International Consensus Results: Development of Practice Guidelines for Assessment of Peristomal Body and Stoma Profiles, Patient Engagement, and Patient Follow-up.

Evidence indicates that a common problem for the person with an ostomy is pouch leakage and the development of peristomal skin irritation, which can negatively affect quality of life. While it is clear that the pouching system seal leakage can cause profound problems for the person with an ostomy, little information is available on interventions that focus on leakage. To address this gap, an international group of ostomy nurse experts was convened to develop consensus-based practice guidelines to assist ostomy nurses in determining the best pouching system for the patient. The outcomes of these guidelines for the person with a stoma are to decrease leakage and increase security and confidence leading to an increased quality of life. A large-scale Modified Delphi Consensus-Building Process was used to identify key factors in assessing body and stoma profiles to determine the best pouching system. The resulting consensus provides practice guidelines on how to assess body and stoma profiles, engage and educate patients, and when to follow up with patients after hospital discharge or product change.

Stoma Bridge Types and Their Impact on Patient Outcomes: A Retrospective Analysis and Prospective Global Survey of Surgical Practice.

PURPOSE: The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist. DESIGN: Retrospective chart review and cross-sectional survey. SAMPLE AND SETTING: The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS). METHODS: In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist. RESULTS: Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team. CONCLUSIONS: Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

Comparison of Anterior Segment Optical Coherence Tomography Bleb Grading, Moorfields Bleb Grading System, and Intraocular Pressure After Trabeculectomy.

PURPOSE: To compare a novel anterior segment optical coherence tomography (AS-OCT) bleb grading system with a clinical bleb grading system and both with intraocular pressure (IOP) following trabeculectomy surgery. MATERIALS AND METHODS: A novel AS-OCT grading system based on bleb size and internal reflectivity was developed. An imaging center was tasked with masked grading of AS-OCT images acquired by multiple surgical sites at postoperative week (POW) 2, postoperative month (POM) 4, 6, and 12, respectively. The Moorfields Bleb Grading System was used by another independent imaging center to grade clinical photos. The results of the 2 grading systems were compared and correlated with IOP. RESULTS: Blebs of 124 eyes were assessed in this study. Higher (worse) AS-OCT bleb grades was significantly associated with: decreased bleb height at POM4, 6, and 12 (P<0.001, 0.001, and 0.0001), increased central bleb vascularity at POM4 and 12 (P=0.0026;0.036) and decreased maximal bleb area at POM6 and 12 (P=0.026; 0.01). A higher AS-OCT bleb grade correlated with a higher IOP at POM4 and 6 (P=0.004; 0.02), though no longer significant at POM12 (P=0.1). Increased maximum bleb vascularity was associated with increased IOP at POM4 (P=0.003) though none of the remaining MGBS parameters correlated significantly with IOP. Eyes with a final IOP of ≤12 mm Hg had significantly lower AS-OCT bleb grades at POM6 (P=0.045). CONCLUSION: A novel AS-OCT bleb grading system correlated well with a number of Moorfields Bleb Grading System variables throughout the 1-year postoperative period. Although the AS-OCT grades also correlated well with IOP throughout most of the postoperative period, it was limited in their abilities to predict final IOP.

Cuidados de enfermeria a pacientes con ostomias digestivas / Nursing care for patient with digestive ostomies

Revision bibliografica del tema cuidados de enfermeria a pacientes ostomizados a los efectos de que el mismo sea de utilidad para la elaboración actualizada del protocolo de cuidados de estos pacientes en nuestra institución. Se estudiaron los distintos tipos de ostomias y sus caracteristicas principales, complicaciones.(AU)

Cuidados de enfermeria a pacientes con ostomias digestivas / Nursing care for patient with digestive ostomies

Revision bibliografica del tema cuidados de enfermeria a pacientes ostomizados a los efectos de que el mismo sea de utilidad para la elaboración actualizada del protocolo de cuidados de estos pacientes en nuestra institución. Se estudiaron los distintos tipos de ostomias y sus caracteristicas principales, complicaciones.

[Intestinal stomas--indications, stoma types, surgical technique]. / Der künstliche Darmausgang--Indikationen, Stomaformen, chirurgische Technik.

The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.