Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

Risk factors and outcomes of occurrence of anastomotic leakage and reoperations for its management after colorectal surgery

Background: Anastomotic leakage (AL) is still the most annoying postsurgery complication after colorectal resection due to its serious complications up to death. Limited data were available regarding differences in AL incidence, management, and consequences for different types of colorectal resection. The aim of the present work was to evaluate differences in incidence of AL, incidence of postoperative complications, and length of hospital stay in a large number of patients who underwent elective colorectal resection for management of colorectal lesions. In addition to detect when and what type of reoperation for management of AL occur after colorectal resection. Patients: All 250 included patients underwent elective surgeries for colorectal resection with performance of primary anastomosis for management of colorectal neoplastic and non-neoplastic diseases in the period between May 2016 and July 31, 2021. We followed the patients for 90 days; we registered the follow-up findings. Results: the rates of AL occurrence were variable after the different procedures. The lowest rate of AL occurrence was found in patients who underwent right hemicolectomy, then in patients who underwent sigmoidectomy, left hemicolectomy, transversectomy and anterior resection (p= 0.004). A stoma was frequently performed during reoperation (79.5%) which was significantly different between different procedures: 65.5% in right hemicolectomy, 75.0% in transversectomy, 85.7% in left hemicolectomy, and 93.0% in sigmoid resection (p< 0.001). Conclusion Rates, types, time of occurrence and severity of AL vary according to the type of colectomy performed and selective construction of stoma during AL reoperation is currently safely applied with comparable mortality rates for patients who did and who did not have a stoma after reoperation. (AU)

Construção e validação de cenário de telessimulação no contexto da criança com estomia intestinal / Construcción y validación del escenario de telesimulación en el contexto de niños con estomia intestinal / Construction and validation of telessimulation scenario in the context of children with intestinal stoma

Objetivo: Descrever a construção e validação de um cenário de telessimulação para a assistência de enfermagem à criança com colostomia. Método: Estudo metodológico desenvolvido em três etapas: elaboração, validação e teste piloto do cenário. Resultados: O roteiro docenário foi construído e posteriormente aprovado por três estomaterapeutas com percentil de 95%. Subsequente o cenário foi validado por telessimulação com cinco peritas e atingiu índice de validade de conteúdo de 0,88. Após a validação foi realizado teste piloto com três acadêmicas de enfermagem. Conclusão: A validação do cenário atingiu um percentil satisfatório e permitiu organizar e corrigir a estrutura da telessimulação, priorizando a soma de experiências e o desenvolvimento profissional de estudantes. Foi tracejado que a utilização da telessimulação consiste em uma promissora alternativa como método ativo de ensino simultâneo à simulação clínica tradicional.

Purpose: Describe the construction and validation of a telesimulation scenario for nursing care for children with colostomy. Methods: Methodological study developed in three stages: elaboration, validation and pilot test of the scenario. Results: The scenario script was constructed and subsequently approved by three stomatherapists with a 95% percentile. Subsequent scenario was validated by telessimulation by five experts and reached a content validity index of 0.88. After validation, a pilot test was performet with three nursing students. Conclusion: The validation of the scenario reached a satisfactory percentile and allowed the organizing and correcting of the structure of the telessimulation, prioritizing the sum of experiences and the professional development of students. It was traced that the use of telessimulation consists of a promising alternative as an active method of simultaneous teaching to traditional clinical simulation.

Objetivo: Describir la construcción y validación de un escenario de telesimulación para la atención de enfermería de niños con colostomia. Método: Estudio metodológico desarrollado en tres etapas: elaboración, validación y prueba piloto del escenario. Resultados: El guión del escenario fue construido y posteriormente aprobado por tres estomaterapeutas con un percentil del 95%. El escenario posterior fue validado por telesimulación por cinco peritas y alcanzó un índice de validez de contenido de 0,88. Después de la validación, se realizo uma prueba piloto com tres estudiantes de enfermería. Conclusión: La validación del escenario alcanzó un percentil satisfactorio y permitió la organización y corrección de la estructura de la telesimulación, priorizando la suma de experiencias y el desarrollo profesional de los estudiantes. Se trazó que el uso de la telesibulación consiste en una alternativa prometedora como método activo de enseñanza simultánea a la simulación clínica tradicional.

Técnica de la incisión y cierre de piel en "punto de mira" para la reversión de estoma. Experiencia en el Centro Médico Nacional "La Raza", México / Gunsight skin incision and closure technique for stoma reversal. Experience in Centro Médico Nacional "La Raza", México

RESUMEN Antecedentes: la cirugía de restitución del tránsito intestinal presenta complicaciones posoperatorias tales como infección de sitio quirúrgico, asociado a percepción de pobre resultado cosmético por parte de los pacientes. Objetivo: describir la técnica quirúrgica de incisión y cierre de piel en "punto de mira" para la reversión de estoma y los resultados posoperatorios. Material y métodos: entre noviembre de 2020 y mayo de 2021 se realizó esta técnica a 15 pacientes con estatus de colostomía e ileostomía. Se analizaron los resultados transoperatorios y posoperatorios. Resultados: edad promedio: 38±2,5 años, índice de masa corporal: 28±1,5 kg/m2, tiempo de estadía hospitalaria: 4±2 días. La técnica presentó buena exposición de tejidos y ningún paciente presentó infección de sitio quirúrgico. A los 30 días del alta, el 100% de los pacientes expresaron alta satisfacción por el resultado estético evidenciado mediante la escala Likert 3. Conclusión: la utilización de este procedimiento ofrece ventajas técnicas, y alta satisfacción de los pacientes.

ABSTRACT Background: Stoma reversal has postoperative complications such as surgical site infection associated with patients' perception of a poor cosmetic outcome. Objective: The aim of this study is to describe the gunsight skin incision and closure technique for stoma reversal and the postoperative results. Material and methods: Between November 2020 and May 2021, this technique was performed on 15 patients with colostomy and ileostomy. The intraoperative and postoperative results were analyzed. Results: Mean age was 38 ± 2.5 years, body mass index was 28±1.5 kg/m2, and length of hospital stay was 4 ± 2 days. The technique provided good tissue exposure and no patients presented surgical site infection. Thirty days after discharge 100% of patients reported high satisfaction with the cosmetic result as evidenced by the 3-point Likert scale. Conclusion: This procedure offers technical advantages and high patient satisfaction.

Glyphosate-resistant hairy fleabane (Conyza bonariensis) exhibits a larger number of trichomes and altered stomatal density relative to the susceptible counterpart

Following the adoption of Roundup Ready crops, glyphosate spraying frequency increased, while the use of other herbicide modes of action was neglected. Herbicide-resistant biotypes were reported in three major Conyza species in Brazil, including Conyza bonariensis, increasing growers' bottom line. Considering that leaf surface structures affect proper herbicide deposition, uptake, and performance, this study aimed to characterize epicuticular surface components in glyphosate-resistant (R) and -susceptible (S) C. bonariensis. Conyza spp. seeds were collected in 36 locations in Brazil, and plants were subjected to resistance screening tests by spraying glyphosate at 720 and 1440 g ae ha-1 (0.5X and 1X the label recommended rate, respectively). For resistance level characterization, C. bonariensis biotypes with contrasting responses were selected for glyphosate dose-response assays. Leaf tissues for epicuticular surface analysis were harvested from newly-obtained R and S biotypes at two growth stages. Histological cuts were made on a leaf area of 25 mm² with a blade. Samples were fixed in Karnowsky solution, gradually changed to 100% ethanol, critical-point dried with CO2, and coated with gold, followed by stomatal and trichome density quantification using scanning electron microscopy. Results indicated a poor control with glyphosate in 33 of 36 Conyza spp. biotypes, and a high (31.5) resistance factor was calculated after dose-response trials. Leaf surface analysis indicated that C. bonariensis leaves are amphistomatic and exhibit tectorial trichomes. A higher number of trichomes and altered stomatal density (number.mm²) were quantified in R compared to the S counterpart, potentially reducing glyphosate uptake and effectiveness.

The effect of simulation on nursing students' knowledge about colostomy irrigation: a quasi-experimental study / Efecto de la simulación en los conocimientos de estudiantes de enfermería sobre irrigación de colostomía: estudio cuasiexperimental / Efeito da simulação no conhecimento de estudantes de enfermagem sobre irrigação de colostomia: estudo quase experimental

ABSTRACT Objective: to compare the effect of clinical simulation and of a lectured class on Nursing students' knowledge about the colostomy irrigation procedure. Method: a quasi-experimental study conducted in September 2019 with Nursing students attending Universidade Federal do Rio Grande do Norte in Natal, Brazil. The instruments used were a questionnaire targeted at sociodemographic issues and a knowledge analysis tool at three different moments. The Control Group had a lectured class and the Intervention Group took part in the laboratory simulation. The Chi-Square and Mann-Whitney tests were used for data analysis. Results: no statistically significant differences were observed between the groups in terms of the sociodemographic profile. In the analysis of the means of correct answers, better measures were observed in the post-test of both groups when compared to the pre-test; however, in the retention test, the students from the Intervention Group had better and statistically significant results than those from the Control Group (p-value=0.015). Conclusion: it is noticed that both teaching strategies exerted a positive effect on the students' learning process. Although both are equally important and effective, simulation showed better performance in knowledge retention. It is expected that this research enables educators to reflect on their work and allows them to use strategies that enhance their teaching practice, in order to benefit teaching and the students' development.

RESUMEN Objetivo: comparar el efecto de la simulación clínica y de una clase expositiva en los conocimientos de estudiantes de Enfermería sobre el procedimiento de irrigación de colostomía. Método: estudio cuasiexperimental realizado en septiembre de 2019 con estudiantes de Enfermería de la Universidade Federal do Rio Grande do Norte en Natal, Brasil. Como instrumentos se utilizaron un cuestionario dirigido a cuestiones sociodemográficas y una herramienta de análisis del conocimiento, en tres ocasiones diferentes. Al Grupo Control se le ofreció la clase expositiva y el Grupo Intervención participó de la simulación en laboratorio. Para el análisis de los datos se emplearon las pruebas de Chi-Cuadrado y de Mann-Whitney. Resultados: no se observaron diferencias estadísticas significativas entre los grupos en relación con el perfil sociodemográfico. En el análisis de los valores medios de respuestas correctas se observaron mejores medidas en el post-test de ambos grupos, en comparación con el pre-test; sin embargo, en el test de retención, los estudiantes del Grupo Intervención obtuvieron mejores resultados que los del Grupo Controle, además de ser estadísticamente significativos (valor p =0,015). Conclusión: se percibió que ambas estrategias de enseñanza produjeron un efecto positivo en el proceso de aprendizaje de los estudiantes. Aunque ambas son importantes y eficaces, la simulación presentó mejor desempeño en la retención de conocimientos. Se espera que este trabajo de investigación permita que los educadores reflexiones acerca de su trabajo y haga posible la utilización de estrategias que mejoren su práctica docente, a fin de beneficiar la educación y el desarrollo de los estudiantes.

RESUMO Objetivo: comparar o efeito da simulação clínica e da aula expositiva dialogada no conhecimento de estudantes de enfermagem sobre o procedimento de irrigação de colostomia. Método: estudo quase experimental, realizado em setembro de 2019 com acadêmicos de enfermagem da Universidade Federal do Rio Grande do Norte, em Natal, Brasil. Utilizaram-se como instrumentos um questionário voltado para questões sociodemográficas e um de análise de conhecimento em três diferentes ocasiões. O grupo controle teve aula expositiva dialogada e o grupo intervenção participou da simulação em laboratório. Para análise de dados foram usados os testes Qui-Quadrado e o de Mann-Whitney. Resultados: observou-se ausência de diferenças estatísticas significantes entre os grupos quanto ao perfil sociodemográfico. Na análise das médias de acertos, observaram-se melhores medidas no pós-teste dos dois grupos, quando comparado ao pré-teste, contudo, no teste de retenção os discentes do grupo intervenção tiveram resultados melhores que o grupo controle e estatisticamente significantes (p-valor=0,015). Conclusão: percebeu-se que as duas estratégias de ensino produziram efeito positivo no processo de aprendizagem dos discentes. Apesar de ambas serem importantes e eficazes, a simulação apresentou melhor desempenho na retenção do conhecimento. Espera-se que a pesquisa possibilite aos educadores a reflexão de seu trabalho e oportunize a utilização de estratégias que aprimorem sua prática docente, com vistas a beneficiar o ensino e desenvolvimento dos estudantes.

