Stomal and peristomal complications management: a retrospective study.

OBJECTIVE: Correctly identifying and managing stomal and peristomal complications are key to assisting individuals with an ostomy when they are facing challenges with self-care. Providers that are knowledgeable and experienced with stomal and peristomal care are vital when complications arise. Providing care that is consistent with findings in current high evidence-based literature supports the goal of providing optimal patient outcomes in a timely manner. The objective of this study was to explore stomal and peristomal that presented in an outpatient ostomy clinic and compare these interventions with information found in the literature. METHOD: This retrospective study used a sample population of convenience that included adult patients aged ≥18 years who presented for stomal or peristomal complications in an outpatient ostomy clinic in northwest Ohio, US. Electronic medical records were reviewed to determine the presenting stomal or peristomal complication(s) of each patient and treatment was provided or prescribed. The interventions were then compared with information found in the literature. Length of treatment and reasons for referral to the surgeon that created the stoma were also reviewed. RESULTS: This study showed that interventions for adult individuals with a stomal or peristomal complications that presented to the clinic were consistent with that found in the literature. This study also sought to deliver information to healthcare providers that may not be directly involved in ostomy care, helping to increase their understanding of problems that patients with an ostomy may experience. CONCLUSION: This study showed that interventions completed in this setting where the research took place was consistent with information found in literature.

Pearls in hyperbaric oxygen therapy: a challenging case series.

INTRODUCTION: Providers involved in treating patients who would benefit from HBOT need to be knowledgeable about the absolute and relative contraindications to HBOT. OBJECTIVE: This case series evaluates several challenging clinical scenarios in which HBOT was administered. Patients who may benefit from HBOT can present with relative contraindications, and it is the responsibility of the members of the health care team to know what additional information may be required to determine if the patient can safely undergo HBOT. However, such information is sparse in some cases. MATERIALS AND METHODS: Nine patients underwent HBOT to manage diverse presentations, some for which there was no or scant published information on the potential interaction between in situ devices and HBOT. RESULTS: All patients demonstrated clinical improvement, and there were no adverse events. CONCLUSION: Providers may encounter uncommon or unique situations when considering whether or not to administer HBOT, and it may be necessary to consult with others (eg, experts in other specialties, device manufacturers or vendors) to provide optimal patient care.

A Case of Thrombotic Vasculopathy in the Setting of High-Dose Hydroxyurea Use.

This case study describes the presentation of a 76-year-old male with a past medical history that included atrial fibrillation, essential hypertension, coronary artery disease status post cardiac stent placement, heart failure, hyperlipidemia, thyroid cancer (with thyroid resection resulting in hypothyroidism), prostate cancer status post brachytherapy (in remission), and a history of JAK2-positive myeloproliferative disease. He presented with painful areas of hyperpigmentation appearing as purple discoloration to his neck, lower abdominal skinfold, and bilateral groin areas that progressed to painful ulcerations a few weeks after a myocardial infarction. Due to the patient's multiple medical conditions and uncommon presentation of wounds, a multidisciplinary team was involved in his care. Differential diagnosis included antiphospholipid syndrome, symmetrical drug-related intertriginous and flexural exanthema, warfarin-induced necrosis, cutaneous thrombotic vasculopathy, myeloproliferative disorder, and high-dose hydroxyurea therapy. It was determined by the authors that the high-dose hydroxyurea therapy was the cause of the wounds. Because of the patient's initial health status, treatment of the wounds included use of collagenase and sodium hypochlorite solution to reduce the risk of infection and attempt to promote autolytic debridement until surgical wound debridement could be done. The patient required multiple hospital stays, but ultimately his health status improved and the wounds resolved with the assistance of the combined efforts of the multidisciplinary team to diagnose and treat this complex patient and his uncommon wound presentation.