Journal of Wound Ostomy and Continence Nursing最新文献

Purpose: The purpose of this study was to examine health-related quality of life and adaptation of persons with a colostomy before and after use of a colostomy plug.

Design: Single group before-and-after study.

Subjects and setting: The study sample comprised 19 people with a colostomy who attended an outpatient clinic João Pessoa, in Paraiba, Brazil. Inclusion criteria were: over 18 years, protruding colostomy, diameter 20 to 45 mm, elimination pattern of up to 3 solid or pasty fecal stools per day, and medical prescription for the use of the colostomy plug.

Methods: Data were collected between November 2018 and February 2019. Three outpatient visits per participant were completed; informed consent and baseline data were collected during clinic visit one. Data collected at baseline included demographic and pertinent clinic data. Stoma specific quality of life was measured using the City of Hope Quality of Life - Ostomy Questionnaire; adaptation to an ostomy was measured using the Scale for the Level of Adaptation of Ostomy Patients (SLAOP). Participants were also taught to use a colostomy plug during this visit. A second visit occurred between the 8th and 10th day of use; participants' ability to use the device was assessed during this visit. A third visit occurred 30 to 35 days after plug use; instruments used to measure adaptation and health-related quality of life were readministered.

Results: Participants who had significantly higher scores for quality of life and adaptation were identified in people who used the plug in all dimensions of the Scale for Level of Adaptation of people with stomas and City of Hope Quality of Life - Ostomy Questionnaire, except for the interdependence mode. Significant, positive and strong correlations were identified between adaptation and quality of life before (r = 0.823; P = .000015) and after (r = 0.808; P = .000028) use of the colostomy plug.

Conclusion: Findings suggest that use of a colostomy plug improved adaptation and quality of life in some patients living with a colostomy.

Background: Peristomal pyoderma gangrenosum (PPG) is a non-infectious neutrophilic dermatosis most commonly seen in the context of ostomies in inflammatory bowel disease. The lack of established treatment guidelines and high-quality evidence in the form of randomized controlled trials present a major challenge in PPG management, owing to the rarity of the condition. Treatment can be further complicated by difficulties in maintaining the stoma pouch seal with conventional topical corticosteroids.

Case: We present a case of PPG treated with aerosol steroid inhaler, highlighting the need for innovative solutions in the management of the condition to maintain the stoma pouch seal.

Conclusion: We achieved rapid and sustained resolution with the aerosol steroid, thus sparing the need for systemic agents, and we would like to advocate for its licensed use in PPG.

Purpose: The purpose of this study was to investigate whether a self-compassion expressive writing activity could improve psychological well-being in people with an ostomy, as assessed by changes in body image distress, ostomy-specific quality of life (QOL), self-compassion, and dispositional disgust.

Design: Randomized controlled trial design was used.

Subjects and setting: The sample comprised 175 English-speaking patients over 18 years of age with a fecal or urinary ostomy; all participants resided in Australia and New Zealand. All were recruited online between May and July 2019.

Methods: Following completion of a baseline questionnaire, participants were randomly assigned to complete either an online self-compassion expressive writing exercise (intervention group; n = 88; 50.29%) or a control expressive writing exercise (n = 87; 49.71%). Online questionnaires were completed 1-week and 1-month following completion of either expressive writing task. Intent-to-treat repeated-measure ANOVA analyses assessed benefits to self-compassion, body image distress, and ostomy-specific quality of life. Dispositional disgust sensitivity and propensity, as assessed by baseline scores on the Dispositional Disgust Sensitivity and Propensity Scale (DPSS), were assessed as moderators.

Results: Analyses revealed that younger people with an ostomy had poorer self-compassion, greater body image distress, and poorer ostomy-specific QOL than older people, and those who had lived with their ostomy for longer had lower body image distress and greater QOL. There were no significant main effects of writing condition on primary measures; however, individuals in the intervention condition with low dispositional disgust had greater self-compassion, greater ostomy-specific QOL, and lower body image distress than those with high dispositional disgust.

Conclusion: Although expressive writing is a pragmatic and accessible intervention, our findings suggested that it was of benefit only to people with low dispositional disgust. Further work is required to establish an effective psychological tool for this under-researched population.

Purpose: Global pressure injury (PI) statistics reveal that hospital-acquired pressure injuries (HAPIs) remain a substantial burden, with over 1 in 10 hospitalized adults being affected. The purpose of this analysis is to describe how consistent collection, analysis, and use of data allow hospitals to validate their clinical and economic outcomes and to adjust PI prevention strategies.

Participants and setting: HAPI incidence data for acute care patients at a 280-bed regional community hospital in the Mid-Atlantic region of the United States (West Virginia) were collected from January 2012 to July 2023.

Approach: Multilayered silicone foam dressings from 3 manufacturers were used during data collection and outcomes evaluated. The average annual HAPI incidence was calculated retrospectively to allow comparison of outcomes during the time periods that various soft silicone multilayered foam manufacturers were used.

Outcomes: When using dressing 1, the hospital experienced an average of 10.40 HAPI per year. When using dressing 2, the hospital experienced an average of 5.56 HAPI per year, and when using dressing 3, the average was 26.29 HAPI per year. Additionally, an estimated sum of US $451 229.91 was saved when using dressing 2 compared to dressing 3, and US $105 352.28 was saved during the use of dressing 2 as compared to dressing 1.

Implications for practice: Monitoring data over time can validate product selection decisions to ensure they are advantageous to both costs and the delivery of quality care.

Purpose: the purpose of this study was to evaluate the content, readability, understandability, and suitability of online resources for patient specific ostomy care.

Design: Retrospective cohort study.

Subject and setting: Online websites for ostomy care designed for patients.

Methods: Ostomy care websites designed for patients were identified by querying three online search engines. Content areas were established following assessment of all websites by two reviewers. Readability of each website was determined using the Flesch Reading Ease Test and the Simple Measure of Gobbledygook (SMOG) index. Understandability was measured using the Patient Education Materials Assessment Tool (PEMAT), and suitability was determined using the Suitability Assessment of Materials (SAM). Chi-Square and rank sum tests were used to compare these measures across website type and by number of content areas.

Results: Twenty-three websites met inclusion criteria; 26.1% were for-profit, 13% were government, 26.1% were academic, and 34.8% were non-profit. Nineteen content areas were identified including themes related to pouching, bathing, physical activity, managing output, lifestyle, mental health, and eating. The median number of content areas covered was 8.5 [interquartile range (IQR) 4-13]. The most common content areas were changing/emptying a pouching system (82.6% of websites), preventing/managing peristomal skin irritation (78.3%), eating (60.9%), and odor management (60.9%). Less than 27% of websites had content on irrigation, blockage/constipation, and body image. Readability scores using the Flesch Reading Ease (mean 58, IQR 54.7-69.5) and SMOG Index (mean 9.1, IQR 7.6-9.9) correlated to a high-school or "fairly difficult" reading level. The mean PEMAT measuring understandability was 80 (IQR 78.9-84.0). The mean SAM score checking for suitability (literacy demand, graphics, layout and type, learning stimulation and motivation and cultural appropriateness) was 55% (IQR 48.4%-61.3%), indicating "adequate material." A greater number of content areas on the websites were associated with worse readability (SMOG and Flesch Reading Ease scores) than websites presenting fewer content areas (P = .001 & P < .001, respectively).

Conclusions: We found significant variability in the content, readability, understandability, and suitability of online materials for ostomy care. Websites with more content areas were associated with worse readability.

Purpose: The purpose of this study was to explore the performance of pouching systems with respect to leakage and the development of peristomal skin complications (PSCs) in an acute care setting immediately following ostomy creation.

Design: Non-experimental, retrospective cohort study.

Subjects and setting: The sample comprised 214 patients admitted for stoma-creation surgery at one of the 2 University of Pittsburgh Medical Center Presbyterian-Shadyside campuses located in the Northeastern United States (Pittsburgh, PA). Patients were seen in an in-patient care setting.

Methods: Electronic health records from patients who were in the hospital for ostomy creation surgery were reviewed by wound ostomy continence nurses from each hospital. Demographic and selected clinical data were collected. The main outcome variables used to evaluate pouching system performance were leakage and PSCs. These outcomes were assessed starting at pouch placement in the operating room and at every subsequent pouch change (up to 5) through discharge or 2 weeks following surgery.

Results: Use of an elastic tapeless barrier (ETB) significantly reduced the risk of leakage compared to a ceramide-infused tape-border barrier (CIB) for patients (41% reduced risk of leakage, P = .011). Use of the ETB also reduced leakage risk compared to the CIB for patients who experienced leakage 2 or more times during the observation period (31% reduction in leakage risk, P = .043). Five types of PSCs occurred during the study and statistical analysis indicated no significant differences in the number of PSCs was documented between barrier types.

Conclusion: The use of an ETB significantly reduced the risk of leakage compared to a CIB.

Background: Ms. S was a 50-year-old woman hospitalized with necrotizing fasciitis from a labial abscess. After several surgical interventions wound debridements were performed consecutively for 6 days. She was left with extensive full thickness tissue destruction of her abdomen, bilateral groin areas, and complete displacement of skin over her mons pubis. Wounds related to necrotizing fasciitis can be especially challenging to manage, especially when the perineal region is involved. Due to the location of such wounds, it can be difficult to maintain dressings, including negative pressure wound therapy with instillation devices (NPWTi). Ms. S. also had a history of uncontrolled diabetes mellitus, which can hinder wound healing.

Case: The Wound, Ostomy and Continence (WOC) nurse was consulted on day 6 of Ms. S's admission, for application of NPWTi. Complex NPWTi dressings were completed in the operating room (OR), 2 times weekly for 2 weeks. When Ms. S was transferred from the intensive care unit to the surgical unit, NPWT dressings with instillation were used but later converted to standard NPWT, changed twice weekly by the WOC nurse. Dressings were changed at the bedside until day 29 of her admission.

Conclusion: The management of Ms. S's extensive wounds was successful, and her wounds were closed by plastic surgery on day 29 of her admission. Ms. S was the first patient at our hospital with extensive wounds from necrotizing fasciitis to undergo surgical closure of her wounds during the same hospital admission.

Purpose: The aim of the study was to analyze the characteristics of the biofilm of venous ulcers in terms of location and formation and to relate the presence of the biofilm to ulcer characteristics including duration, injured area, and necrotic tissue.

Design: Descriptive clinical study.

Materials and methods: We obtained 2 biopsy fragments (tissue samples) from 44 patients with venous ulcers treated at a public outpatient clinic in a university hospital in Belo Horizonte, Brazil. Ulcers were photographed and classified according to the duration. In addition, the wound size and proportion of wound surface covered by necrotic tissue were measured. One fragment from each ulcer underwent microbiological analysis, while the other was analyzed using transmission electron microscopy. Data analysis was limited to fragments from patients with bacteria in the microbiological analysis.

Results: Data analysis is based on samples obtained from 21 ulcers in 21 patients who had bacteria in their ulcer based on microbiologic analysis of a tissue sample. Most ulcers were open for 2 to 10 years, 57% (n = 12) were 16 cm2 or smaller, and the proportion of the wound bed covered by necrotic tissue coverage varied widely. Of the 21/44 patients (48%) with bacteria in their ulcers, only 3 patients had bacterial biofilm present in the transmission electron microscopy, corresponding to 7% of the 44 patients. Pseudomonas aeruginosa was the most frequent bacterium, identified in 10 fragments. The biofilm was not present on the surface but in a layer slightly below it. The detection of biofilms was not directly related to the duration of the ulcer. It was not possible to establish a correlation between the size of the lesion and the presence of these microorganisms due to the small sample size.

Conclusions: Our findings indicate that detecting biofilm in venous ulcers is challenging, as it does not uniformly occur throughout the wound bed, can occur at different depths, and is often not present on the wound surface. There is a need to develop studies that can contribute to the detection of biofilm in clinical practice.