Comparison of adjustment to a temporary or permanent ostomy using the OAI-23.

AIM: The aim of this work was to compare adjustment between those with a new temporary or permanent ostomy in a cohort of Australian adults. METHOD: This is a multicentre, longitudinal observational study. Ostomy adjustment was measured using the Ostomy Adjustment Inventory (OAI-23) at six possible time points ending at 9 months postsurgery or at the time of ostomy closure in those with a temporary stoma. The OAI-23 includes four domains: anger, acceptance, anxious preoccupation and social engagement. RESULTS: Eligibility criteria were met by 1230 patients, with 849 (69%) recruited and consented. Of these, 108 were excluded as their surgery did not result in the formation of an ostomy and a further 41 were excluded due to there being no data on ostomy type (temporary or permanent). This left a study population of 700, of whom 397 had a temporary and 303 a permanent ostomy. Only small differences were observed between the temporary and permanent ostomy groups at most time points within the four OAI-23 domains. There were no statistically significant differences found beyond 2 weeks postdischarge and the differences were of small size. While no difference was found between the groups in the domain of anxious preoccupation, both groups demonstrated an increase in anxious preoccupation over time. Neither group regained their presurgery confidence to attend social engagements. CONCLUSION: We found only minor differences in adjustment in those with a new temporary ostomy compared with a new permanent ostomy. Both groups demonstrated increasing anxious preoccupation and problems with social engagement. This suggests that access to education, training and support should be equitable between these two groups in clinical practice, and needs to incorporate a focus on psychological as well as physical outcomes.

Comparison of Adjustment or Adaptation to the Formation of a Temporary Versus a Permanent Ostomy: A Systematic Review.

PURPOSE: The aim of this systematic review was to review evidence on adjustment or adaptation to an ostomy in persons with a temporary versus permanent ostomy. METHOD: Systematic review. SEARCH STRATEGY: We comprehensively searched the following bibliographic databases: MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO, CINAHL, Joanna Briggs, Scopus, and EThOS and ProQuest dissertations from inception to July 21, 2021. We located 570 studies. Data were extracted into Covidence, and the risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs tool. FINDINGS: Thirty-one studies met inclusion criteria and were included; only 2 assessed adjustment using a validated adjustment tool (Ostomy Adjustment Inventory, OAI-23). One found better adjustment in those with a permanent ostomy at 6 months; the second did not formally test for statistically significant differences between groups. Other included studies assessed aspects of adjustment such as health-related quality of life and psychological symptoms. Findings differed between studies; the majority of studies were deemed at a high risk of bias. CONCLUSIONS: The quality of evidence among studies evaluating adjustment to an ostomy in permanent versus temporary stomas was poor; the majority did not measure adjustment using a validated adjustment instrument. Therefore, differences in the ways those with a temporary ostomy or permanent ostomy adjust or adapt remain largely unknown. IMPLICATIONS: Further high-quality studies are needed that compare adjustment to a temporary or permanent ostomy using a validated instrument. An understanding of differences in adjustment in those with a temporary and permanent ostomy is important for planning how health care services can be better tailored to meet the needs of ostomy patients beyond the initial postoperative period of recovery.

Peristomal Medical Adhesive-Related Skin Injury: Results of an International Consensus Meeting.

Stomal and peristomal skin complications (PSCs) are prevalent in persons living with an ostomy; more than 80% of individuals with an ostomy will experience a stomal or peristomal complication within 2 years of ostomy surgery. Peristomal skin problems are especially prevalent, and a growing body of evidence indicates that they are associated with clinically relevant impairments in physical function, multiple components of health-related quality of life, and higher costs. Several mechanisms are strongly linked to PSCs including medical adhesive-related skin injuries (MARSIs). Peristomal MARSIs are defined as erythema, epidermal stripping or skin tears, erosion, bulla, or vesicle observed after removal of an adhesive ostomy pouching system. A working group of 3 clinicians with knowledge of peristomal skin health completed a scoping review that revealed a significant paucity of evidence regarding the epidemiology and management of peristomal MARSIs. As a result, an international panel of experts in ostomy care and peristomal MARSIs was convened that used a formal process to generate consensus-based statements providing guidance concerning the assessment, prevention, and treatment of peristomal MARSIs. This article summarizes the results of the scoping review and the 21 consensus-based statements used to guide assessment, prevention, and treatment of peristomal MARSIs, along with recommendations for research priorities.

