The Young Adult Male's Perception of Life with Inflammatory Bowel Disease and a Stoma: A Qualitative Examination.

While the experiences of young adults with inflammatory bowel disease (IBD) and a resultant stoma have been investigated in the USA, there is a paucity of such qualitative research in Europe. In Ireland, the voices of this patient cohort have remained remarkably silent. The purpose of this study was to achieve an understanding of the lived experience as depicted by young adults with IBD and a stoma. Purposive sampling was employed. Those with a histological diagnosis of IBD and a consequential stoma within the last 12 months were approached via a letter of invitation. Of those approached, 5 male patients aged 20-30 years agreed to participate. A qualitative approach was adopted comprising a single, detailed semi-structured interview with each of the participants. Verbatim transcripts of these interviews and associated field notes were analysed using interpretative phenomenological analysis methodology. Five superordinate themes emerged from the analysis: (1) Control, (2) Secrecy, (3) Patient education and support services, (4) Difficult emotions, (5) Acceptance and growth. A universal struggle to preserve autonomy of bodily function, emotions and healthcare decisions existed among participants. Participants embraced the predictability of their stoma relative to the restraints imposed on them by their erratic pre-operative bowel habit. Moreover, participants also reinforced the importance of timely patient education in the peri-operative period to limit uncertainty and distress. This study provides a unique insight into the lived experience of young adult males with IBD and a stoma and in particular provides a greater understanding of the peri-operative education requirements of this patient cohort.

Antiseptic wick: does it reduce the incidence of wound infection following appendectomy?

The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15/174). In patients with wound wicks it was 11.6% (10/86) compared to 5.6% (5/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.