Journal of Wound Ostomy and Continence Nursing最新文献

Purpose: The aim of this study was to develop a model to determine the correlation between comfort level and quality of life in women with UI.

Design: Cross-sectional, descriptive correlational research design with causal modeling.

Subjects and setting: The study was conducted in the urology outpatient clinic of a university hospital in the Central Anatolia region of Turkey. The sample comprised 233 women admitted to the outpatient clinic between December 2017 and May 2018. Participants had a mean age of 52.5 (SD = 13.9) years.

Methods: Data were collected using a researcher-designed Descriptive Characteristics Form, the Incontinence Quality of Life (I-QOL) form, the Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ), and the Short Form-36 (SF-36). Multivariate correlations were analyzed using structural equation modeling; an AMOS covariance-based structural equation model was developed.

Results: The correlational pathway between I-QOL, UIFCQ, and SF-36 was statistically significant. As a result of the confirmed model, I-QOL scores were moderately correlated with SF-36 scores (r = .65, P = .001) and highly correlated with UIFCQ scores (r = .76, P = .001). Mean UIFCQ scores were moderately correlated with SF-36 scores (r = .66, P = .001). The structural equation modeling resulted in a model with a good fit.

Conclusions: The higher the comfort level, the higher the UI-specific and health-related quality of life. Risk factors related to UI should be monitored, and necessary training and counseling should be provided to eliminate this common problem.

Purpose: The purpose of the study was to investigate the fit of a two-piece pouching system with a concave-shaped skin barrier on people with an outward peristomal body profile and its effect on leakage, wear time, and quality of life (QoL) related to using an ostomy product.

Design: Randomized, controlled, open-label, cross-over trial.

Subjects and settings: The sample comprised 53 subjects with outward peristomal body profiles and problems with leakage of ostomy effluent from their pouching system. Participants were randomized to the concave two-piece pouching system or a comparator (two-piece pouching system with a flat skin barrier) for 3 weeks. Subjects were then crossed over to the opposite skin barrier for an additional 3 weeks. The study was conducted in Denmark, Norway, Germany, and the Netherlands; data were collected in multiple ambulatory clinics or during home visits.

Methods: The primary end point was the ability of the skin barrier to fit body contours; secondary outcomes were leakage of effluent from the pouching system, wear time, and QoL related to using an ostomy product via the validated Ostomy-Q questionnaire. Primary comparisons between concave and comparator pouching systems were evaluated using proportional odds models and mixed models taking test period into account.

Results: Analysis included randomized subjects who had been exposed to at least one product and with information on at least one end point (full-analysis-set, n = 52). The concave pouching system provided a better fit to body contours than the comparator (P< .001) and reduced the degree of leakage underneath the skin barrier (LS mean difference = -1.84, 95% CI -3.31 to -0.37; P = .016). Participants experienced fewer episodes of leakage outside the skin barrier when using concave versus comparator pouching system (13.0% vs. 26.7%, respectively). Participants reported significant improvements in QoL (LS mean difference = 14.3; 95% CI 9.4 to 19.2; P < .001). No significant difference in wear time between skin barrier shapes was reported.

Conclusions: Study findings indicate that a pouching system with a concave skin barrier achieved a better body fit on people with an outward peristomal body profile and resulted in fewer leakage incidents and higher QoL compared to using a pouching system with a flat skin barrier.

Purpose: This study aimed to compare the odor components before and after spraying a deodorizing spray (DS) on volatile odorants in malignant wounds (MWs) in women with breast cancer; a secondary aim was to evaluate the deodorizing effect of the DS.

Design: This is an observational study.

Subjects and setting: We investigated 3 patients who had MWs resulting from breast cancer. Participants were recruited from outpatient clinics in the Breast Surgery Department, University Hospital, Kanagawa, Japan.

Methods: The target material was exudate-containing dressings collected from MWs. After collection, the odor components (air) were collected into a sampling bag by using a handheld pump. Then, after 5 sprays of a DS, air was collected in the same manner. All odor components were analyzed objectively by gas chromatography-mass spectrometry-olfactometry (GC/MS-O). The concentration in parts per million (ppm) of the main odor components in the air before and after spraying DS was compared, and the residual concentration rate (%) was calculated. Sniffing tests before and after spraying were also conducted to determine the subjective deodorizing effect of DS.

