Site Marking Research Articles

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis.

Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition. Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively. Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study. The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

Comparison of the interactions of flupyrimin and nitenpyram with serum albumins via multiple analysis methods

Flupyrimin and nitenpyram are emerging neonicotinoid insecticides that may cause potential harm to the human body. In the present work, the interactions of flupyrimin/nitenpyram with serum albumins under normal physiological conditions were thoroughly studied by using multiple spectroscopic techniques, DFT calculations and molecular docking. Flupyrimin/nitenpyram can quench the endogenous fluorescence of HSA/BSA and form a complex with HSA/BSA through a static process, causing conformational and secondary structure changes of HSA/BSA. Thermodynamic analysis shows that the combination of flupyrimin/nitenpyram with HSA/BSA is a spontaneous process, mainly driven by hydrogen bonds and hydrophobic forces. Site marking and molecular docking experiments indicated that flupyrimin/nitenpyram binds with HSA/BSA at site II (subdomain IIIA). The binding constant Ka in HSA-flupyrimin, HSA-nitenpyram, BSA-flupyrimin and BSA-nitenpyram systems at 298 K was 2.11 × 105 M−1, 2.35 × 105 M−1, 1.91 × 105 M−1 and 2.11 × 105 M−1, respectively. The binding constant Ka of nitenpyram with HSA/BSA was greater than flupyrimin, indicating that nitenpyram binds HSA/BSA was more stable than that of flupyrimin, which was consistent with the DFT calculation. In addition, the acute toxicity bioassay showed that flupyrimin and nitenpyram exhibited low toxicity to zebrafish, with 96 h LC50 values of 181.662 and 250.658 mg a. i. L−1, respectively. These results can help understand the interactions of flupyrimin/nitenpyram with HSA/BSA.

Preventing Bleeding Complications Of Paracentesis Using Point-Of-Care Ultrasound: An n-of-1 Case Study

Abdominal paracentesis is a common bedside procedure, and the advent of point-of-care ultrasound has provided an opportunity to reduce the associated risks. Multiple society guidelines now recommend both site and vascular marking to avoid potential complications. This case illustrates the importance of vascular marking specifically to avoid damage to adjacent blood vessels.

Factors predictive of optimal peristomal skin status in patients with an ostomy: a secondary analysis.

Peristomal skin problems are common in ostomy patients and are connected to decreased quality of life and patient independence, as well as increased treatment costs. This study analysed the factors related to peristomal skin changes in order to better define the clinical profile of patients with optimal peristomal skin status. Secondary analysis of data from a nationwide, cross-sectional, retrospective, multicentre study performed in Spain (Uses and Attitudes in Ostomy) (Bueno Cruz et al, 2021) evaluated clinical data, including demographics, preoperative stoma site marking, type of ostomy, device used, frequency of leakage and scores from the Ostomy Skin Tool (OST) and quality of life (QoL) questionnaires. Risk factors for peristomal skin changes were analysed using multivariate analysis, and a predictive nomogram to anticipate optimal peristomal skin status (defined here as discolouration (D), erosion (E), and tissue overgrowth (T) (DET) score of 0) was developed. Some 871 patients with an ostomy using different commercial devices in Spain were evaluated. Multivariate analysis to predict optimal peristomal skin status revealed leakage frequency, patient age, type of ostomy, preoperative siting and type of baseplate used were independent predictors of peristomal skin status. Optimal peristomal skin care should be a treatment goal for nurse specialists in stomal therapy, and its individual influencing variables should be taken into account by nurses specialising in ostomy care.

WOCN Society, AUA, and ASCRS Position Statement on Preoperative Stoma Site Marking for Patients Undergoing Ostomy Surgery.

