Ostomy Nurses Research Articles

Multidisciplinary Perspectives on Medical Decision-Making for Ostomy Surgery in Pediatric IBD: Themes from Focus Groups.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

A longitudinal assessment of factors affecting training transfer among new clinical nurse specialists

ObjectiveThis study aimed to explore the determinants influencing training transfer and evaluate how those factors change over time among nurses who graduated from clinical nurse specialist training to provide a theoretical basis for improving the training transfer of clinical nurse specialists (CNSs). MethodsA quantitative longitudinal survey with four rounds of data collection was utilized to measure the influencing aspects of training transfer from June 2018 to December 2019. A total of 46 new CNSs participated in this study, including 30 and 16 nurses receiving training programs for CNSs in Infusion, Wound and Ostomy. The factor influencing training transfer (FITT) questionnaire was used to collect data for the first month (time 1), the third month (time 2), the sixth month (time 3), and the first year (time 4) after training. This questionnaire contains 53 items divided into five dimensions, including managerial support (20 items); hindrance in the organization (6 items); the validity of the training program (10 items); organizational and personal facilitators (11 items); and personal attitudes towards training transfer (6 items). ResultsThe influencing factors of CNSs transfer decreased over time, with managerial support, hindrance in the organization, the validity of the training program, and personal attitudes towards training transfer changing statistically over time (P < 0.05), and no statistical difference in organizational and personal facilitators over time (P = 0.229). During early after training (the first month and the third month after training), hindrance in the organization is the biggest obstacle to training transfer. During the later of training (the sixth month and first year after the training), managerial support is the biggest obstacle to training transfer. Overall level of influencing factors of training transfer decreased in three months after training among Infusion nurses (P < 0.001), and Wound and Ostomy nurses decreased in the first year after training (P < 0.001). ConclusionsThe trend and level of training transfer predictors decreased depending on time. Clarifying the factors influencing transfer and its patterns may help nursing managers enhance the implementation and impact of nurse specialist training.

A Qualitative Study on How Younger Women Experience Living with an Ostomy

There is a growing demand that ostomy patients receive more systematic and individualised follow-up by ostomy nurses. The purpose of the study was to explore how younger women experience everyday life after an ostomy and to map what healthcare personnel can do to ensure that the patient group can feel safe and looked after. This qualitative study included four younger women who had a stoma fitted. Individual in-depth interviews were conducted, and two participants were interviewed twice. The findings resulted in three main themes: (1) The importance of follow-up and information from healthcare personnel, (2) Experience with illness and freedom in everyday life and (3) Self-image and social relationships. We found that time to prepare before surgery and learning to live with the stoma provide a good basis for handling the new everyday life with a stoma. We conclude that ostomy nurses provide support and security to those undergoing ostomy operations. Healthcare professionals should focus on providing individually tailored information to ensure that patients are receptive to the information being shared with them. Having parts of a bowel removed can be experienced as relief, especially when the disease has previously contributed to poor self-image and social isolation.

The lived experience of colorectal cancer patients with a temporary ileostomy and the patient’s perception of the ostomy nurses’ educational interventions

This study is aimed at exploring the lived experiences of colorectal cancer patients regarding temporary ileostomy and the educational interventions of ostomy nurses. This study is conducted using Heideggerian phenomenological focus group. Focus group interviews were conducted from November 2021 to February 2022 using a semi-structured guide with nine colorectal cancer patients having a temporary ileostomy. The interview data were analyzed using latent content analysis RESULTS: Four main categories and 13 sub-categories are identified as the result of data analysis. Main categories were "colorectal cancer and ileostomy: patient's adaptation," "supporting resources for the patient with ileostomy," "ileostomy closure: hope and concerns," and "ostomy nurse's professionalism." The main categories reflect the shared experiences and perceptions of colorectal cancer patients, across the timeline from colorectal cancer diagnosis to ileostomy closure. This study provides a timely response to a pilot project for recognizing ostomy nurse's education for patients with stomas. Also, the findings of this study contribute to nursing knowledge by providing patients' perspectives on the education provided to them by the ostomy nurse. Lastly, this study inspires future studies to evaluate and recognize ostomy nurse's practice by using various methodological approaches.

Intensive preoperative ostomy education for the radical cystectomy patient.

Patients undergoing radical cystectomy with ileal conduit formation usually receive training on the use of their stoma during their initial hospitalization - while actively recovering from surgery - often with little follow-up or reinforcement. Many of these patients are not equipped to deal with these significant body changes, which can lead to additional clinic visits, stoma-related complications, and decreased patient satisfaction/health-related quality of life (HRQOL). In an effort to improve patient education, we sought to evaluate the feasibility of implementing a preoperative comprehensive stoma education session termed the "stoma bootcamp" for patients scheduled for a radical cystectomy and ileal conduit (RCIC). We tracked patient related outcomes to determine its impact. We performed a longitudinal, quality-improvement feasibility study at the University of Kansas Health System. All patients who were scheduled to undergo a RCIC for bladder cancer were offered enrollment into the study at their preoperative clinic visit. The "stoma boot camp" consisted of a 3-hour group session within 2 weeks of the surgery date. Patients were given a short presentation by residents and advanced practice providers regarding the operation, recovery, and expectations for their post-operative care. Ostomy nurses then demonstrated basic urostomy care - pouching, sizing, emptying - along with trouble-shooting tips for common ostomy problems. Measurements of HRQOL questionnaires were completed at the initial visit, after "boot camp," and at defined time points after surgery for 12 weeks. This included using an ostomy adjustment score. Length of stay, unplanned stoma-related interventions, and re-admissions within 30 days were also tracked. In this initial pilot program, 51 patients participated in the stoma bootcamp. The patients had an average ostomy adjustment score (OAS) of 150.4 (95% CI 142.0, 158.8) at discharge from the hospital, and these high OAS levels persisted throughout the 12 weeks of follow-up data without any significant decline. Short-form 36 (SF-36) scores demonstrated numerical improvements in each individual category at the 6-week mark above baseline. These improvements persisted at the 12-week mark. In this study we were able to establish the feasibility of implementing a preoperative comprehensive stoma education session for patients scheduled for a RCIC. Additionally, we were able to document favorable HRQOL data and improved ostomy adjustment scores surrounding the education session.

Factors contributing to the quality of life among Thai patients diagnosed with colorectal cancer with a stoma: An integrative review.

To appraise and synthesize research investigating the factors contributing to the quality of life (QOL) among Thai patients diagnosed with colorectal cancer (CRC) with a stoma. An integrative review. The scientific databases CINAHL, Medline, PubMed, Web of Science, Google Scholar and ThaiJO were queried for English or Thai research articles published between 2011 and 2021. Included studies were searched utilizing the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines. The eligible studies were critically appraised by evaluating the study level and quality using the John Hopkins Research Evidence Appraisal Tool. Whittemore and Knafl's five-stage framework was used to guide this integrative review. Primary data from each suitable study were abstracted, coded and categorized into sub-themes. Finally, themes were identified based on the review question and objective. Eight articles met the inclusion criteria. Twelve sub-themes and five significant themes were identified: Sociodemographic and clinical, physiological, psychological, social and spiritual aspects. Factors contributing to QOL among Thai CRC ostomates can be categorized into five domains. The sociodemographic and clinical, physiological and psychological aspects are similar to those in other countries. In the meanwhile, the social and spiritual domains differ from those in other countries, particularly in extended family support and Buddhist belief. By providing the QOL contributing factors, nurses can investigate the significant QOL predictors and create the appropriate interventions for promoting QOL, specifically among Thai CRC adults with a stoma. Likewise, it will be helpful to integrate this result into the nursing curriculum in Thailand and other similar countries to teach nursing students who could give direct holistic care to CRC adults with a stoma. In addition, it will serve as the basis for healthcare policy regarding nursing practice guidelines for assessing the individuals' QOL factors and promoting QOL activities after ostomy surgery. Patient or Public contribution: The ostomy nurses in Thailand are involved in the data analysis stage. They read all the included studies before the meeting. They considered and commented on the generating and synthesizing of codes, subthemes and themes.

