Ostomy-Related Quality of Life in Puerto Ricans Living With Inflammatory Bowel Disease: A Prospective Cohort Study.

PURPOSE: The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma. DESIGN: Prospective cohort study. SUBJECTS AND SETTINGS: The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014. METHODS: One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables. RESULTS: Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores. CONCLUSIONS: The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.

Increase in the number of IBD surgical resections at the Puerto Rico Medical Center: A brief report.

OBJECTIVE: There is limited data describing Inflammatory Bowel Disease (IBD) among Hispanics. In Puerto Rico, three studies have been conducted that estimate the prevalence of this disease. Although still rare, these studies coincide that IBD has increased during the last decades. This study aims to describe the IBD surgical resections received in the Pathology Laboratory of the Puerto Rico Medical Center (PRMC) in two periods: 1966-82 and 2002-2008. METHODS: A retrospective review of the Surgical Pathology reports was done. A total of 133 reports complied with the inclusion criteria for IBD out of a total of 314,493 pathologies evaluated. For purposes of comparison, the data was grouped into 3 time periods: 1966-1973, 1974-1982 and 2002-08. RESULTS: The number of IBD cases per 100,000 pathologies for the period 1966-73 was 15.1, for the period 1974-82 was 19.1 and for the period 2002-08 was 125.0. The number of IBD resections increased 87.9% when comparing years 1966-73 with 2002-2008, with similar increases in Ulcerative Colitis and Crohn's Disease. Although this result was not statistically significant (p>0.05), a higher proportion of IBD patients had an IBD resection at a younger age in the 2002-2008 time period. A change in the sex profile of the patients was also identified; the majority of cases (75%) were females in the years 1966-1973 while 50.6% were males in 2002-2008. CONCLUSION: Our results confirm an increase in IBD surgical resections at the PRMC. Although not significant, a higher proportion of incident cases are occurring among younger age groups and the distribution of incident cases has become similar between males and females in recent years.

Surveillance for dysplasia in patients with ileal pouch-anal anastomosis for ulcerative colitis: an interim analysis.

BACKGROUND: The risk of developing cancer in the ileal pouch of patients with surgery for ulcerative colitis has not been defined. Dysplasia in the pouch is quite rare. Although some suggest pouch surveillance based on previous histological assessments, there are no guidelines for surveillance of these patients. The aim of our study was to investigate that risk and identify time intervals for ileoanal pouch surveillance. METHODS: Endoscopy and biopsies of the ileal pouch were performed at 3, 6, and/or 12 months after ileal pouch-anal anastomosis (IPAA) became functional. Biopsies were evaluated by two pathologists using Riddel's criteria. Interim data analysis using descriptive statistics is reported. RESULTS: Thirty-eight patients have entered the study. Average patient age at 3, 6, and 12 months of surveillance was 39.1, 36.8, and 39.1 years, respectively. Average disease duration was 8.2 years. Ten of 38 cases (26%) had colonic dysplasia prior to surgery. Dysplasia within the pouch was reported in one patient 6 months after IPAA became functional. This patient demonstrated no dysplasia at 12 months or statistical divergence by age, duration of disease or history of colonic dysplasia prior to IPAA. No subgroup of patients with dysplasia was identified to calculate cumulative risk or perform comparative statistical analysis. CONCLUSION: A study with longer follow-up after IPAA should precede any attempt to recommend routine surveillance. However, the finding of dysplasia early after surgery underscores the importance of early pouch surveillance in our population, at least until definite predisposing variables are identified.

Ileal pouch-anal anastomosis for ulcerative colitis: the University of Puerto Rico experience

OBJECTIVE: To review the experience with ileal pouch-anal anastomosis surgery for ulcerative colitis at the University Hospital. BACKGROUND: As many as 40 of patients with ulcerative colitis (UC) and 75 with Crohn's disease (CD) require some surgery for their disease. The number of patients referred to our clinics for evaluation and management of Inflammatory Bowel Disease (IBD) has risen in the past seven years. A multidisciplinary IBD service has been created at the University Hospital for the care of these patients, leading to a dramatic increase in the number of surgeries performed for IBD. Over the past decade the ileal pouch-anal anastomosis (IPAA) has emerged as the procedure of choice in most patients with ulcerative colitis requiring total colectomy for management of their disease. Even though the procedure is associated with a considerable morbidity rate, it has become very popular since it avoids the need for a permanent stoma and presumably rids the patient of disease and subsequent cancer risk. RESULTS: Twenty-five patients were identified as having IPAA for ulcerative colitis between 1993-2000. Indications for surgery were intractability and toxic megacolon. Complications were pouchitis in 11/25 (44), anastomotic stricture in 6/25 (24), small bowel obstruction in 4/25 (16), and pouch failure in 2/25 (8). Other complications included wound abscess in 1/25 (4), and sexual dysfunction in 1/25 (4) patients. There was no mortality; the patients' quality of life was rated as greatly improved in 14 of 17 patients interviewed (82.4) and 16 of 17 said they would recommend the surgery to others (94.1). CONCLUSIONS: The results of IPAA surgery, morbidity, mortality, and patient satisfaction in our series were similar to other centers around the world.

Impericia médica en Puerto Rico: 1990-1996 / medical negligence in Puerto Rico: 1990-1996

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3 percent), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36 percent, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic