Home visits as part of a new care pathway (iAID) to improve quality of care and quality of life in ostomy patients: a cluster-randomized stepped-wedge trial.

AIM: Morbidity in patients with an ostomy is high. A new care pathway, including perioperative home visits by enterostomal therapists, was studied to assess whether more elaborate education and closer guidance could reduce stoma-related complications and improve quality of life (QoL), at acceptable cost. METHOD: Patients requiring an ileostomy or colostomy, for any inflammatory or malignant bowel disease, were included in a 15-centre cluster-randomized 'stepped-wedge' study. Primary outcomes were stoma-related complications and QoL, measured using the Stoma-QOL, 3 months after surgery. Secondary outcomes included costs of care. RESULTS: The standard pathway (SP) was followed by 113 patients and the new pathway (NP) by 105 patients. Although the overall number of stoma-related complications was similar in both groups (SP 156, NP 150), the proportion of patients experiencing one or more stoma-related complications was significantly higher in the NP (72% vs 84%, risk difference 12%; 95% CI: 0.3-23.3%). Although in the NP more patients had stoma-related complications, QoL scores were significantly better (P < 0.001). In the SP more patients required extra care at home for their ostomy than in the NP (60.6% vs 33.7%, respectively; risk difference 26.9%, 95% CI: 13.5-40.4%). Stoma revision was done more often in the SP (n = 11) than in the NP (n = 2). Total costs in the SP did not differ significantly from the NP. CONCLUSION: The NP did not reduce the number of stoma-related complications but did lead to improved quality of care and life, against similar costs. Based on these results the NP, including perioperative home visits by an enterostomal therapist, can be recommended.

Growth and development issues in adolescents with ostomies: a primer for the WOC nurses.

Caring for the adolescent (13-18 years of age) with an ostomy presents multiple challenges. The purpose of this article is to provide strategies to assist the WOC nurse in minimizing the potential impact on growth and development for this age group with an ostomy. This is relevant to the WOC nurse since it is estimated that between 6% and 14% of all adolescents have symptoms of irritable bowel disease, and many will require an ostomy. Thus the WOC nurse will be called upon to provide care to this age group. This article discusses normal adolescent growth and development and provides strategies to support the normal growth and development.

[Patient education, perioperative management, patient support groups]. / Die Stomaberatung--Patientenschulung, perioperative Betreuung, Selbsthilfeorganisation.

In our division, highly qualified enterostomal therapists treat approximately 300 patients each year Patient care consists of extensive preoperative information, localization of the ideal stoma position and providing patient-education in stoma handling. A regular ambulatory consultation allows early recognition of typical stoma related complications and their effective treatment in a timely manner. Another important issue of our consulting service includes patients concerns, such as social integration and physical independence. The creation of a specialized center provides an efficient and continuous care of enterostomy patients and their relatives. Thus, initial fears and emotional crisis can be addressed and minimalized. It is our goal to provide individual and comprehensive service in order to accommodate our patients needs.

[The importance of the Support Network for the stomized patient]. / A relevância da Rede de Apoio ao estomizado.

The purpose of the study was to learn about the social support stomized patients turn to, as well as their benefits in facing the changes a new way of life incur in. The methodological reference was oral history of topic lives. Ten half-structured interviews have been conducted with subjects with definitive intestinal ostomy It was used the technique of content analysis, which provided us with three important supporting networks: religious and spiritual beliefs, family and the Ostomy Association. Those networks worked as pillars that minimized the suffering of stomized patients. Health care professionals must value those supporting networks so as to enhance the lives of stomized patients.

[The meaning of the new way of life of individuals with permanent intestinal ostomy]. / O significado da mudança no modo de vida da pessoa com estomia intestinal definitiva.

The research aims to identify and analyze the main modifications that affect the way of life of an ostomate, and strategies developed to face the situation of having an ostomy. The method used was oral history of topic life. Ten semi-structured interviews were conducted with permanent ostomates. For data analysis, the method used was thematic content analysis. Five themes emerged from the analysis of the interviews: the experience of signs and symptoms and the need for an ostomy; learning to live with an ostomy, the pouching system, and the search for alternatives to replace the usage of the pouching system; facing the changes caused by an ostomy in terms of feeding, clothing and sex life; the search for social reintegration, the challenge of facing death, and the search for future perspectives; the search for a social support network: religious and spiritual beliefs, family and the ostomates association.

