC nurse. Explorative or randomized controlled studies are needed to identify optimal nursing strategies to decrease complication rates.

National trends in bowel and upper abdominal procedures in ovarian cancer surgery.

OBJECTIVES: In the United States, trends in the initial treatment approach for ovarian cancer reflect a shift in paradigm toward the increased use of neoadjuvant chemotherapy and interval cytoreductive surgery. The aim of this study was to evaluate the trends in surgical cytoreductive procedures in ovarian cancer patients who underwent either primary or interval cytoreductive surgery. METHODS: This retrospective, population-based study examined patients with stage III/IV ovarian cancer diagnosed between January 2000 and December 2013 identified using SEER-Medicare. Small or large bowel resection, ostomy creation, and upper abdominal procedures were identified using relevant billing codes and compared over time. A 1:1 primary and interval cytoreductive propensity matched cohort was created using demographic and clinical variables. 30-day complications and the use of acute care services were compared. RESULTS: A total of 5417 women were identified. 34% underwent bowel resections, 16% ostomy creation, and 8% upper abdominal procedures. There was an increase in bowel resections and upper abdominal procedures from 2000 to 2013 in patients who underwent primary cytoreductive surgery. Compared with patients who received primary cytoreduction, patients who underwent interval cytoreductive surgery were less likely to undergo bowel resection (OR=0.50; 95% CI [0.41, 0.61]) or ostomy creation (OR=0.48; 95% CI [0.42, 0.56]). Upper abdominal procedures did not differ between groups. For patients who underwent primary cytoreductive surgery, these procedures were associated with intensive care unit stay (4.6% vs <2%, P<0.01). In both primary and interval cytoreductive surgery patients, the receipt of bowel and upper abdominal procedures was associated with multiple 30-day postoperative complications and higher rates of readmission and emergency room visits. CONCLUSIONS: The performance of upper abdominal procedures in ovarian cancer patients increased from 2000 to 2013. Interval cytoreductive surgery was associated with decreased likelihood of bowel surgery. In matched primary and interval cytoreductive surgery cohorts, the receipt of these procedures were associated with the increased likelihood of postoperative complications and use of acute care services.

Implantación de la Guía de buenas prácticas para el cuidado y manejo de la ostomía: resultados en cuidados / Implementation of best practice guidelines for ostomy care and management: Care outcomes

INTRODUCCIÓN: Los cuidados proporcionados a las personas ostomizadas son cruciales para su evolución y rehabilitación. Las Guías de práctica clínica de la Registered Nurses' Association of Ontario recogen las intervenciones enfermeras con mayor evidencia en el cuidado del paciente ostomizado. El objetivo del estudio es analizar el impacto en los cuidados y los resultados de salud de los pacientes tras la implantación de la guía Cuidado y manejo de la ostomía. MÉTODO: Estudio cuasiexperimental pre-post test en todos los pacientes a los que se les realizó una ostomía digestiva o urológica en 8 Centros Comprometidos con la Excelencia en Cuidados® donde se implanta la guía para el cuidado y manejo de la ostomía, desde 2012 hasta 2018. Se analizaron y compararon variables clínicas de proceso y de resultados en salud en 3 períodos de tiempo. Se realizó un análisis descriptivo y se compararon las proporciones entre períodos, mediante Chi cuadrado, aplicando la corrección de Yates, considerando un nivel de confianza del 95%. RESULTADOS: La educación preoperatoria pasó del 36,7 al 47,3% (p < 0,05); el marcaje de la ostomía, del 25,2 al 33,8% (p < 0,05); la evaluación postoperatoria, del 94,8 al 59% (p < 0,05); la educación postoperatoria, del 75,5 al 91,9% (p < 0,05); las complicaciones en la piel periestomal, del 16,6 al 10,9% (p < 0,05), y las complicaciones en la ostomía, del 21,8 al 27,9% (p < 0,05). CONCLUSIONES: La implantación de la guía para el cuidado y manejo de la ostomía produjo mejoras en los cuidados preoperatorios, el marcaje del estoma y en las complicaciones de la piel periestomal

INTRODUCTION: Care provided to ostomized people is crucial in their progress and rehabilitation. The Registered Nurses' Association of Ontario clinical practice guidelines include greatest evidence nursing interventions for ostomized patient care. The aim of the study is to analyze the impact on patients' care and health outcomes after Care and management of ostomy guideline implementation. METHOD: Pre-post quasi-experimental study, carried out in all patients who underwent a digestive or urological ostomy in 8 centres of Best Practices Spotlight Organization® where the ostomy care and management guideline was implanted from 2012 to 2018. Clinical, process and health outcome variables were analyzed and compared in 3 periods of time. Descriptive analysis and comparison of proportions between the periods was performed, using Chi square, applying Yates correction, considering a 95% confidence interval. RESULTS: Preoperative education went from 36.7 to 47.3% (P<.05); stoma site marking from 25.2 to 33.8% (P<.05); postoperative evaluation from 94.8 to 59% (P<.05); postoperative education from 75.5 to 91.9% (P<.05); peristomal skin complications from 16.6 to 10.9% (P<.05), and ostomy complications from 21.8 to 27.9% (P<.05). CONCLUSIONS: The implementation of the ostomy care and management improved preoperative care, stoma site marking and peristomal skin complications

Evaluation of a New Elastic Ostomy Appliance to Decrease Skin Complications: Results of a Pilot Study.

Peristomal skin complications due to appliance leakage frequently occur in all types of ostomies, resulting in great emotional, social, and financial impact for patients. PURPOSE: This pilot study was conducted to evaluate the safety and use of a new, reusable, nonadherent, elastic device. METHOD: A convenience sample of nonhospitalized patients with ileostomies and colostomies was recruited through the Dutch ostomy patient association. Participant inclusion criteria stipulated the presence of ileostomy or colostomy, a body mass index (BMI) between 18 and 30, and presence of an osto-my for at least 1 month. Patients with existing prolapse or necrosis of the ostomy, inability to give consent, or concurrent usage of other aids to prevent leakage or skin problems were excluded. Participants were fitted with and asked to wear the appliance continuously for 4 weeks and report experiences in a structured diary. Patient charts were reviewed for baseline demographic characteristics that included age, gender, American Society of Anaesthesiologists classification, and BMI. Study nurses performed structured weekly interviews and inspections of the ostomies and peristomal skin. The primary outcome measure was occurrence of serious adverse events such as ostomy necrosis or perforation. Secondary outcome measures were patient reported incidents of leakage and satisfaction during wear and changing of the appli-ance. Peristomal skin complications also were recorded. Descriptive statistics were used to analyze results. In addition, subgroup analysis of patients with a parastomal hernia was performed because of the potential benefits of the device design in these cases. RESULTS: Participants included 23 patients (16 with colostomies, 7 with ileostomies); 13 participants (57%) were female. Mean age and BMI were 64 years and 28.3, respectively. Six (6) patients had a parastomal hernia. Due to shifting or discomfort while wearing the appliance, 16 participants discontinued use before the end of the study and were excluded from analysis from the point they left the study. Mean duration of participation was 12.8 days. No adverse events occurred. Mean number of incidents of leakage/week decreased from 3.5 ± 4.9 at start of the study to 1.8 ± 1.3 at week 4. The mean number of pouches used/week decreased from 10.5 ± 5.4 to 8 ± 2.6. Peristomal skin reactions present in 15 patients at start of the study decreased to 1 patient at the end of the study. Patient satisfaction did not change over the course of the study. Patients with parastomal hernias had similar results. CONCLUSION: No serious adverse events were reported and leakage and skin irritation were found to improve, but participant dropout rate was high and average usage time was only 12.8 days, which limited interpretation of the results. The data suggest that the appliance may offer an (intermittent) alternative to existing ostomy materials for patients experiencing troublesome leakages, peristomal skin problems, or parastomal hernias, but further research is needed to explore these outcomes.

Regional Differences in Palliative Care Utilization Among Geriatric Colorectal Cancer Patients Needing Emergent Surgery.

BACKGROUND: The benefits of palliative care (PC) in critical illness are validated across a range of diseases, yet it remains underutilized in surgical patients. This study analyzed patient and hospital factors predictive of PC utilization for elderly patients with colorectal cancer (CRC) requiring emergent surgery. METHODS: The National Inpatient Sample was queried for patients aged ≥ 65 years admitted emergently with CRC from 2009 to 2014. Patients undergoing colectomy, enterectomy, or ostomy formation were included and stratified according to documentation of PC consultation during admission. Chi-squared testing identified unadjusted group differences, and multivariable logistic regression identified predictors of PC. RESULTS: Of 86,573 discharges meeting inclusion criteria, only 3598 (4.2%) had PC consultation. Colectomy (86.6%) and ostomy formation (30.4%) accounted for the operative majority. PC frequency increased over time (2.9% in 2009 to 6.2% in 2014, P < 0.001) and was nearly twice as likely to occur in the West compared with the Northeast (5.7 vs. 3.3%, P < 0.001) and in not-for-profit compared with proprietary hospitals (4.5 vs. 2.3%, P < 0.001). PC patients were more likely to have metastases (60.1 vs. 39.9%, P < 0.001) and die during admission (41.5 vs. 6.4%, P < 0.001). On multivariable logistic regression, PC predictors (P < 0.05) included region outside the Northeast, increasing age, more recent year, and metastatic disease. CONCLUSIONS: In the USA, PC consultation for geriatric patients with surgically managed complicated CRC is low. Regional variation appears to play an important role. With mounting evidence that PC improves quality of life and outcomes, understanding the barriers associated with its provision to surgical patients is paramount.

Perfil das crianças e adolescentes estomizados e os desafios para o atendimento nos serviços de saúde / Profile of children and adolescents with ostomies and the challenges of providing care in health services

Este estudo abordou um grupo de crianças em condição crônica complexa de saúde, as crianças estomizadas, que devido a um conjunto de condições tais como as anomalias congênitas do aparelho digestivo, urinário, do sistema nervoso central e sequelas de complicações perinatais, tiveram indicação de uso contínuo ou temporário de dispositivo tecnológico como suporte para sobreviver. O objetivo foi conhecer perfil das crianças e adolescentes estomizados e os desafios para o atendimento nos serviços de saúde. Trata-se de um estudo com abordagem mista, descritivo, realizado em hospital de referência federal localizado no município do Rio de Janeiro com crianças estomizadas. O critério de inclusão foi o paciente possuir estoma respiratório, gastrointestinal e/ou urinário, cadastrado no ambulatório de estomaterapia e ter completado 1 ano de acompanhamento no ambulatório. A abordagem quantitativa abrangeu uma amostra de 284 pacientes no período de 2012 a 2017 . Uma ficha com questões estruturadas para caracterizar a população foi utilizada. A coleta ocorreu no banco de dados do serviço de estomaterapia e seguidamente com os prontuários. Complementando com a abordagem qualitativa foram realizadas 14 entrevistas com familiares/cuidadores, sendo aplicado um instrumento com perguntas abertas para resgatar a experiência de acesso em outros serviços de saúde, referente aos cuidados decorrentes da estomia e aqueles decorrentes das doenças comuns da infância. Os resultados da pesquisa apontaram que a maior parte da população de estudo foi composta por pacientes do sexo masculino, por crianças de cor parda, procedentes de famílias que possuíam baixo nível socioeconômico. As anomalias congênitas (40,80%) foram as principais causas que motivaram a realização de algum tipo de estoma. A instituição de estudo foi responsável por (75%) das cirurgias para confecção dos estomas. Além da instituição do estudo, outros serviços da rede local foram procurados, sendo os serviços de emergência e as unidades de pronto atendimento (56,69%) os mais demandados. Nestes serviços o estudo apontou uma grande dificuldade de resolutividade das demandas da clientela. Na análise das doenças comuns da infância, foi observado que (47,03%) das crianças apresentaram infecção de vias áreas superiores e que houve um grande número de complicações relacionadas às estomias no período do estudo. Além de conhecer o perfil, este estudo identificou como desafios a necessidade de planejamento da hierarquização da assistência e de aprimoramento de recursos humanos na busca dos serviços de saúde em diferentes níveis de atenção.

This study addressed a group of children with complex chronic health condition, stomized children, who due to a set of conditions such as congenital anomalies of the digestive tract, urinary tract, central nervous system and sequelae of perinatal complications, had indication of use continuous or temporary technological device as a support to survive. The objective was to know the profile of stomized children and adolescents and the challenges for care in health services. It is a study with a mixed, descriptive approach, carried out in a federal reference hospital located in the city of Rio de Janeiro, with stomized children. The inclusion criterion was the patient having respiratory, gastrointestinal and / or urinary stoma, enrolled in the stomatherapy outpatient clinic and having completed 1 year of follow-up in the outpatient clinic. The quantitative approach covered a sample of 284 patients in the period from 2012 to 2017. A questionnaire with questions structured to characterize the population was used. The collection took place in the database of the stomatherapy service and then with the medical records. Complementing with the qualitative approach, 14 interviews with family / caregivers were carried out, and an instrument with open questions was applied to rescue the experience of access in other health services, referring to the care due to the stomies and those resulting from the common childhood illnesses. The results of the research indicated that the majority of the study population was composed of male patients of brown children from families with low socioeconomic status. The congenital anomalies (40,80%) were the main causes that motivated the accomplishment of some type of stoma. The study institution was responsible for (75%) of the surgeries for making the stomas. Besides the institution of the study, other services of the local network were sought, being the emergency services and the units of prompt service (56.69%) the most demanded. In these services, the study pointed to a great difficulty in solving customer demands. In the analysis of the common childhood diseases, it was observed that (47.03%) of the children presented infection of the upper areas and that there were a large number of complications related to the stomies during the study period. In addition to knowing the profile, this study identified as challenges the need to plan the hierarchy of care and improve human resources in the search for health services at different levels of care.