Stakeholder engagement and participation in the design, delivery, and dissemination of the ostomy self-management telehealth (OSMT) program

Stakeholder engagement is increasingly integrated into clinical research processes. We conducted a mixed methods analysis to describe stakeholders' (peer ostomates, ostomy nurses, telehealth engineers) perceptions of their engagement and participation in a multisite, randomized trial of a telehealth-delivered curriculum for cancer survivors with ostomies. Stakeholder notes were analyzed using narrative analysis. We constructed a 15-item survey that assessed the following areas: adherence to stakeholder engagement principles, engagement/influence throughout the study process, impact on perceived well-being, and satisfaction. Stakeholders were invited to complete the survey anonymously. Quantitative survey data were tabulated through summary statistics. Across intervention sessions, an average of 7.7 ± 1.4 stakeholders attended and 2.6 ± 1.4 submitted a note per session. The survey response rate was 73% (11/15). Stakeholders reported high agreement that the study adhered to engagement principles (91% reciprocal relationships, 100% co-learning, partnership, and transparency/honesty/trust). They felt highly engaged (18% moderate, 73% great deal) and that they had influence on study initiation (27% moderate, 55% great deal), intervention delivery (9% moderate, 82% great deal), fidelity assessment (18% moderate, 73% great deal), analysis and interpretation (55% moderate, 27% great deal), and dissemination (45% moderate, 45% great deal). They reported high overall satisfaction with roles (91% great deal), believed the program was helpful for participants (91%), and that serving on study team benefited their own well-being (100%). Our strategy of stakeholder inclusion led to high engagement, input, satisfaction, and belief in success of program, which could be mirrored in other trials.

MEDICAL DECISION-MAKING AND EDUCATION RELATED TO OSTOMY SURGERY IN PEDIATRIC PATIENTS WITH IBD: QUALITATIVE THEMES FROM MULTIDISCIPLINARY PROVIDER FOCUS GROUPS

Abstract INTRODUCTION Pediatric patients with Inflammatory Bowel Disease (IBD) may undergo ostomy surgery, which surgically diverts stool to be collected in a bag worn on the abdomen. In addition to medical decision-making about ostomy surgery being innately complex and necessary to take a developmental approach, the medical decision also intersects with multiple disciplines and arguably requires nuanced coordination and collaboration for optimal medical decision-making and educational support. METHODS Multidisciplinary providers at a large, urban pediatric institution were recruited to participate in semi-scripted focus groups on medical decision-making and education related to ostomy surgery in pediatric patients with IBD. Focus groups occurred virtually and were recorded and transcribed for qualitative analysis of focus group content, with iterative analysis to generate qualitative themes. RESULTS Three focus groups were held, with a total of n=12 providers across all focus groups. Participants included pediatric GI providers (n=6), surgeons (n=2), GI nurse practitioner (n=1), GI social worker (n=1), and ostomy nurses (n=2). Participants reported providing care to patients at the institution for an average of 10 years (SD=9.7), and all worked with pediatric IBD patients. Focus group themes included 1) Ostomy surgery as a later treatment option for IBD patients, 2) Perception of “Defeat”/“failure,” 3) Differences between IBD patients (e.g., Crohn’s Disease versus ulcerative colitis), 4) Patients feeling unwell medically pre-operatively plays a role, 5) Psychosocial needs/support of patients, 6) Professional role issues/Provider Role considerations, 7) Provider perceptions of ostomies, 8) Provider Concerns/Needs, 10) Timing Considerations/Concerns, 11) Family Considerations/Challenges, and 12) Coordination/collaboration challenges. CONCLUSIONS The decision to consider ostomy surgery in pediatric IBD is often a complex decision that requires nuanced medical decision-making conversations and education for the patient and the parent/family. Further, this medical decision-making process often involves coordination and collaboration with multidisciplinary providers and often occurs over a period of time. This work assessed multidisciplinary providers’ perception of coordination and collaboration across specialties in supporting young people with IBD considering ostomy surgery. Qualitative themes identified psychosocial needs of patients and families throughout the process, various roles of multidisciplinary providers in the ostomy surgery decision, and logistical timing and coordination concerns during this medical decision. This work highlights the developmental and psychosocial considerations in supporting patients and parents through a complex medical decision.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

Ostomy 101 for dermatologists: Managing peristomal skin diseases.

An estimated 1 million North Americans live with ostomies, with up to 80% of ostomy patients developing stoma-related skin morbidities. While ostomy nurses are often the first line of management, dermatologists may be involved in the care of ostomy patients with complex or persistent peristomal skin complications. Therefore, an understanding of the ostomy apparatus and possible peristomal skin conditions that may arise allows dermatologists to identify skin complications early and work effectively with a multidisciplinary team. In this article, we aim to review the ostomy apparatus, discuss the differential diagnoses, and provide practical guidelines for the management of peristomal skin conditions. Pubmed, Ovid Medline, and Google Scholar were searched for relevant articles assessing peristomal skin complications and their management. Peristomal skin complications may be local (e.g., contact dermatitis, infection, fistula, and mechanical trauma) or secondary to systemic disease (e.g., inflammatory bowel disease, pyoderma gangrenosum, and psoriasis). Ensuring appropriate ostomy fit and proper use of ostomy accessory products helps to reduce effluent leakage and prevent damage to the peristomal skin. For persistent peristomal skin conditions, corticosteroid sprays, systemic therapies, and surgical interventions may be warranted.