[Intestinal stoma: preoperative and postoperative management]. / Les stomies digestives: indications, complications, prise en charge pré et postopératoire.

The aim of this review is to present the management and indications of intestinal stomas. A stoma induces a body image alteration with important familial and social consequences. A preoperative visit to the stoma nurse prevents technical and/or psychological complications. Stoma nurses, surgeons and general practionners work together to help the patient in his/her new life. New stoma devices have also contributed to improve quality of life. Social and sexual activity can be maintain despite intestinal stoma with appropriate education.

Aplicabilidade da teoria de Orem no autocuidado de pessoa com estomia intestinal: estudo reflexivo / Aplicabilidad de la teoría de Orem en el autocuidado de personas con ostomía intestinal: un estudio reflexivo / Applicability of the Orem theory in self-care of the person with intestinal stomies: a reflexive study

A confecção de uma estomia intestinal leva a modificações físicas que podem afetar todas dimensões da vida do ser humano. Acredita-se que por meio da Teoria de Enfermagem do Déficit do Autocuidado é possível promover o cuidado de enfermagem à pessoa com estomia intestinal. Dessa forma, o objetivo deste estudo foi refletir sobre a aplicabilidade da Teoria do Déficit do Autocuidado de Dorothea Orem no cuidado de enfermagem à pessoa com estomia intestinal. Trata-se de um estudo teórico-reflexivo e para tanto, realizou-se uma revisão narrativa com busca do material nas bases de dados LILACS, Pubmed e Google Acadêmico e síntese qualitativa dos trabalhos analisados. Diante das mudanças ocasionadas pela presença da estomia, a pessoa necessita realizar cuidados importantes para seu autocuidado. O planejamento da assistência de enfermagem fundamentado na Teoria do Déficit d Autocuidado contribui para a o retorno às atividades de vida diária, a reinserção social, ao cuidado com a estomia e equipamento coletor e prevenir complicações. Assim, a aplicabilidade desta teoria demonstra o seu potencial para subsidiar o planejamento e a implementação da assistência à pessoa com estomia de modo a promover a sua autonomia e independência para realizar o seu autocuidado, além de subsidiar a Prática Avançada de Enfermagem no cenário nacional

La realización de una ostomía conlleva a modificaciones físicas que pueden afectar todas las áreas de la vida del ser humano. Se piensa que por medio de la Teoría de Enfermería del Déficit del Autocuidado, es posible promover el cuidado de enfermería a la persona con ostomía intestinal. De esta forma, el objetivo de este estudio fue reflexionar sobre la aplicabilidad de la teoría del autocuidado de Dorothea Orem en el cuidado de enfermería a la persona con ostomía intestinal. Se trata de un estudio teórico-reflexivo, por tanto, se realizó una revisión narrativa con búsqueda del material en las bases de datos LILACS, Pubmed e Google Académico y una síntesis cualitativa de los trabajos analizados. Durante los cambios ocasionados por la presencia de la ostomía, la persona necesita realizar cuidados importantes para su autocuidado. El planeamiento de la asistencia de enfermería fundamentado en la Teoría del Déficit del Autocuidado, contribuye para el retorno de las actividades de la vida diaria, cuidado de la ostomía y del equipo recolector, prevenir complicaciones, además, del reintegro a la sociedad. En este sentido, la aplicabilidad de la teoría del Autocuidado de Dorothea Orem, demuestra su potencial para subsidiar el planeamiento y la implementación de la asistencia a la persona con ostomía, de tal forma que promueve la autonomía e independencia para realizar su autocuidado, además, de subsidiar la Práctica Avanzada de Enfermería en el escenario nacional

The making of an intestinal ostomy leads to physical changes that can affect all dimensions of human life. It is believed that through the Nursing Theory of Self-Care Deficit it is possible to promote nursing care to people with intestinal ostomy. Thus, the aim of this study was to reflect on the applicability of Dorothea Orem's Self-Care Deficit Theory in nursing care for people with intestinal ostomy. It is a theoreticalreflective study and for that, a narrative review was carried out with search for the material in the LILACS, Pubmed and Google Scholar databases and a qualitative synthesis of the analyzed works. In view of the changes caused by the presence of the ostomy, the person needs to perform important care for their self-care. The planning of nursing care based on the Theory of Self-Care Deficit contributes to the return to activities of daily living, social reintegration, care with the ostomy and collection equipment and preventing complications. Thus, the applicability of this theory demonstrates its potential to support the planning and implementation of assistance to people with ostomy in order to promote their autonomy and independence to perform their self-care, in addition to subsidizing Advanced Nursing Practice in the national scenario

Reoperation in patients with the short bowel syndrome.

