Peristomal cutaneous Crohn's disease by contiguity.

Peristomal ulcer is a frequent complication that, in most cases, is mild and responds to topical treatment. In much less frequent cases, it is associated with other pathologies, such as Crohn's disease, requiring in these cases systemic treatment, including surgery. The differential diagnosis between Cutaneous Inflammatory Bowel Disease and Pyoderma Gangrenosum is interesting, although both are managed in a similar way.

Aplicación de convexidad ligera y anillos moldeables en ostomía para evitar fugas en el postoperatorio precoz del paciente con ostomía digestiva: estudio CONAN / Application of slight convexity and moldable rings in ostomy to prevent leaks in the early postoperative period of patients with digestive ostomy: CONAN study

Objetivo: evaluar la seguridad y la efectividad de la cura CONAN, teniendo en cuenta la reducción del número de fugas, el estado de la piel periestomal y la calidad de vida percibida por el paciente. Método: estudio prospectivo no-randomizado de ámbito nacional, realizado en 54 unidades de estomaterapia, para evaluar la eficacia y seguridad de la cura CONAN consistente en el uso de dispositivo Easiflex® Confort Convex Light y de anillos moldeables Brava® en el postoperatorio precoz de pacientes con ostomía digestiva con pérdidas de efluente. La intención del estudio fue evaluar el efecto de esta estrategia para disminuir la pérdida, prevenir el deterioro de la piel periestomal y aumentar el bienestar de los pacientes al alta. Se compararon diferencias estadísticas entre estas variables empleando las pruebas t-test, Chi cuadrado, Mc Nemar y Bowker. Resultados: se evaluaron 257 pacientes y 244 completaron el estudio. Con la cura CONAN el número de fugas se redujo en el 56% de los pacientes y el número medio de fugas evolucionó de 3,4 ± 5,2 (V1) a 1,3 ± 2,3 (V2) (p< 0,0001). El 62% de los pacientes que tenía problemas en la piel dejó de tenerlos y la mejora en las condiciones de la piel fue muy evidente. La puntuación media DET cambió de 3,3 ± 3,3 (V1) a 1,6 ± 2,3 (V2) (p< 0,0001). La satisfacción media percibida por el paciente evolucionó de 5,1 ± 2 (V1) a 7,2 ± 1,7 (V2) (p< 0,0001). La proporción de pacientes con estoma protruido aumentó de 32,9% a 40% (p= 0,025). La mayoría de los pacientes retomó sus hábitos diarios: 67% pasear, 75% salir de casa, 55% descansar por la noche. El 92% de los participantes deseó seguir usando el dispositivo Easiflex® Convex Light. Conclusiones: los pacientes con ostomía digestiva y fuga de efluentes en el periodo postoperatorio temprano se benefician claramente del empleo del dispositivo convexo suave (Easiflex® Confort Convex Light) con anillo moldeable (Brava®). Se confirmó la seguridad y efectividad de este abordaje.(AU)

Objective: to assess the safety and efficacy of the CONAN cure, taking into account the reduction in the number of leaks, the status of peristomal skin, and the quality of life perceived by the patient. Method: a prospective non-randomized study at national level, conducted in 54 Stomal Therapy Units, in order to evaluate the efficacy and safety of the CONAN cure, consisting in the use of the Easiflex® Confort Convex Light device and Brava® moldable rings during the early post-surgical stage in patients with digestive system ostomy with effluent leaks. The study intended to evaluate the effect of this strategy on leak reduction, to prevent peristomal skin deterioration, and to increase the wellbeing of patients at discharge. Statistical differences were compared between these variables, using the t-test, Squared-chi, McNemar and Bowker tests. Results: there was an evaluation of 257 patients, and 244 completed the study. With the CONAN cure, the number of leaks was reduced in 56% of patients, and the mean number of leaks moved from 3.4 ± 5.2 (V1) to 1.3 ± 2.3 (V2) (p< 0.0001); skin problems disappeared in 62% of patients who presented them, and the improvement in skin condition was highly evident. There was a change in the mean DET score from 3.3 ± 3.3 (V1) to 1.6 ± 2.3 (V2) (p< 0.0001). The mean satisfaction perceived by the patient increased from 5.1 ± 2 (V1) to 7.2 ± 1.7 (V2) (p< 0.0001). The proportion of patients with protruding stoma increased from 32.9% to 40% (p= 0.025). The majority of patients resumed their daily habits: 67% going for walks, 75% going out of their house, and 55% resting at night; 92% of participants wanted to continue using the Easiflex® Convex Light device. Conclusions: patients with digestive system ostomy and effluent leak during their early post-surgical period could clearly benefit of using the soft convex device (Easiflex® Confort Convex Light) with moldable ring (Brava®). The safety and efficacy of this approach was confirmed.

Value-Based Healthcare in Ostomies.

In order to achieve significant improvements in quality, cost, and accessibility (the health "iron triangle"), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient.