Journal of Wound Ostomy and Continence Nursing最新文献

Purpose: The objectives of this study were to determine the incidence of parastomal hernia (PSH) in ostomy patients, define their sociodemographic and clinical profile, establish the time of PSH appearance following ostomy surgery, and identify related symptoms.

Design: Descriptive longitudinal retrospective study.

Subjects and setting: The target population was non-hospitalized patients followed by an ostomy nurse specialist for more than 6 months in an ostomy clinic located in a tertiary hospital in Madrid, Spain. The sample comprised 360 persons with an ostomy; their mean age was 66.33 (SD 13.74) years; a slight majority 56.45% (n = 197) were men.

Methods: We retrospectively reviewed the medical records of patients who underwent ostomy surgery between January 2015 and December 2019. Sociodemographic and relevant clinical variables, reported symptoms, and use and perception of an abdominal compression binder, and the characteristics of PSH in patients with PSH were collected. The diagnosis of PSH was made by CT scan, physical examination, or a combination of both techniques.

Results: A majority of participants (71.7%, n = 258) underwent ostomy surgery to manage a malignancy; most (65.8%, n = 237) had not undergone previous abdominal surgeries. More than half (68.69%, n = 248) had comorbid conditions such as hypertension, thyroid disorders, dyslipidemia, cardiopathy, Parkinson disease, additional types of cancer such as breast, prostate and lung, depression, anxiety, benign prostatic hyperplasia/prostatic enlargement, or chronic kidney disease. Less than 1 in 10 (8.6%, n = 31) underwent intraoperative prophylactic mesh placement during ostomy surgery. Stoma site marking was performed in 44.7% (n = 161), and preoperative education with the ostomy nurse specialist was documented in 39.2% (n = 141). Presence of a PSH was determined by abdominal CT scan in 135 (37.5%), versus 41.49% (n = 149) who had a PSH detected by physical examination alone. Parastomal hernia severity was classified in 51.01% (n = 76) of cases; 81.57% (n = 62) were type I or III, based on the European Hernia Society classification system. The mean time of development of PSH was 8.57 (SD 6.09) months.

Conclusion: In this study, patients with PSH were older and had more associated comorbidities. They had PSH-related discomfort and did not use an abdominal compression binder because it was uncomfortable.

Lower extremity arterial disease (LEAD) affects millions, particularly the elderly and those with diabetes mellitus. The Ankle Brachial Index (ABI) compares systolic pressures in the ankle and brachial arteries to assess lower extremity arterial perfusion. Despite its benefits, the ABI has limitations like low sensitivity in asymptomatic patients and inaccuracies due to arterial calcification. An ABI is beneficial for screening for LEAD in individuals with lower extremity wounds, assessing arterial blood flow before compression therapy, and evaluating wound healing potential. Understanding ABI's limitations and proper use ensures accurate diagnosis when evaluating and managing LEAD. It is crucial that clinicians are well-versed and knowledgeable in the proper use of ABI in the assessment of LEAD and recognize when to refer patients to a vascular specialist.

Purpose: The aim of this systematic review was to synthesize the published literature to determine the validity, reliability, and usability of the Studio Alterazioni Cutanee Stomali (SACS) and Ostomy Skin Tool (OST) instruments.

Method: Systematic literature review.

Search strategy: We searched the following electronic databases: PubMed, CINAHL via EBSCO, Embase, and CENTRAL. The search was limited to studies published after 2005 and written in the English or Dutch languages. Inclusion criteria were adults (18 years or older) with any type of abdominal ostomy created for any medical indication. Elements were selected for inclusion when they examined or described at least one psychometric aspect regarding validity, reliability, or usability of the OST or SACS.

Findings conclusions: The search retrieved 3077 records after removing duplicate elements. This systematic review is based on findings from four studies identifying two different psychometric properties. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist and the COSMIN Risk of Bias Tool were used to assess the methodological quality of the included studies. The modified GRADE-approach was used to evaluate the quality of evidence for outcomes reported in this systematic review. According to the COSMIN criteria, the overall assessment for reliability and content validity was variable or indeterminate. This results in a low quality of evidence regarding the assessment instruments SACS and OST. Based on these findings, we conclude that neither the SACS nor OST have been sufficiently evaluated to fully determine their validity, reliability and usability in the clinical setting.

Implications: More research of peristomal skin assessment instruments SACS and OST is needed for further refining and validation before they can be introduced as a "gold standard" in practice among nurses, experts, and clinicians.

Purpose: The purpose of this systematic review was to evaluate the effectiveness of educational interventions in improving knowledge, attitudes and/or practices (KAP) related to Urinary Incontinence (UI) in women.

Method: Systematic review.

Search strategy: We searched the databases PubMed, Cochrane, Scopus, Virtual Health Library and Embase and identified 467 potential records. We selected studies that measured any component of the KAP before and after an educational intervention. We excluded studies that used health care professionals as subjects. Two independent authors extracted data from the eligible studies using a standard form. We used the "Risk of Bias tool", the Rob 2.0 tool, and the ROBINS-I tool to assess methodological quality of studies and possible sources of bias. Findings were synthesized qualitatively.

Findings/conclusions: The sample comprised five studies. The non-randomized studies showed a low risk of bias, and randomized studies were classified as having "some concerns". Most activities were conducted in classrooms and in group settings, with oral discussion of the theme and use of videos and brochures. Trained professionals delivered all interventions. Findings suggest that the educational interventions were effective in improving women's knowledge and may improve attitudes and/or practices related to UI. Evidence related to the effect of these interventions was sparse.

Implications: The differences in KAP found before and after interventions suggest that educational strategies improve women's knowledge and may improve attitudes and practices related to UI, although additional research is needed to confirm these findings.