Patients With Temporary Ostomies: Veterans Administration Hospitals Multi-institutional Retrospective Study.

PURPOSE: The purpose of this study was to describe clinical outcomes of patients with temporary ostomies in 3 Veterans Health Administration hospitals. DESIGN: Retrospective descriptive study, secondary analysis. SAMPLE AND SETTING: Veterans with temporary ostomies from 3 Veterans Health Administration hospitals who were enrolled in a previous study. The sample comprised 36 participants all were male. Their mean age was 67.05 ± 9.8 years (mean ± standard deviation). Twenty patients (55.6%) had ileostomies and 16 patients (44.4%) had colostomies. METHODS: This was a secondary analysis of data collected using medical record data. Variables examined included etiology for creation and type of ostomy, health-related quality of life, time to reversal, reasons for nonreversal, postoperative complications after reversal, and mortality in the follow-up period. RESULTS: Colorectal cancer and diverticular disease were the main reasons for temporary stoma formation. The reversal rate was 50%; the median time to reversal was 9 months in our sample; temporary ileostomies were reversed more often than temporary colostomies (P = .18). Comorbid conditions were identified as the main reason for nonreversal. Mortality was not significantly different between the reversal and nonreversal groups. No significant differences were reported with health-related quality-of-life parameters between reversal and nonreversal groups. CONCLUSIONS: This study identified that the proportion of temporary ostomies was limited to 50%. Complications during the index operation, medical comorbidities, and progression of cancer are the main reasons for nonreversal of temporary stomas. Study findings should be included in the counseling of patients who are likely to get intestinal stomas with temporary intention, and during consideration for later reversal of a stoma.

A Prospective, Explorative Study to Assess Adjustment 1 Year After Ostomy Surgery Among Swedish Patients.

Having ostomy surgery changes a person's life. To assess adjustment to life with an ostomy and quality of life (QOL) 1 year after ostomy surgery, a prospective, explorative study was conducted among patients of a stoma clinic at a university hospital in Sweden. All consecutive patients who had undergone nonemergent or emergency surgery involving formation of an ostomy and who received regular follow-up at the ward and at the outpatient clinic during the first year by an enterostomal therapist (ET) were prospectively included in the study; their demographic information (including age, gender, diagnosis/reason for an ostomy, nonemergent or emergency surgery, ostomy type, preoperative counselling/siting [Yes/No], self-sufficiency in stoma care, professional activity, and whether they lived with a spouse/partner) was recorded upon admission to the study. Participants independently completed the Ostomy Adjustment Scale (OAS), a 36-item instrument, with each response scored from worst to best adjustment (1 to 6) for a total score ranging from 36-216. The tool addresses 5 factors: normal functioning, functional limitations, negative affect, positive role function, and positive affect. In addition, QOL was assessed using a visual analogue scale (0 to 100 mm) along with 2 open-ended QOL questions. Quantitative and qualitative data were included on the same questionnaire and were entered into an Excel file by 2 of the researchers. The quantitative data were transferred to statistical software for analysis; the qualitative data were analyzed according to Graneheim and Lundman. Descriptive statistics were used for quantitative data and based on nonparametric analysis, and qualitative data were analyzed using content analysis. Of the 150 patients eligible for inclusion (82 women, 68 men, median age 70 [range 21-90] years), 110 (73%) underwent nonemergent surgery, 106 (71%) had a colostomy, and 44 (29%) had an ileostomy. Most ostomies were created due to cancer (98, 65%) and inflammatory bowel disease (28, 19%), and 90% of participants were self-sufficient in ostomy care. The overall median score on the OAS was 162 with no significant differences between genders and diagnoses. The OAS scores for patients who did versus did not have preoperative counselling by an ET were 163 and 150, respectively (P = .313). Mean OAS scores were 136 for patients with cancer and an ileostomy and 163 for patients with cancer and a colostomy. Patients with cancer and an ileostomy had a significantly worse adjustment (mean 3.6 ± 1.32) than patients with cancer and a colostomy (mean 4.4 ± 1.21) in the factor Normal function (P = .015). Lowest adjustment scores were in the areas of sexual activities and attractiveness and participating in sports and physical activities; the highest scores concerned contact with an ET, feeling well informed, and knowing the correct methods of handling the ostomy. The median score for QOL for all patients was 76 (interquartile range 59-86). Three (3) categories emerged from the qualitative content analysis as obstacles to QOL: ostomy-related concerns and impact on life, limitations in physical and social activities, and negative impact on physical and mental health. The ET was found to have an important role in education and counselling to promote adjustment to life with an ostomy from preoperative to follow-up care. Future explorative studies are needed to determine how patients want questions about sex and sensitive issues to be designed and how the ET can best discuss sexuality and intimacy after ostomy surgery.