Quality of life of people with intestinal ostomies and associated factors / Calidad de vida de personas con estomas intestinales y factores asociados / Qualidade de vida das pessoas com estomias intestinais e fatores associados

ABSTRACT Objective: to assess the quality of life of individuals with intestinal ostomies and its association with sociodemographic and clinical factors. Method: a cross-sectional and correlational study conducted between August 2019 and December 2021, involving individuals with intestinal ostomies registered at the Orthotics and Prosthetics Service of the Municipal Health Department of São Luís-Maranhão. The questionnaires used included a sociodemographic one, a clinical one, and the City Of Hope - Quality Of Life - Ostomy Questionnaire (COH-QOL-OQ). The statistical analyses were conducted using the SPSS Statistics 20.1 software for Windows, with a 5% significance level. Normality was verified using the Shapiro-Wilk test, and the correlations between independent and dependent variables were assessed using paired t-tests. Results: the sample consisted of 154 participants, mostly men (62.6%), with a mean age of 49.94 years old and Incomplete Elementary School (35%). The majority had colostomies (81.2%), temporary (61%), and cancer as etiology (47.4%). In terms of quality of life, the mean scores for the spiritual well-being domain (8.45) stood out, followed by the physical (4.05), psychological (5.85) and social (6.33) domains. The association between sociodemographic/clinical factors, and quality of life was statistically significant (p≤0.05) for religion, schooling, type and characteristics of the household, ostomy permanence and complications, post-ostomy employment, presence of spouse, physical activity, and access to health services. Etiology of the ostomy was found to be significantly associated with the physical (p=0.03), psychological (p=0.01) and social (p=0.01) domains, as well as overall (p=0.05). Conclusion: the study revealed a significant association for the physical, psychological, social and spiritual domains, impacting the quality of life and care practices for individuals with ostomies and their families.

RESUMEN Objetivo: evaluar la calidad de vida de personas con estomas intestinales y la asociación con factores sociodemográficos y clínicos. Métodos: estudio transversal y correlacional realizado entre agosto de 2019 y diciembre de 2021 con personas ostomizadas registradas en el Servicio de Órtesis y Prótesis de la Secretaría Municipal de Salud de São Luís-Maranhão. Se utilizó un cuestionario sociodemográfico, uno clínico y el City Of Hope - Quality Of Life - Ostomy Questionnary (COH-QOL-OQ). Los análisis estadísticos se procesaron en el programa de software SPSS Statistics 20.1 para Windows, con nivel de significancia del 5%. En la prueba de Shapiro-Wilk se verificó la normalidad y, con la prueba t pareada, las correlaciones de las variables independientes y dependientes. Resultados: la muestra estuvo compuesta por 154 participantes, con mayoría de hombres (62,6%), media de edad de 49,94 años, con estudios primarios incompletos (35%), colostomías (81,2%), temporarias (61%) y cáncer como etiología (47,4%). En relación con la calidad de vida, se destacaron los valores medios correspondientes a los dominios de bienestar espiritual (8,45), físico (4,05), psicológico (5,85) y social (6,33). La asociación entre factores sociodemográficos/clínicos y calidad de vida presentó significancia estadística (p ≤ 0,05) para religión, nivel de estudios, tipo y característica del hogar, permanencia del estoma y complicaciones, trabajar después del estoma, presencia de cónyuge, actividad física y acceso a servicios de salud. Se verificó que la mayor significancia de la etiología del estoma correspondió a los dominios físico (p=0,03), psicológico (p=0,01), social (p=0,01) y general (p=0,05). Conclusión: el estudio demostró una asociación significativa para los dominios físico, psicológico, social y espiritual, con efecto sobre la calidad de vida y en las prácticas de atención a personas con estomas y sus familiares.

RESUMO Objetivo: avaliar a qualidade de vida das pessoas com estomias intestinais e associação com fatores sociodemográficos e clínicos. Método: estudo transversal e correlacional realizado entre agosto de 2019 e dezembro de 2021, com pessoas estomizadas cadastradas no Serviço de Órtese e Prótese da Secretaria Municipal de Saúde de São Luís-Maranhão. Utilizou-se questionários sociodemográfico, clínico e City OF Hope - Quality Of Life - Ostomy Questionnary (COH-QOL-OQ). As análises estatísticas foram processadas pelo Software SPSS Statistics 20.1 para Windows, nível de significância 5%. No teste Shapiro-Wilk verificou-se a normalidade e no teste-t pareado as correlações das variáveis independentes e dependente. Resultados: amostra composta por 154 participantes, maioria homens (62,6%), idade média 49,94 anos, com ensino fundamental incompleto (35%), colostomia (81,2%), temporária (61%) e câncer como etiologia (47,4%). Em relação à qualidade de vida, destacaram-se as médias para os domínios bem-estar espiritual (8,45), físico (4,05), psicológico (5,85) e social (6,33). A associação entre fatores sociodemográficos, clínicos e qualidade de vida foi estatisticamente significante (p ≤ 0,05) para religião, escolaridade, tipo e característica do domicílio, permanência da estomia e complicações, trabalho pós-estomia, presença de cônjuge, atividade física e acesso ao serviço de saúde. Verificou-se a maior significância da etiologia da estomia para domínios físico (p=0,03), psicológico (p=0,01), social (p=0,01) e geral (p=0,05). Conclusão: o estudo mostrou associação significante para os domínios físico, psicológico, social e espiritual, com impacto a qualidade de vida e nas práticas de cuidado às pessoas com estomias e seus familiares.