Peristomal pyoderma gangrenosum: 12-year experience in a single tertiary referral centre.

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage. METHODS: This was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence. RESULTS: Of 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19-72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14-2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3-31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti-inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28-1751 days). DISCUSSION: Medical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.

The embodied experience of pregnancy with an ileostomy.

AIMS AND OBJECTIVES: To understand women's experience of pregnancy with an ileostomy following bowel resection for inflammatory bowel disease or familial adenomatous polyposis. BACKGROUND: While symptoms of IBD/FAP can be debilitating and life-threatening, ostomy formation can effectively manage symptoms. Research on pregnant women with an ostomy is sparse. While some literature suggests pregnant women with an ostomy can have a normal pregnancy and birth, documented stoma complications include intestinal obstruction, peristomal hernia, retraction, stenosis, laceration, bleeding, prolapse, pouching problems, nausea, vomiting and dehydration. DESIGN: Hermeneutic phenomenology. METHODS: All known women (n = 8) who had been pregnant with an ileostomy were recruited from the stomal therapy departments of two teaching hospitals. Single in-depth interviews were digitally recorded and transcribed verbatim. Hermeneutic phenomenological analysis was guided by the philosophy of Merleau-Ponty. Reporting rigour was guided by the consolidated criteria for reporting qualitative research. RESULTS: There was a lower level of concern among pregnant woman with an ostomy than anticipated. Women described the following: the "hell" of the disease; the stoma as a lifeline; heading into uncharted waters; wanting to be normal; the shared space of the baby and the diseased abdomen; pregnancy as a dark tunnel; and the unreliable body. CONCLUSION: Women with inflammatory bowel disease frequently experience debilitating symptoms and serious ill health. Ileostomy formation improves symptoms and the sense of "feeling normal," facilitating readiness for conception, pregnancy and motherhood. However, women's uncertainty about conception and pregnancy persists due to the scarce information and experiences offered by clinicians, and fears around their unreliable body during pregnancy. Given this uncertainty for both women and their treating clinicians, outcomes should be documented and shared to reassure women of child-bearing age that pregnancy and birth can be safe with a stoma. RELEVANCE TO PRACTICE: Women and clinicians should aim for disease remission, peer support, ongoing monitoring and involvement of a Stomal Therapy Nurse.

Outcomes of support rod usage in loop stoma formation.

AIM: Traditionally, support rods have been used when creating loop stomas in the hope of preventing retraction. However, their effectiveness has not been clearly established. This study aimed to investigate the rate of stoma rod usage and its impact on stoma retraction and complication rates. METHOD: A prospective cohort of 515 consecutive patients who underwent loop ileostomy/colostomy formation at a tertiary referral colorectal unit in Sydney, Australia were studied. Mortality and unplanned return to theatre rates were calculated. The primary outcome measure of interest was stoma retraction, occurring within 30 days of surgery. Secondary outcome measures included early stoma complications. The 10-year temporal trends for rod usage, stoma retraction, and complications were examined. RESULTS: Mortality occurred in 23 patients (4.1 %) and unplanned return to theatre in 4 patients (0.8 %). Stoma retraction occurred in four patients (0.78 %), all without rods. However, the rate of retraction was similar, irrespective of whether rods were used (P = 0.12). There was a significant decline in the use of rods during the study period (P < 0.001) but this was not associated with an increase in stoma retraction rates. Early complications occurred in 94/432 patients (21.8 %) and were more likely to occur in patients with rods (64/223 versus 30/209 without rods, P < 0.001). CONCLUSIONS: Stoma retraction is a rare complication and its incidence is not significantly affected by the use of support rods. Further, complications are common post-operatively, and the rate appears higher when rods are used. The routine use of rods warrants judicious application. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: It remains unclear whether support rods prevent stoma retraction. This study, the largest to date, confirms that stoma retraction is a rare complication and is not significantly affected by the use of rods. Consequently, routine rod usage cannot be recommended, particularly as it is associated with increased stoma complications.

A retrospective review of outcomes using a fecal management system in acute care patients.