Results: Of the possible hundreds of volatile odorants, 3 to 11 main components of volatile odorants were detected per subject. After DS spraying, the odorants dimethyl disulfide, dimethyl trisulfide, and benzyl alcohol were reduced according to GC/MS-O. The residual concentration of the following main odor components was also reduced: benzyl alcohol (30%), octanal (56%), p-dichlorobenzene (56%), isovaleric acid (56%), propylene glycol (63%), and nonanal (66%).

Conclusions: DS was effective against some volatile odorants in MWs, but no clear deodorizing effect was observed. Since there are individual differences in the type and number of odorants in MWs, the use of DS needs to be examined and verified in a larger number of cases.

Purpose: This systematic review analyzed evidence related to risk factors for Incontinence Associated Dermatitis (IAD) in critically ill incontinent patients.

Method: Systematic review and meta-analysis.

Search strategy: Eight databases, including PubMed, Embase, CINAHL, Cochrane Library, and Web of Science, were searched for studies published in the English language. The China National Knowledge Infrastructure, WanFang Data, and Chinese Scientific Journal Database were also searched for studies evaluating risk of IAD in critically ill incontinent patients published in the Chinese language.

Findings: Twenty-four studies with moderate-to-high methodological quality were included. Significant risk factors for developing IAD were being older [odds ratio (OR) = 1.06, 95% confidence interval (CI): 1.02-1.10, P = .007], fever (OR = 2.57, 95% CI: 1.87-3.57, P < .00001), diagnosed with consciousness disorder (OR = 5.70, 95% CI: 2.28-14.22, P = .0002), having higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.71, 95% CI: 1.25-2.35, P = .0009), lower Braden score (OR = 0.73, 95% CI: 0.56-0.96, P = .02), lower oxygen saturation (OR = 2.76, 95% CI: 1.52-5.00, P = .0008), double incontinence (OR = 4.10, 95% CI: 2.34-7.17, P < .00001), liquid stool (OR = 6.55, 95% CI: 4.12-10.41, P < .00001), frequent incontinence (OR = 1.21, 95% CI: 1.03-1.43, P = .02), and higher perineal assessment tool (PAT) score (OR = 3.18, 95% CI: 1.76-5.76, P = .0001).

Implications: Findings of this systematic review and meta-analysis suggest that healthcare providers should consider risk factors such as older age, fever, consciousness disorder, higher APACHE II score, lower Braden score and double incontinence matter when developing strategies for the prevention and management of IAD in critically ill incontinent patients.

Purpose: The purpose of this quality improvement (QI) project was to develop and implement repositioning guidelines that reduce pressure injury (PI) in hemodynamically unstable pediatric intensive care unit (PICU) patients.

Participants and setting: All PICU patient ages 0 to 36 months who required sedation for invasive mechanical ventilation and had a Braden Q score ≤ 18 were eligible for inclusion. The project was implemented in 116 patients preimplementation and 100 postimplementation. Their median t age was 5 months (interquartile range 2-13 months). The QI project setting was an academic hospital PICU with a Level I trauma center located in the Mid-Atlantic Region of the United States.

Approach: A pre-post observational design was used to compare the at-risk population for 21 weeks before (August-December 2018) and after (August-December 2019) implementing repositioning guidelines. Turn attempts were undertaken every 2 hours. Repositioning attempts were defined as (1) full (30°); (2) partial (15°); (3) unable to turn owing to hemodynamic instability; or (4) noncompliance. The primary outcome was incidence of Stage II or higher PI.

Outcomes: We found a significant reduction in the incidence of PI before and after implementation of the repositioning intervention (16.4% vs 2.0%, P = .0003).

Implications for practice: A structured intervention for repositioning hemodynamically unstable PICU patients has the potential to significantly lower PI incidence in a group of hemodynamically unstable children.