ORIGINATED BY: Wound, Ostomy, and Continence Nurses Society™ (WOCN®) Stoma Site Marking Task Force in collaboration with the American Society of Colon and Rectal Surgeons (ASCRS) in 2007. UPDATED/REVISED BY: WOCN Society's Stoma Site Marking Task Force in collaboration with the ASCRS and the American Urological Association (AUA) in 2015 and 2021. TASK FORCE CHAIR Ginger Salvadalena, PhD, RN, CWOCN, Hollister Incorporated, Libertyville, Illinois. [email protected] TASK FORCE MEMBERS Christine Baker, MSN, APRN, CWOCN University of Chicago Comer Children's Hospital, Chicago, Illinois Carole Bauer, MSN, RN, ANP-BC, OCN, CWOCN Beaumont Health System, Troy, Michigan Janice Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois Daniel L. Feingold, MD, FACS, FASCRS, Rutgers University, New Brunswick, New Jersey Vashti Livingston, MS, RN, CWOCN, DAPWCA, Memorial Sloan Kettering Cancer Center, New York City, New York Michael F. McGee, MD, FACS, FASCRS, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Leanne Richbourg, MSN, APRN-BC, CWON-AP, CCCN, GCNS-BC Duke University Hospital, Durham, North Carolina Elizabeth Savage, MSN, RN, ACNS-BC, CWON, IIWCC-NYU NYU Langone Health, New York City, New York Gary D. Steinberg, MD Perlmutter Cancer Center, NYU Langone Health, New York City, New York WOCN SOCIETY SUPPORT Anna Shnayder Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (JWOCNOnline.com).

Hans Jonas, Günther Anders, and the Atomic Priesthood: An Exploration into Ethics, Religion and Technology in the Nuclear Age

This article investigates the ethical implications of the notion of an Atomic Priesthood, an artificially constructed religion built around the preservation of knowledge related to nuclear-waste storage by using the work of Hans Jonas (1903–1993) and Günther Anders (1902–1992). Building on Jonas’ The Imperative of Responsibility from 1979 and Anders’ The Outdatedness of Human Beings from 1956, this article participates in the debate regarding the ethics of the post-closure marking of nuclear-waste storage sites. Assuming that we have a moral obligation toward future generations, as Jonas argued, even after the nuclear-waste storages have been filled and closed, there remains a need to communicate the danger of these sites to future civilizations to whom our languages and other semiotic systems are incomprehensible. Discussing the hypothetical concept of the Atomic Priesthood, an artificial religion whose central purpose would be to make it taboo to approach certain “impure” sites where our civilization had buried nuclear waste, this article argues that due to the unsolved ethical stakes, technological solutions are unequipped to deal with the long-term ramifications of nuclear power.

Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery: A Scoping Review.

Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. Scoping literature review. Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.

The effectiveness of preoperative stoma site marking on patient outcomes: A systematic review and meta-analysis.

This study systematically reviews the literature regarding preoperative stoma site marking and discusses the effectiveness of the procedure on complication rates, self-care deficits and health-related quality of life (HRQOL). Systematic review and meta-analysis. Our review was conducted following the PRISMA guidelines. PubMed, EMBASE, Cochrane and CINAHL databases were searched to obtain articles published in English. Articles were also retrieved from Korean databases as well. Our last search was conducted on 2June 2019. Two reviewers independently selected relevant studies, evaluated their methodological quality and extracted data. Experimental and observational studies were included. Our main focus was on complication rates, self-care deficits and HRQOL. We conducted meta-analysis using the statistical software spss 25.0 and Stata 13.0. Of the 1,039 articles reviewed, 20 were included for review, and 19 were used for quantitative synthesis. Preoperative stoma site marking reduced complication rates (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.36-0.62; I2 : 70.6%), lowered self-care deficits (OR: 0.34; 95% CI: 0.18-0.64; I2 : 0%), and increased HRQOL (standardized mean difference, 1.05; 95% CI: 0.70-1.40; I2 : 0%). Quality appraisal results for both the individual studies and the studies overall were excellent. The possibility of publication bias was low. Our findings indicate that preoperative stoma site marking improves patient outcomes: stoma-related complication rates and self-care deficits decrease and HRQOL rises. For this reason, preoperative stoma site marking should be a mandatory procedure in clinical settings. The practice should also be supported by policymakers and healthcare expert associations. Preoperative stoma site marking reduces overall complication rates by 53% and skin problems by 59%. Preoperative stoma site marking also improves self-care and health-related quality of life. We recommend that preoperative stoma site marking should be a mandatory procedure in clinical settings.