Scarless two-stage delayed coloanal anastomosis: a technique description

Introduction: In current clinical practice, immediate coloanal anastomosis (ICA) remains the standard technique for restoring the gastrointestinal tract following coloproctectomy for low rectal cancer. This anastomosis still requires a temporary diverting stoma to decrease the postoperative morbidity, which remains significantly high. As an alternative, some authors have proposed a two-stage delayed coloanal anastomosis (TS-DCA). This article reports on the surgical technique of TS-DCA. Methods: The case described is of a 53-year-old woman, without any particular history, in whom colonoscopy motivated by rectal bleeding revealed an adenocarcinoma of the low rectum. Magnetic resonance imaging showed a tumor ~ 1 cm above the puborectalis muscle, graded cT3N +. The extension workup was negative. Seven weeks after chemoradiotherapy, a coloproctectomy with total mesorectal excision (TME) was performed. A TS-DCA was chosen to restore the digestive tract. Conclusion: Two-stage delayed coloanal anastomosis is a safe and effective alternative for restoring the digestive tract after proctectomy for low rectal cancer. Recent data seem to show a clear advantage of this technique in terms of morbidity. (AU)

Analysis of the clinical effect of single J tube of bilateral ureter through the bladder stoma to treat vesicovaginal fistula after radiotherapy of cervical cancer / 中华泌尿外科杂志

This article retrospectively analyzed the clinical data of 8 patients with vesicovaginal fistula after radiotherapy for cervical cancer admitted in our hospital from January 2015 to October 2021. All of them underwent cystostomy under local anesthesia. A single J tube of bilateral ureters was retained under cystoscope, and the single J tube was introduced into the fistula bag through the cystostomy opening. All patients wore diapers for a long time before operation, and used urine pads 0-2 pieces/day after operation. QOL score was 5.3±0.5 points before operation, and 2.5±0.5 points after operation. The patient's body odor basically disappeared. The vesicovaginal fistula can be repaired by surgery, but for patients who cannot be operated or failed repeatedly due to various reasons, a single J tube of bilateral ureters can be drawn out through the cystostomy opening, which can improve the quality of life of patients through minor trauma.

Aplicativos Móveis Incorporados à Assistência de Enfermagem ao Estomizado Intestinal / Aplicaciones Móviles Incorporadas a la Asistencia de Enfermería a Estomizados Intestinales / Mobile Applications Incorporated to Nursing Assistance to Intestinal Stomized

Objetivo: investigar as evidências científicas sobre o uso de aplicativos móveis para o cuidado de pessoas com estomias intestinais. Método: Realizou-se revisão integrativa da literatura nas bases de dados MEDLINE, SciELO e LILACS, adotando um recorte temporal do período de 2016-2021. Resultados: Ao total foram selecionados 09 artigos cujos resultados mostraram que a criação de aplicativos móveis em saúde tem se mostrado válida como estratégia de acompanhamento e prescrição de condutas terapêuticas, devido ao seu potencial em aliar a teoria à prática contemplando o indivíduo na sua integralidade e individualidade, promovendo e facilitando a sua reabilitação. Conclusão: Representam, portanto, os aplicativos móveis, ferramentas de promoção de autocuidado em pacientes estomizados intestinais para a prevenção de complicações na pele periestomal, traduzindo-se em uma grande inovação devido aos seus benefícios em relação à qualidade, rapidez, dinamismo e segurança. Entretanto, tem-se ainda uma lacuna relacionada à tímida produção de estudos.(AU)

Objective: to investigate the scientific evidence on the use of mobile applications for the care of people with intestinal ostomy. Method: An integrative literature review was carried out in the MEDLINE, SciELO and LILACS databases, adopting a time frame of the period 2016-2021. Results: In total, 09 articles were selected whose results showed that the creation of mobile health applications has proved to be a valid strategy for monitoring and prescribing therapeutic conducts, due to its potential to combine theory with practice, contemplating the individual in its entirety and individuality, promoting and facilitating their rehabilitation. Conclusion: Therefore, mobile applications represent tools to promote self-care in intestinal ostomized patients for the prevention of complications in peristomal skin, resulting in a great innovation due to its benefits in terms of quality, speed, dynamism and safety. However, there is still a gap related to the timid production of studies.(AU)

Objetivo: investigar la evidencia científica sobre el uso de aplicaciones móviles para el cuidado de personas con ostomía intestinal. Método: Se realizó una revisión integradora de la literatura en las bases de datos MEDLINE, SciELO y LILACS, adoptando un marco temporal del período 2016-2021. Resultados: En total se seleccionaron 09 artículos cuyos resultados mostraron que la creación de aplicaciones móviles de salud ha demostrado ser una estrategia válida para el seguimiento y prescripción de conductas terapéuticas, por su potencial para combinar la teoría con la práctica, contemplando al individuo en su totalidad y individualidad, promoviendo y facilitando su rehabilitación. Conclusión: Por tanto, las aplicaciones móviles representan herramientas para promover el autocuidado en pacientes ostomizados intestinales para la prevención de complicaciones en la piel periestomal, resultando en una gran innovación por sus beneficios en términos de calidad, rapidez, dinamismo y seguridad. Sin embargo, todavía existe una brecha relacionada con la tímida producción de estudios.(AU)

Study on the role of ET-led one-to-one teaching method in the wound stoma teaching of gastrointestinal surgery residents / 中华医学教育探索杂志

Objective:To explore the role of one-to-one teaching led by international enterostomal therapist (ET) in the standardized training of wound stoma in gastrointestinal surgery.Methods:A total of 36 interns who underwent standardized training in the Gastrointestinal Surgery Department of The First Affiliated Hospital of Kangda College of Nanjing Medical University from July 2019 to January 2020 were selected as the control group, and the traditional teaching was adopted. Other 38 interns who were trained from May 2020 to October 2020 wre grouped into research group, and ET-led one-to-one teaching was adopted. The scores of theoretical knowledge and practical operation skills of gastrointestinal surgery wound stoma were compared between the two groups after the training, and the scores of case analysis, problem analysis and solving, knowledge application and comprehensive ability before and after the training were compared. Besides, satisfaction with methods and teaching effectiveness was compared. SPSS 25.0 was used for t test and chi-square test. Results:The clinical theoretical knowledge [(93.45±5.28) vs. (90.11±6.39)] and practical operation skills assessment scores [(92.25±6.18) vs. (89.13±5.36)] of the research group were all significantly higher than those of the control group after training ( P<0.05); the scores of case analysis ability, problem analysis and solving ability, knowledge application ability, and comprehensive ability of the two groups after the training were significantly higher than those before the training ( P<0.05), and the above scores in the research group were all higher than those in the control group ( P<0.05); the satisfaction of the interns in the study group with teaching methods and teaching effects was higher than that in the control group ( P<0.05). Conclusion:Applying ET-led one-to-one teaching to the wound and stoma teaching of gastrointestinal surgery residents can significantly improve their assessment performance, teaching satisfaction, and the teaching effect, and improve their case analysis ability, problem analysis and solving ability, knowledge application ability, and comprehensive ability.

Influences of continuous nursing on WeChat platform upon the nursing effects on patients with intestinal stoma / 中国实用护理杂志

Objective:To analyze the effects of continuous nursing intervention on patients with intestinal stoma using WeChat, China′s most popular messaging App.Methods:A total of 60 patients undergoing permanent intestinal stoma surgery, who were admitted to Dalian Third People′s Hospital from January 2018 to December 2019, were selected as the research objects. They were divided into the control group and the observation group with 30 cases each using random number table method. The control group adopted the traditional continuous nursing model while the observation group received both traditional continuous nursing model and continuous nursing interventions via WeChat. By using the Exercise of Self-Care Agency Scale (ESCA), City of Hope-Quality of Life-Ostomy Questionnaire Chinese Version (C-COH), and Ostomy Adjustment Inventory (OAI), the differences in self-care capability, quality of life, stoma adaptability, incidence of intestinal stoma complications, and patients′ satisfaction with the new nursing model in the two groups were compared before the intervention, 1 month and 3 months after the intervention, respectively.Results:Before intervention, there was no significant difference between the two groups in ESCA total score, C-COH score and OAI score ( P>0.05). After 1 month and 3 months of intervention, the observation group had the total ESCA scores of (91.50 ± 2.86) and (104.87 ± 3.45) points, which were higher than control group′s (81.37 ± 2.98) and (92.80 ± 2.91) points, respectively, and the differences between the two groups were statistically significant ( t=13.13, 14.38, both P<0.05); the observation group had the C-COH scores of (5.00 ± 1.13) and (6.37 ± 1.22) points, which were higher than the control group′s (3.90 ± 1.14) and (4.67 ± 1.04) points, respectively, and the differences between the two groups were statistically significant ( t=3.71, 5.69, both P<0.05); the observation group had the OAI scores of (48.13 ± 8.55) and (60.07 ± 7.43) points, which were higher than the control group′s (39.57 ± 7.43) and (43.47 ± 7.39) points, respectively, and the difference between the two groups was statistically significant ( t=4.07, 8.53, both P<0.05); after 3-month intervention, the observation group had a 16.7 % (5/30) incidence of stoma complications, which was lower than the control group′s 46.7% (14/30), and the difference between the two groups was statistically significant ( χ2=6.24, P<0.05); after 3-month intervention, the observation group had a score of (95.90 ± 1.66) points for the patient′s satisfaction with continuous care, which was higher than the control group′s (89.80 ± 2.44) points, and the difference between the two groups was statistically significant (t value was 11.13, P<0.05). Conclusions:Delivering the WeChat continuous nursing interventions for patients with intestinal stoma has improved the patients′ self-care capability, enhanced stoma adaptation level and quality of life, reduced the incidence of intestinal stoma complications, and improved patients′ satisfaction. Thereby, continuous nursing on WeChat is worthy of clinical application.

Establishment and implementation of management information system for patients with stomas in cancer special hospital / 中国实用护理杂志

Objective:To establish and implement a management information system for patients with stomas based on the hospital information system.Methods:Relying on information system resources of Beijing Cancer Hospital, Beijing Institute for Cancer Research, the management information system for patients with stomas was developed by the Nursing Department and the Information Center from August 2018 according to the requirement of whole process management for patients with stomas.Results:A whole process management information system was constructed for patients with stomas including stoma construction, stoma care, management of complications and stoma closure. It was applied to 12 departments covering clinical departments and stoma clinics of the hospital, including 326 cases with stomas and 6 358 cumulative visits. 28 cases with skin complications around stoma were detected and the rate of complications was 8.59% (28/326) from May 2019 to October 2020.Conclusions:The management information system for patients with stomas can realize the whole-process management from stoma construction, stoma care, management of complications to stoma closure, and provide basis and guidance for nursing staff to implement professional nursing timely and accurately, which can also provide basis for continuously improving the quality of stoma care.

Several Critical Issues of Low Rectal Cancer Surgery / 肿瘤防治研究

Colorectal cancer is one of the top three malignant tumors in the world. With the rapid development of medical technology and the strengthening of national awareness of cancer screening, rectal cancer has been diagnosed and treated timely. At present, the application of low rectal tumor preservation operation is becoming more and more common. Anastomotic leakage and anterior resection syndrome are the most common complications of low rectal cancer. How to preserve anal and reduce the incidence of complications has always been the concern of scholars at home and abroad. In order to improve the survival time and quality of life of patients with low rectal cancer, this paper expounds five key problems: fully preoperative evaluation of anorectal function and staging, reasonable neoadjuvant therapy, safe distal margin, the selection of surgical methods and the timing of preventive stoma.

Quality of life of patients with locally advanced rectal cancer after neoadjuvant therapy and sphincter-preserving surgery / 中华胃肠外科杂志

Objective: To investigate quality of life (QoL) of patients with locally advanced rectal cancer (LARC) who underwent low anterior resection with protective stoma under neoadjuvant therapy mode, and to explore the changes of QoL of patients from before neoadjuvant therapy to 12 months after stoma reversal. Methods: A descriptive case series study was carried out. A retrospective study was performed on patients with mid and low LARC who received complete neoadjuvant long course radiotherapy and chemotherapy, followed by radical low anterior resection (LAR) combined with protective stoma at Peking Union Medical College Hospital from December 2017 to January 2020. Inclusion criteria: (1) patients with rectal MRI assessment of mT3-4b or mN1-2 without distant metastasis (M0) before neoadjuvant therapy; (2) distance from tumor lower margin to the anal verge <12 cm; (3) rectal adenocarcinoma confirmed by biopsy before neoadjuvant therapy; (4) complete cycle of neoadjuvant therapy; (5) patients undergoing radical LAR with sphincter preservation and protective ostomy; (6) patients receiving follow-up for more than 12 months after stoma reversal. Exclusion criteria: (1) patients as grade Ⅳ to Ⅴclassified by the American Society of Anesthesiologists (ASA); (2) patients with multiple primary colorectal cancer; (3) patients with history of other malignant tumors in the past 5 years; (4) patients of emergency surgery; (5) pregnant or lactating women; (6) patients with history of severe mental illness; (7) patients with contraindication of MRI, radiotherapy, chemotherapy, or surgical treatment. A total of 83 patients were enrolled, including 51 males and 28 females with median age of 59 years and mean BMI of (24.4±3.1) kg/m(2). EORTC QLQ-CR29, international erectile function index (IIEF), Wexner constipation score and low anterior resection syndrome (LARS) score were applied to investigate the QoL of the patients before neoadjuvant therapy, 3 and 12 months after ostomy reversal, including rectal anal function and sexual function. M (P25, P75) was used for the scores of the scale. Results: (1) EORTC QLQ-CR29 score showed that before neoadjuvant therapy, before surgery, 3 months and 12 months after ostomy reversal, anxiety [64.4 (52, 0, 82.5), 75.3 (66.0, 89.5), 82.6 (78.5, 90.0), 83.6 (78.0, 91.0)] and concern about body image [76.8 (66.0, 92.0), 81.1 (76.5, 91.5), 85.5 (82.5, 94.0), 86.1 (82.0, 92.0)] were improved (all P<0.01); pelvic pain [5.4 (2.0, 8.0), 5, 0 (2.0, 7.8), 3.9 (1.0, 5.0), 3.0 (1.0, 5.0)], urinary incontinence [15.7 (7.0, 22.0), 11.1 (0, 17.5), 10.0 (0, 17.0), 9.9 (0, 16.0)], impotence [14.3 (4.2, 19.0), 12.2 (0, 16.8), 5.6 (0, 10.0), 5.2 (0.2, 8.0)], urinate [26.4 (13.0, 38.5), 13.9 (0, 20.0), 13.4 (2.5, 21.5), 13.2 (2.0, 20.0)] and mucous bloody stool [4.7 (3.0, 6.0), 2.6 (0, 5.0), 2.2 (0, 5.0), 1.9 (0, 4.0)] were improved as well (all P<0.01). The scores fluctuated in the improvement of male sexual function, abdominal pain, dry mouth, worry about body mass change, skin pain and dyspareunia, but the symptoms were significantly improved after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). There were no significant changes in female sexual function, dysuria, dysgeusia and fecal incontinence after ostomy reversal compared with before neoadjuvant therapy (all P>0.05). (2) IIEF scale showed that all scores were similar before and after neoadjuvant therapy (all P>0.05). (3) Rectal and anal function scale revealed that before neoadjuvant therapy, before operation, 3 months and 12 months after stoma reversal, gas incontinence [3.1 (0, 4.0), 2.3 (0, 4.0), 1.8 (0, 4.0), 1.2 (0, 3.0)] and urgent defecation [7.2 (0, 11.0), 5.2 (0, 11.0), 2.9 (0, 9.0), 1.7 (0, 0)] were improved (all P<0.001). In terms of improving incomplete emptying sensation, the symptoms fluctuated, but the symptoms improved significantly after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). While the symptoms of assistance with defecation [0 (0, 0), 0.7 (0, 1.0), 0.6 (0, 1.0), 0.7 (0, 1.0)] and defecation failure [0.2 (0, 0), 1.0 (0, 2.0), 0.8 (0, 1.5), 0.8 (0, 1.0)] showed a worsening trend (all P<0.001). Stratified analysis was performed on patients with different efficacy of neoadjuvant therapy to compare the changes in QoL before and after neoadjuvant therapy. Patients with less sensitive and more sensitive neoadjuvant therapy showed similar changes in function and symptoms. Patients with less sensitive therapy showed significant improvement in dysuria, urinary incontinence, skin pain and dyspareunia (all P<0.05), and the symptom of defecation frequency in more sensitive patients was significantly improved (P<0.05). Conclusions: For patients with LARC, neoadjuvant radiochemotherapy combined with radical LAR and protective stoma can improve QoL in many aspects. It is noted that patients show a worsening trend in the need for assistance with defecation and in defecation failure.

Histórias de vida de pessoas em situação de rua com estomia no município de Porto Alegre (RS) / Life stories of homeless people with ostomies in the city of Porto Alegre (RS)

Estudo de abordagem qualitativa etnográfica que tem como objetivo conhecer o contexto vivenciado pelas pessoas em situação de rua com estomias no município de Porto Alegre, Rio Grande do Sul, Brasil. Visa contribuir para prover a lacuna na área do conhecimento, pois estudos sobre pessoas em situação de rua com estomia são incipientes. A amostra foi constituída por quatro usuários cadastrados em um Centro de Referência de atendimento a pessoas com estomia no município de Porto Alegre (RS), ativos e inativos, assim como por aqueles indivíduos que possuem estoma e não estão vinculados a um serviço de atendimento. A coleta de dados foi realizada de maio de 2021 a junho de 2022, sendo utilizados a Observação Participante, o diário de campo, os dados de prontuários e as entrevistas. Como resultado, os dados foram agrupados com as características das pessoas em situação de rua com estomias, como idade, cor, escolaridade, renda, vínculo familiar, estado civil, comorbidades, uso de álcool/drogas, procedência, tempo em que vive na rua e que tem o estoma. Foram realizadas entrevistas, observações participantes e pesquisa de campo e os dados encontrados foram separados nos seguintes tópicos: Quem foram os participantes da pesquisa?; Como foram localizados os participantes da pesquisa?; Percurso etno-cartográfico: mobilização de afecções do campo na pesquisadora; Como é a vida dos usuários com seu estoma?; Como foi o comportamento dos participantes observado pela pesquisadora no período da pesquisa?; O uso de drogas entre os participantes; O que mais chamou a atenção da pesquisadora nesta caminhada e Como estavam os participantes no final da coleta de dados. O estudo foi aprovado pelo CEP/SMS pelo CAAE: 45171021.2.0000.5338 sob o Parecer de no 4.676.428. Concluiu-se que possuir um estoma e viver nas ruas requer diferentes adaptações na rotina dos indivíduos, demonstrando a relevância de aprofundar as pesquisas na temática, bem como a formulação de novas políticas públicas para a população em situação de rua.

A study with an ethnographic qualitative approach that aims to know the context experienced by homeless people with stomas in the city of Porto Alegre, Rio Grande do Sul, Brazil. It aims to contribute to fill the gap in the area of knowledge, because studies on homeless people with ostomy are incipient. The sample consisted of four users registered in a Reference Center for assistance to people with stomas in the city of Porto Alegre (RS), active and inactive, as well as those individuals who have a stoma and are not linked to a care service. Data collection was carried out from May 2021 to June 2022, using Participant Observation, field diary, data from medical records and interviews. As a result, the data was grouped with the characteristics of homeless people with stomas, such as age, color, education, income, family ties, marital status, comorbidities, alcohol/drug use, origin, time living on the streets, and the time they have the stoma. Interviews, participant observation and field research were carried out and the data found were separated into the following topics: Who were the research participants; How were the research participants located; Ethno-cartographic path: mobilization of field conditions in the researcher; How is the life of users with their stoma; How was the behavior of the participants observed by the researcher during the research period; Drug use among the participants; What most called the attention of the researcher in this journey and how were the participants at the end of data collection. The study was approved by the CEP/SMS by CAAE: 45171021.2.0000.5338 under Opinion number 4.676.428. It was concluded that having a stoma and living on the streets requires different adaptations in the routine of individuals, demonstrating the relevance of further research on the subject, as well as the formulation of new public policies for the homeless population.

Application of Snyder’s hope theory in patients with pelvic floor exercise after prophylactic stoma retraction / 中国实用护理杂志

Objective:To explore the effect of pelvic floor muscle functional exercise based on Snyder hope theory in patients after prophylactic stoma retraction.Methods:74 patients with low rectal cancer who underwent prophylactic stoma retraction from July 2019 to June 2021 were randomly divided into intervention group and control group. The patients in the control group received routine nursing and pelvic floor muscle functional exercise. The patients in the intervention group received functional exercise intervention based on Snyder′s hope theory on the basis of the control group. The hope level and self-care ability of the patients in the two groups were evaluated before the intervention and 3 months after stoma restitution. The anal function of the patients in the two groups was evaluated 1 month and 3 months after stoma restitution.Results:Before the intervention, there was no significant difference in the score of hope level and self-care ability between the two groups ( P>0.05). Three months after the operation, the score of hope level in the observation group was 36.20 ± 3.82, which was higher than that in the control group (31.26 ± 5.03) ( t = 4.63, P<0.05). Three months after the operation, the self-care ability score of the observation group was 123.57 ± 10.82, which was higher than that of the control group (108.23 ± 9.48) ( t = 6.31, P<0.05). One month and three months after stoma retraction, the anal function scores of the observation group were 12.03 ± 3.94, 5.91 ± 2.05 respectively, which were lower than those of the control group (13.86 ± 2.19, 7.26 ± 1.74) ( t = 2.40, 2.99, both P<0.05). Conclusion:Pelvic floor muscle functional exercise based on Snyder′s hope theory can improve the hope level of patients after stoma retraction, improve their anal function and improve their self-care ability.

Indicadores sociodemográficos e de saneamento e moradia na qualidade de vida de pessoas com estomia / Sociodemographic and sanitation and housing indicators on the quality of life of people with stoma / Indicadores sociodemográficos y sanitarios y habitacionales sobre la calidad de vida de las personas ostomizadas

Objetivo:Analisar as relações entre a qualidade de vida (QV) de pessoas com estomia com indicadores sociodemográficos, clínicos, de estilo de vida, de saneamento e moradia. Métodos: Estudo transversal com amostra de 106 indivíduos com estomia entrevistados de maio a dezembro de 2019. Utilizou-se um questionário sociodemográfico e clínico e o City of Hope - Quality of Life - Ostomy Questionnary. Resultados: O bem-estar espiritual (7,71±1,09) foi o domínio com melhor performance. A QV não diferiu entre homens e mulheres (p = 0,372), porém esteve associada à escolaridade (< 0,001) e renda familiar (p = 0,025), ao diabetes (p = 0,008) e etilismo (p = 0,044), às condições da água para consumo (p < 0,001), ao destino do lixo (p = 0,021), em ter energia elétrica (p = 0,034), ao tipo de moradia (p = 0,026) e ao número de cômodos (p = 0,023) e tipo de cobertura da habitação (p = 0,021). Conclusão: Piores indicadores socioeconômicos, de saneamento básico e moradia, parecem impactar negativamente a QV de pessoas com estomias.