Intrarectal catheters (ie, large bore, soft, silicone catheters with a retention balloon intended to hold the catheter within the rectum and create a seal) may be used for the temporary management of diarrhea and fecal incontinence, to protect perineal skin and wounds, and to prevent cross infection. To evaluate reasons for insertion, duration, and outcomes of use, a retrospective study of patients who used a fecal management system (FMS) in an acute care, non-ICU setting was conducted at a tertiary-referral hospital between August 2005 and November 2012. Reasons for FMS implementation, patient demographics, history, length of FMS use, reason for removal or reinsertion, and results/complications data were abstracted from the medical records. Continuous variables were analyzed for mean, range, and standard deviation, and statistical significance was assessed using unpaired t-tests; categorical variables were expressed as counts and percentages, with significance assessed using chi-squared tests. The records of 50 patients (29 women, 21 men; average age 63 [range 21-90] years) who had a total of 69 study FMS inserted (mean 1.4 FMS) were available and included in the study. The majority (43) had their FMS inserted for <29 days (mean 17.4 days, range 1-74). Indications for use included diarrhea (31; 62%); burn injury (10; 20%); pressure ulcer (7; 14%); and necrotizing fasciitis (2; 4%). Most patients (37, 74%) experienced no complications; 7 (14%) had their retention balloon overinflated but suffered no injury to the rectal mucosa; 4 (8%) experienced temporary anal atony; and 2 (4%) suffered excessive leak of stool around the device. The complication rate for longer duration use (17+ days) was significantly higher than in the shorter duration (<17 days) group (44% and 15%, respectively, P = 0.024). The longer the FMS was in place, the more likely sphincter tone would be compromised. No serious adverse events - eg, fistula or mucosal necrosis - occurred, but overinflation of the balloon was noted in 7 patients. Overall, these results suggest intrarectal catheters such as the FMS are safe and effectively contained fecal material when used judiciously and checked regularly. Further prospective studies of the device in relation to its continuing safety, efficacy, and cost effectiveness, together with educational support requirements and policy/ procedure development, may lead to greater acceptance of its increased use in general hospital wards. Comparison studies involving other intrarectal catheters examining aspects such as safety, ease of insertion, and patient comfort also are warranted.

Faecal management systems for disabling incontinence or wounds.

Protecting the perineum from faecal enzymes and preventing faeces from spreading to wounds has been a major challenge for nurses and doctors. Clinicians whose patients are at risk of faecal contamination of wounds have used various methods and many non-standard devices have been trialled, including: large French urinary catheters; rigid rectal catheters; faecal collection bags; mushroom-tipped catheters; nasopharyngeal airway; pharmacological and dietary interventions; incontinence pads; and barrier creams. An initial literature review identified a number of papers of possible interest, but overall we found that little work has been done to evaluate the various ad hoc devices used to manage faecal incontinence, or indeed to consider more formal, purpose-designed systems, such as the ConvaTec Flexi-Seal® faecal management system (FMS). The purpose of this paper is to consider the use of purpose-designed faecal or bowel-management systems-the ConvaTec Flexi-Seal® FMS and Hollister InstaFlo® and ActiFlo® bowel management systems (BMS)-available in Australia at the time of writing. Overall, the authors believe that such purpose-designed systems are more efficient and cost-effective than other ad hoc measures.

Marking time: the temporal experience of gastrointestinal cancer.

This study uses Heideggerian Phenomenology to explore the lived experience of gastrointestinal cancer and treatment with a curative intent. Eighteen patients and carers engaged in in-depth, conversational style interviews. Four recurring themes that spoke of the temporal significance of the cancer diagnosis included a recall of intricate details around significant dates; waiting; a changing pace of perceived time and being-towards-death. Fear and anxiety around cancer progression and recurrence underlie these themes. The meaning of time altered so that it was experienced as a precious commodity to be consciously managed in the context of their changed present and future. Being-towards-death was constituted of fear, but allowed the person to redefine meaning and purpose in their life. These insights will better prepare health professionals to guide discussions and provide perspective for the concerns of patients and families, particularly in relation to waiting times for tests and cancer interventions.

A comparison of nurses' perceptions of elective laparoscopic or elective open colorectal resections.

The purpose of this study was to develop an instrument to measure the perceived benefits nurses observe in the recovery of patients who have undergone elective laparoscopic colorectal resections vs. traditional open elective colorectal resections. Secondly, to determine if there are perceived differences in the intensity of nursing required to care for these patients. A twenty-three-point questionnaire was developed and distributed to 23 colorectal nurses working in a single tertiary referral hospital. There was an 83.6% response rate. The findings demonstrate that the participants believe there are significantly better outcomes for the laparoscopic patients in the postoperative period. These benefits include more rapid resumption of independence, decreased pain and fewer complications. The nurses also perceived less time and effort was required when caring for these patients.