The clinical courses of 53 adult patients with the short bowel syndrome (SBS) were evaluated to determine the incidence of and indications for reoperation. Mesenteric vascular disease (23 patients) and malignancy/irradiation (18 patients) were the most frequent causes of resection. Early reoperation was necessary in nine (17%) patients, primarily for intestinal complications. Twenty (53%) of the 38 patients leaving the hospital required a later abdominal procedure during the mean follow-up of 30 months (range: 2 to 108 months). Three (33%) of nine patients with ulcer disease had gastric resection. Six (21%) of 28 patients at risk for cholelithiasis developed symptoms. Four of these patients underwent cholecystectomy, and three others had a prophylactic cholecystectomy. Ten patients underwent ostomy closure or formation. Intestinal disease necessitated stricturoplasty (three), serosal patch (one), minimal resection (three), or takedown of an ileal conduit (one). Twenty-four (63%) of 38 patients with SBS received home total parenteral nutrition for a mean of 22 months (range: 2 to 105 months). Eleven patients required more than 1 vascular access procedure, and 4 had more than 3 procedures. Patients with the SBS frequently require reoperation for intestinal conditions, cholelithiasis, peptic ulceration, and vascular access. Prophylactic cholecystectomy and strategies for preserving intestinal length are important considerations in these patients.

[Gastrointestinal surgery and gastroenterology. XII. Care of stoma patient]. / Gastro-intestinale chirurgie en gastro-enterologie. XII. Zorg voor de stompatiënt.

A stoma nurse provides information, counselling and care to patients with gastrointestinal and urological conditions such as a stoma, incontinence, fistulas or an ileoanal anastomosis with a pouch. The stoma nurse will provide the patient and his or her partner with pre-operative information, post-operative counselling, practical care and instruction as well as check-ups at the outpatients' clinic. Careful selection of the most suitable collection device is highly important. This stoma care has a positive effect on the quality of life of a patient with a stoma. The most common complication is peristomal dermatitis which, in combination with care problems, may lead to social restrictions. Providing the patient's physical and psychological health is not in danger, the stoma care nurse can treat or control these complications, thereby avoiding the need for further surgery.

[Stomatherapy]. / Stomathérapie.

The stoma is not just a "hole" through which faeces can be expelled but may be considered as a new organ surgically created to enable the patient to still lead a normal life without suffering the side effects of this diversion. The main objective of the enterostomal-therapist nurse (E.T nurse) is to give back to the ostomate patient a good quality of life and a quick return to self sufficiency. The implementation of an adequate and effective rehabilitation process is as important as the correct use of appliances. This rehabilitation process will include: information on type of surgery and consequences, psychological support for patients and relatives, preoperative stoma sitting, appliances management, management of complications, patient education and long term follow-up.

A new image to accept: psychological aspects of stoma care.

Patients undergoing ileostomy or colostomy surgery face permanent changes to their accepted body image and lifestyle. This article examines the conscious and subconscious reactions patients exhibit in response to this.

[Rehabilitation of children with external intestinal fistula]. / Reabilitatsiia detei s naruzhnymi kishechnymi svishchami.

Experience in the treatment of 153 children with external intestinal fistulas is discussed. In 6 children the intestinal fistulas occurred as the result of a pyodestructive process in the abdominal cavity, in 147 children they were formed for therapeutic purposes. The choice of the method of treatment is individual and is determined by the character of the fistula. A magneto-++-compressive inter-intestinal++ anastomosis (MCIA) was formed for exclusion of the intestinal fistulas. Under conditions of peritonitis in gun-barrel enterostomy intraoperative formation of the MCIA can be undertaken. The method was applied in 21 children, no complications occurred. In closure of gun-barrel enterostomy an operative method was elaborated with preservation of the greater part of the magneto-++-compressive anastomosis.