Objectives:To analyze the relationships between the quality of life (QOL) of people with stoma with sociodemographic, clinical, lifestyle, sanitation, and housing indicators. Method: Cross-sectional study with a sample of 106 individuals with stoma interviewed from May to December 2019. A sociodemographic and clinical questionnaire and the City of Hope Quality of Life Ostomy Questionnaire were used. Results: Spiritual well-being (7.71 ± 1.09) was the best performing domain. Quality of life did not differ between men and women (p = 0.372), but was associated with education (< 0.001) and family income (p = 0.025), diabetes (p = 0.008) and alcoholism (p = 0.044), drinking water conditions (p < 0.001), garbage disposal (p = 0.021), having electricity (p = 0.034), housing type (p = 0.026), number of rooms (p = 0.023), and housing coverage (p = 0.021). Conclusion: worse socioeconomic, sanitation, and housing indicators appear to negatively impact the QOL of people with stomata

Objetivo:Analizar las relaciones entre la calidad de vida (CV) de las personas con estoma con indicadores sociodemográficos, clínicos, de estilo de vida, saneamiento y vivienda. Métodos: Estudio transversal con una muestra de 106 ostomizados, entrevistados de mayo a noviembre de 2019. Se utilizó un cuestionario sociodemográfico y clínico y el Cuestionario City of Hope - Quality of Life - Ostomy. Resultados: El bienestar espiritual (7,71 ± 1,09) fue el dominio con mejor desempeño. La CV no difirió entre hombres y mujeres (p = 0,372), pero se asoció con la educación (< 0,001) y los ingresos familiares(p = 0,025), la diabetes (p = 0,008) y el alcoholismo (p = 0,044), con las condiciones de agua potable (p <0,001), el destino de la basura (p = 0,021), la disponibilidad de electricidad (p = 0,034), el tipo de vivienda (p = 0,026) y el número de habitaciones (p = 0,023) y tipo de cobertura de vivienda (p = 0,021). Conclusión: Peores indicadores socioeconómicos, saneamiento básico, vivienda, parecen impactar negativamente la calidad de vida de las personas con ostomía.

Abordagem de temas correlatos a estomaterapia no ensino de graduação em enfermagem: análise documental / Addressing themes related to stomatherapy in undergraduate nursing education: document analysis / Enfoque de temas relacionados a la estomaterapia en la enseñanza de graduación en enfermería: análisis documental

Objetivo:discutir a abordagem de temas correlatos à estomaterapia nos Projetos Pedagógicos (PP) e ementas de cursos de graduação de enfermagem de instituições públicas de ensino superior (IPES) do centro-oeste brasileiro. Método: pesquisa documental, exploratória, de abordagem qualitativa, desenvolvida no período de março a junho de 2020. Os cursos de enfermagem foram localizados por meio de acesso ao portal on-line do Ministério da Educação (e-MEC) e acessados os PP e ementas das disciplinas, quando disponíveis. Resultados: compuseram a amostra 17 cursos de graduação em enfermagem. Temas correlatos à estomaterapia estão presentes em disciplinas obrigatórias, optativas ou atividades extensionistas. Identificou-se predominância do conteúdo de feridas em disciplinas obrigatórias, e os temas estomias e incontinências são ofertados principalmente em disciplinas optativas ou atividades extensionistas. Conclusão: a pesquisa almeja ofertar às IPES subsídios para reflexão e avaliação curricular na difusão de temas correlatos à estomaterapia na formação superior em enfermagem.

Objective:discuss the approach of themes related to stomatherapy in Pedagogical Projects (PP) and syllabuses of undergraduate nursing courses from public institutions of higher education (PIHE) in the Brazilian Midwest. Method: documentary research, exploratory, with a qualitative approach, developed from March to June 2020. The nursing courses were located through access to the Ministry of Education's online portal (e-MEC) and the PP and the subject syllabuss were accessed, when available. Results: The sample consisted of 17 graduation nursing courses. Themes related to stomatherapy are present in mandatory, elective or extension activities. It was identified a predominance of wound content in mandatory subjects, and the themes ostomy and incontinence are offered mainly in elective subjects or extension activities. Conclusion: the research aims to offer the PIHE subsidies for reflection and curriculum evaluation in the dissemination of topics related to stomatherapy in higher education in nursing

Objetivo:discutir el enfoque de temas relacionados a la estomaterapia en los Proyectos Pedagógicos (PP) y descripciones de cursos de graduación de enfermería de instituciones públicas de enseñanza superior (IPES) del centro-oeste brasileño. Método: investigación documental, exploratoria, de enfoque cualitativo, desarrollada en el período de marzo a junio del 2020. Los cursos de enfermería fueron localizados por medio de acceso al portal online del Ministerio de la Educación (e-MEC) y accedidos los PP y descripciones de las asignaturas, cuando estén disponibles. Resultados: compusieron la muestra 17 cursos de graduación en enfermería. Temas relacionados a la estomaterapia están presentes en asignaturas obligatorias, optativas o actividades extensionistas. Se identificó predominancia del contenido de heridas en asignaturas obligatorias, y los temas estomías e incontinencias son ofertados principalmente en asignaturas optativas o actividades extensionistas. Conclusión: la investigación desea ofertar a las IPES subsidios para la reflexión y evaluación curricular en la difusión de temas relacionados a la estomaterapia en la formación superior en enfermería.

Terapia asistida con vacío y estoma flotante (floating stoma): una nueva forma de tratar un absceso periostomal / Vacuum assisted therapy and floating stoma: S new way to treat a periostomal abscess

Resumen Introducción: Los estomas flotantes se definen como un estoma que no está fijado a la piel de la pared abdominal, esta técnica se ha descrito en cirugía para fístulas entero-atmosféricas y de control de daños. Caso Clínico: Presentamos un reporte de caso de manejo de absceso paraostomal en paciente con antecedente de laparotomía por abdomen agudo, por lo que se decide uso de terapia de presión negativa asociada a estoma flotante, demostrando su utilidad en este tipo complejo de pacientes.

Introduction: Floating stomata are defined as a stoma that is not attached to the skin of the abdominal wall, this technique is described in surgery for entero-atmospheric fistulas and damage control. Clinical Case: We present a case report of the management of paraostomal abscess in a patient with a history of laparotomy due to acute abdomen, it was decided to use negative pressure therapy associated with a floating stoma, demonstrating its usefulness in this complex type of patient.