Avaliação da qualidade de vida em pacientes com estomia intestinal / Evaluation of the quality of life of patients with intestinal ostomy

Introdução: A estomia intestinal é uma condição que pode afetar a vida das pessoas, seu convívio em sociedade, bem como ter consequências diretas para a qualidade de vida. Objetivo: Avaliar a qualidade de vida de pacientes com estomia intestinal atendidos em ambulatório de um hospital. Casuística e Métodos: Estudo transversal analítico e quantitativo. A amostra foi composta por 54 pacientes estomizados, acima de 18 anos e acompanhados há pelo menos um ano no ambulatório de estomia de um hospital de Goiânia/GO. Foram aplicados um questionário sociodemográfico e a versão abreviada do instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde World Health Organization instrument to evaluate quality of life (WHOQOL-BREF). Foi confeccionado um banco de dados utilizando o SPSS 18. Foi realizada uma análise descritiva das variáveis e foram utilizados o teste t de Student e o teste de análise de variância (ANOVA) Scheffépara avaliar a existência ou não de diferença estatisticamente significativa (p≤0,05). Resultados: A pesquisa incluiu 54 pacientes, sendo 30 do sexo feminino e 24 do sexo masculino. Quanto à renda familiar, 61,1% informaram receber até um salário mínimo. A maioria afirmou não ter atividades de lazer (62,9%), não praticar atividade física (85,2%) e não estar empregada (92,6%). A média do escore geral da qualidade de vida foi 3,7±0,5. Os domínios apresentaram escores indicando boa qualidade de vida. Identificou-se que não ter religião, ter filhos e maior renda são preditores relacionados a um melhor escore no domínio meio ambiente. Os que referiram melhor autoavaliação da qualidade de vida também tiveram melhores escores em satisfação com a saúde e domínios físico e psicológico. Conclusão: Os pacientes com estomia intestinal apresentaram boa qualidade de vida, com menores escores em meio ambiente, que se relacionam com as facetas dinheiro e lazer. Melhor autopercepção da qualidade de vida indica melhor satisfação com a saúde em geral.

Introduction: Intestinal stoma is a condition that can affect people's lives and the way they interact socially. It can pose direct consequences on people's quality of life. Objective:To Evaluate the quality of life of patients with intestinal ostomies. Patients and Methods: This is a cross-sectional, analytical and quantitative study. The sample consisted of 54 patients aged 18 and over followed for at least one year at a hospital outpatient clinic in the city of Goiânia/GO. We used a sociodemographic questionnaire and the brief version of the World Health Organization instrument to evaluate quality of life, WHOQOL-BREF. We design a database using SPSS 18. In order to analyze variables, we use descriptive analysis,Student's t-test and the ANOVA with a Scheffé post hoctest. We used the tests to evaluate the existence or not of astatistically significant difference (p ≤0.05). Results: Thestudy included 54 patients (30 female and 24 male). Regardingfamily's income, 61.1% reported receiving up to one minimumwage. The majority affirmed that they did not have leisureactivities (62.9%), did not practice physical activity (85.2%),and have no job (92.6%). The overall quality of life score was3.7 ± 0.5. The domains presented scores indicating a goodlife quality. Predictors related to a better environment domainscore were to have no religion, to have children, and a higherincome. Those who reported better self-rated quality of lifealso had better scores on satisfaction with health, physical, andpsychological domains. Conclusion: Patients with intestinalostomies presented a good quality of life, with lower scoresin the environment domain, which is related to money to meetneeds and opportunities for leisure. A best self-perception ofthe quality of life indicates a better satisfaction with the overallhealth.

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.