The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy\u2014protocol of a systematic review and meta-analysis

BackgroundAn intestinal ostomy is an artificial bowel opening created on the skin. Procedure-related mortality is extremely rare. However, the presence of an ostomy may be associated with significant morbidity. Complications negatively affect the quality of life of ostomates. Preoperative stoma site marking can reduce stoma-related complications and is recommended by several guidelines. However, there is no consensus on the procedure and recommendations are based on low-quality evidence.The objective of the systematic review will be to investigate if preoperative stoma site marking compared to no preoperative marking in patients undergoing intestinal stoma surgery reduces or prevents the rate of stoma-related complications.MethodsWe will include (cluster-) randomised controlled trials and cohort studies that involve patients with intestinal ostomies comparing preoperative stoma site marking to no preoperative marking and report at least one patient-relevant outcome. For study identification, we will systematically search MEDLINE/PubMed, EMBASE, CENTRAL and CINHAL as well as Google Scholar, trial registries, conference proceedings and reference lists. Additionally, we will contact experts in the field. Two reviewers will independently perform study selection and data extraction. Outcomes will be prioritised based on findings from telephone interviews with five ostomates and five ostomy and wound nurses prior to conducting the review. Outcomes may include but are not limited to stoma-related complications (infection, parastomal abscess, hernia, mucocutaneous separation, dermatological complications, stoma necrosis, stenosis, retraction and prolapse) or other patient-relevant postoperative endpoints (quality of life, revision rate, dependence on professional care, mortality, length of stay and readmission). We will use the ROBINS-I or the Cochrane risk of bias tool to assess the risk of bias of the included studies. We will perform a meta-analysis and assess the certainty of evidence using the GRADE approach.DiscussionWith the results of the systematic review, we aim to provide information for future clinical guidelines and influence clinical routine with regard to preoperative stoma site marking in patients undergoing ostomy surgery. When the evidence of our systematic review is low, it would still be a useful basis for future clinical trials by identifying data gaps.Systematic review registrationPROSPERO registration number: CRD42021226647

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Effect of Nursing Instructions on Self Care for Colostomy Patients

AbstractBackground: Ostomy nurses should be able to provide nursing care not only on physiological problems but also other problems related to the ostomy. Aim of the study: To evaluate the effect of nursing instructions on self-care for colostomy patients. Hypothesis: The application of nursing instructions will have a positive effect on self- care for colostomy patients. Research design: Quasi‑experimental study design (pre–post test) was used. Subjects: Thirty adult patients from both sex with abdominal operations treated by colostomy .Setting: The study was carried out at General Surgery Departments of Assuit University Hospital. Tools: (I) Pre-post colostomy knowledge questionnaire ,Tool (II): Pre-post observation checklist for colostomy self-care practices and Tool (III): The Ostomy Self‐Care Index (OSCI). Result: A highly significant statistically difference was found regarding total knowledge, practice and (OSCI) scores of the studied sample pre and post(Immediate and one month) implementation of colostomy nursing instructions (p=.001**). Conclusion: It was concluded that implementation of colostomy nursing instructions had statistically significant positive effect on patient's knowledge and self-care practices. Recommendation: The patients should be included in program provided by ostomy care team for improving self care, prevention and treatment of physical and psychological complications.

Development of a Personalized mHealth Program for Cancer Symptom and Complication Management.

Based on care need assessment of colorectal and bladder cancer (CBC) patients with newly created ostomies (stomas) and caregivers, and with the input of the Wound, Ostomy, and Continence Nurses (WOCNs), we have developed an mHealth complication and symptom monitoring and self-management program, titled PRISMS.

