Use of a Convex Pouching System in the Postoperative Period: A National Consensus.

Convex pouching systems have been available for ostomy patients for decades; however, controversy remains over the use of convexity in the postoperative period. A group of 10 nurses and physicians with expertise caring for patients with an ostomy completed a scoping review identifying research-based evidence and gaps in our knowledge of the safety and effectiveness related to the use of a convex pouching system following ostomy surgery. Results of this scoping review demonstrated the need for a structured consensus to define best practices when selecting a pouching system that provides a secure and reliable seal around the stoma, avoids undermining and leakage of effluent from the pouching system, and contributes to optimal health-related quality of life for patients following ostomy surgery. The expert panel reached consensus on 8 statements for the use of convex products immediately after surgery and throughout the first 6 months after stoma creation, as well as describing goals in choosing the best pouching system for the patient with an ostomy.

Survey Results on Use of a Convex Pouching System in the Postoperative Period.

PURPOSE: The purpose of this study was to validate time frames for postoperative care following stoma surgery and to determine participants' current practice with convex pouching systems during the postoperative period. DESIGN: A Cross-sectional survey. SUBJECTS AND SETTING: The sample comprised 332 ostomy care specialists practicing in the United States. Most (n = 220; 66%) had more than 10 years' experience caring for patients with ostomies, 82% (n = 272) were certified WOC or ostomy care nurses (CWOCN and COCN), and 7% (n = 23) were board-certified colorectal surgeons. METHODS: A 23-item online questionnaire was created for purposes of the study. Items in the questionnaire queried professional background and experience caring for patients with an ostomy. A single item was used to identify postoperative care periods following ostomy surgery. Additional items queried current practice patterns related to use of convex pouching systems and the timing of their use. Data were collected from January 18 to February 8, 2021. RESULTS: Most respondents (n = 270; 90%) agreed with the following postoperative periods after ostomy surgery: immediate postoperative period (days 0-8); postoperative period (days 9-30); and transition phase (days 31-180). Most respondents (n = 274; 95%) indicated they would use a convex pouching system when clinically appropriate during the first 30 days following ostomy surgery and 79% (n = 228) indicated using a convex pouching system regardless of when the surgery was performed. Less than 1% (n = 2) indicated never using convexity within the first 30 days following stoma surgery, and only 3% (n = 8) indicated avoidance of convexity pouching systems in the immediate postoperative period. CONCLUSIONS: Findings indicate that use of convexity during the postoperative period is prevalent to provide a secure seal and predictable wear time.

Blood Cells and Interferon-Gamma Levels Correlation in Latent Tuberculosis Infection.

The Mycobacterium tuberculosis (M. tb) infection is largely spread in world's population. Most infected individuals develop latent tuberculosis infection (LTBI). Tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are the available tests to detect the infection. It has been reported that some individuals take a longer period of time to develop the infection than others with the same exposure level. It is suggested that the innate immunity, in which neutrophils have an important protective role, is responsible for this. Many hematologic abnormalities have been described as common findings during severe disease. To investigate if these changes are related to LTBI development and if they interfere in TST and IFN-γ production, we recruited 88 household contacts of tuberculosis (TB) pulmonary patients and compared blood cell counts with these tests' results. There were no statistically significant changes in hemoglobin, hematocrit, platelets, global leukocyte, neutrophils, basophils, eosinophils, typical lymphocytes, atypical lymphocytes, and monocytes counts between infected and noninfected individuals. Also, there was no correlation between TST or IGRA and blood cell counts. These results suggest that blood cell counts are not LTBI markers and do not interfere in TST results or IFN-γ levels obtained by IGRA.

Levels of interferon-gamma increase after treatment for latent tuberculosis infection in a high-transmission setting.

Objectives. We investigated IFN-γ levels before and after a six month course of isoniazid among individuals with latent tuberculosis infection (LTBI) in a high-transmission setting. Design. A total of 26 household contacts of pulmonary tuberculosis patients who were positive for LTBI by tuberculin skin test completed six months of treatment and submitted a blood sample for a follow-up examination. The IFN-γ response to Mycobacterium tuberculosis-specific antigens was measured, and the results before and after the completion of LTBI treatment were compared. Results. Of the 26 study participants, 25 (96%) showed an IFN-γ level higher than their baseline level before treatment (P ≤ 0.001). Only one individual had a decreased IFN-γ level after treatment but remained positive for LTBI. Conclusion. In a high-transmission setting, the IFN-γ level has increased after LTBI treatment. Further studies must be undertaken to understand if this elevation is transient.