Family’s Experience: Nursing Care for Colorectal Cancer Patients with Colostomy

Background: Colorectal cancer patients with colostomy have various complaints about changes in their life including the need for comprehensive and personal care. Ostomy nurses are responsible for managing people with a colostomy, and this particular nursing practice continues to develop globally. Also, previous literature highlights the importance of caregiver’s support, particularly family in colostomy patient care.Purpose: This study aimed to explore the family experience of colorectal cancer patients toward colostomy nursing careMethods: The study design used was descriptive phenomenology to explore the experience of ten participants through in-depth interviews. The participants were selected using purposive sampling with the inclusion criteria: family members of colorectal cancer patients with colostomy, over 21 years old, and able to communicate verbally. The data were analyzed using Colaizzi's method.Results: The results revealed three themes related to the family’s experience: (1) positive and negative behavior in nursing care, (2) living with a colostomy, (3) expectations for nursing care. The findings showed that the families were happy with the ostomy nursing care though some aspects needed to be improved. However, colorectal cancer patients experienced some difficulties in living with a colostomy.Conclusion: The study concluded that the colostomy nursing care still needs to be improved. This study recommends the ostomy nurses to improve their nursing care, especially in terms of skills, responsiveness, and awareness.

MP12-03 COMPLICATIONS AFTER RADICAL CYSTECTOMY: UNDERSTANDING THE CONTEXT OF RECOVERY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II (MP12)1 Apr 2020MP12-03 COMPLICATIONS AFTER RADICAL CYSTECTOMY: UNDERSTANDING THE CONTEXT OF RECOVERY Kinnari Patel*, Leilei Xia, Aseem Malhotra, Anisleidy Fombona, Thomas Guzzo, and Daniel Lee Kinnari Patel*Kinnari Patel* More articles by this author , Leilei XiaLeilei Xia More articles by this author , Aseem MalhotraAseem Malhotra More articles by this author , Anisleidy FombonaAnisleidy Fombona More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , and Daniel LeeDaniel Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000832.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative complications after radical cystectomy are common and bear significant impact to the patient. Over 60% of patients will experience some type of complication and over 30% readmitted to the hospital. Despite significant innovation, the complication rates remain high, and little is understood about potential modifiable patient factors or behaviors that could reduce the complication rate. Therefore, we sought to evaluate the context of the patient recovery process after radical cystectomy to identify key areas that could be modified to potentially reduce complications. METHODS: In cooperation with the Center for Digital Health Innovation, and after receiving approval from the University of Pennsylvania Quality Improvement institutional review board, we identified 44 patients who underwent a radical cystectomy from January 2019 to June 2019. A mixed methods approach using in-depth semi-structured interviews of patients and their caregivers, and shadowing of patient-provider interactions was performed after the radical cystectomy to identify potential key themes and possible modifiable factors. In total, 44 patients and 25 caregivers were interviewed about their experiences. Health literacy was measured according to the METER tool, a validated instrument. RESULTS: Overall, the median age at cystectomy was 71 years, with caregiver age ranging from 52-79 years. Overall the median METER health literacy score was 29, indicating marginal health literacy. Thirty two percent of the patients did not have a smart phone, 34% did not have an email, but 64% did identify a significant primary caregiver. Ninety-one percent of the patients were obese. Postoperatively, 57% experienced a complication within 90 days, 40% of those with complications had more than one complication, and 34% were readmitted. Approximately 54% of all the phone calls to the Urology Department after cystectomy were for logistical follow up questions. There were several recurrent themes amongst all the patients and caregivers about their recovery. All the patients experienced difficulty with processing information. Most patients did not read through the printed material, and felt overwhelmed with all the information during the preoperative counseling sessions and time with the wound ostomy nurses. Videos were the easiest to remember but the most difficult to locate. Most of the patients experienced frustration with communication, especially in knowing how to contact the provider. In addition, it was unclear when to contact a provider, especially if they were uncertain if a symptom was expected or abnormal. A significant theme from the caregivers was how emotionally and physically taxing it was to provide care for their loved one. CONCLUSIONS: There are significant patient, provider, and caregiver factors that may contribute to the high complication rate after cystectomy. Finding practical solutions to address information overload, improve communication, and provide explicit support for caregivers would be essential to implementing any intervention aimed to reduce complications. Future studies that utilize these findings may help to uncover innovative ways to reduce complications and improve patient outcomes. Source of Funding: Pilot grant from the Center for Digital Health Innovation Accelerator © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e145-e145 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kinnari Patel* More articles by this author Leilei Xia More articles by this author Aseem Malhotra More articles by this author Anisleidy Fombona More articles by this author Thomas Guzzo More articles by this author Daniel Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

Total Colonic Hirschsprung's Disease: The Hypermotility and Skin Rash Protocol.

Total colonic Hirschsprung's disease (TCHD) presents a postoperative challenge due to multiple stools and perineal rash. We propose a protocol developed by pediatric surgeons and ostomy nurses to help prevent and treat hypermotility and severe perineal rash, especially in younger children who are not toilet trained. We retrospectively reviewed our TCHD patients' charts from 2014 to 2017. All patients received a prescribed protocol for the treatment of hypermotility and perineal rash. We describe patients who underwent their pull through before and after the age of urine toilet training, and assessed the number of bowel movements, the perineal skin status, and growth. We treated 25 patients. Out of 25, 9 patients received a straight ileoanal pull through before the age of 18 months. Nine of 25 patients presented for a second opinion and had redo pull through. The remaining seven presented for bowel management after having a pull through at another institution. All these were treated following the hypermotility protocol. In total, 19 of 25 patients were not toilet trained. The mean number of bowel movements in all groups was 4 (3-5). All had a resolution of perineal rash and liquid stools after 3 months. Eleven of the 25 patients presented with failure to thrive. Two older patients experienced severe proctalgia requiring replacement of the ileostomy. TCHD patients who underwent definitive pull through had nine high incidence of multiple stool, perineal rash, and low growth. With the implementation of bowel management care to slow the stools and a perineal skin protocol to treat the skin, we believe that these symptoms can be minimized even in patients who are not toilet trained. Since the implementation of this protocol, we have changed our practice to perform the pull through in such patients between the age of 6 and 18 months.

Complicated or not complicated: Stoma site marking before emergency abdominal surgery.

Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting. The approach and behavior of surgical residents regarding stoma creation was also assessed. Patients who had undergone gastrointestinal surgery between January 2012 and December 2013 were assessed. A total of 116 of those patients who had a stoma created during the initial operation were followed by a stoma therapy nurse in the postoperative period and were enrolled in the current study. In addition, a survey of the residents was conducted to evaluate their knowledge about stoma creation and stoma care. A total of 67 (58%) of the 116 patients included were male. The median age was 57±16 years (range: 17-87 years). A body mass index above 30 kg/m2 was detected in 16 patients (14%). The reason for surgery was malignant disease in 93 (80%) patients, and 97 cases (84%) were elective operations. Preoperative stoma marking was performed in 72 patients (62%). The stoma type was an ileostomy in 87 patients (75%). Stoma-related complications were observed in 40 patients (35%). Emergency surgery (p=0.020), preoperative stoma marking (p=0.000), adjuvant therapy (p=0.004), and the stoma caretaker (patient or relatives) (p=0.05) were associated with stoma-related complications. Logistic regression analysis revealed that only the type of surgery (emergency or elective), preoperative stoma marking, and the stoma caretaker increased the rate of stoma-related complications. Marking the stoma location before surgery reduces the risk of stoma-related complications and has a positive effect on the patient's quality of life. Multivariable analysis indicated that marking the stoma site before the operation was the only factor that affected the rate of stoma-related complications, regardless of emergency or elective surgical conditions. Since surgeons will encounter the need for a stoma procedure during their professional career and they will not always have the opportunity to work with stoma therapy nurse, stoma care education should be provided during their residency (internship) education, and ascertaining a stoma localization before surgery for all potential stoma cases should be encouraged in emergency shifts.

Complications After Ostomy Surgery: Emergencies and Obese Patients are at Risk-Data from the Berlin OStomy Study (BOSS).

Complications are common after ostomy surgery. Data from the Berlin OStomy Study were evaluated to determine risk factors for complications. Patients with a bowel ostomy were questioned using a questionnaire concerning patients' characteristics and history as well as the ostomy and its complications. The questionnaire also contained a nine-fielded abdominal sketch to determine the exact ostomy location. Over 42months, 2647 patients completed the questionnaire. Obese patients and patients after emergency surgery were more prone to ostomy-related complications. This result was independent of the kind of ostomy (small bowel ostomy or colostomy) and of the abdominal location. The overall ostomy complication rate was 55.6%. Significantly more complications were recorded after emergency surgery and in obese patients than after elective surgery and in non-obese patients, respectively. There was no preferential abdominal location for avoiding general ostomy complications. The results emphasized the importance of preoperative ostomy site marking by qualified personnel such as ostomy nurses or surgeons to reduce complication rates by respecting individual abdominal configurations. With an increasing prevalence of obesity, ostomy surgery will become even more challenging in the future. A division of the abdominal wall into nine regions might be helpful and more precise for describing and examining ostomy-related complications in the future.