Clinical Issues—June 2021

Selecting an antiseptic skin preparation agent according to the patient's skin pigmentation Key words: preoperative patient skin antisepsis, surgical site marking pen, Fitzpatrick skin type scale, tinted antiseptic, ink visibility. Developing a preoperative bathing protocol Key words: preoperative bathing protocol, preoperative showering regimen, antiseptic soap, antiseptic solution, patient education. Decolonizing health care personnel Key words: methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organism (MDRO), colonization, transmission, nasal decolonization. Composition of bone cement and precautions for perioperative personnel Key words: bone cement, absorption exposure, methyl methacrylate (MMA), occupational hazards, personal protective equipment (PPE).

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

Crohn Disease

The role of surgery in the management of Crohn disease has undergone a dramatic evolution over the past 50 years. Currently, surgical treatment of Crohn disease is seldom performed in the emergency setting; it is nearly always performed after failed medical therapy. The general indications for surgical treatment are described and include specific attention to complications of the disease, including obstruction, symptomatic fistulas, abscess formation, cancer or dysplasia, and failure to grow. The special considerations of surgical therapy are also described, including pregnancy, the marking of stoma sites, and the choice of incision, which may involve laparoscopy. Surgical management of Crohn disease is evaluated in terms of therapy at specific sites, including esophageal, gastric, and duodenal disease; jejunoileal disease; ileocolic disease; colonic disease; and anal disease. Chemoprophylaxis is also described, as is surveillance and behavioral modification. Tables outline the Vienna Classification System, Crohn Disease Activity Index, Harvey-Bradshaw Index, extraintestinal manifestations, and the medical treatment of Crohn disease. Figures show endoscopic images of Crohn disease, computed tomographic enterography, a capsule endoscopy showing large Crohn structures, surgery rates over time, caput medusa, an example of stenotic ileocolic Crohn disease, an enterocutaneous fistula, Heineke-Mikulicz strictureplasty, Finney strictureplasty, a fibrotic stricture, an example of a large ulcer, pyoderma gangrenosum, a sigmoid colon stricture, toxic megacolon, and vessel loops for drainage of abscesses. This review contains 15 figures, 5 tables, and 76 references.

Abstract No. 172 Radiation safety time-out in interventional radiology: analysis of staff perceptions, initial implementation, and results:

“Time-out” checklists prior to starting a procedure are commonly used and typically focus on adequate informed consent, site marking, confirmation of procedure and needed instruments in the room, and addressing any procedure-related concerns, but do not specifically include radiation safety. While studies in the cardiology literature have documented the use of a radiation safety time-out (RSTO) to reduce radiation exposure during fluoroscopic-guided procedures, this has not been documented in the interventional radiology (IR) literature.

Usefulness of preoperative site marking with an indocyanine green fluorescent clip for gastrointestinal stromal tumor.

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Social signals mediate oviposition site selection in Drosophila suzukii

The information that female insects perceive and use during oviposition site selection is complex and varies by species and ecological niche. Even in relatively unexploited niches, females interact directly and indirectly with conspecifics at oviposition sites. These interactions can take the form of host marking and re-assessment of prior oviposition sites during the decision-making process. Considerable research has focused on the niche breadth and host preference of the polyphagous invasive pest Drosophila suzukii Matsumura (Diptera: Drosophilidae), but little information exists on how conspecific signals modulate oviposition behavior. We investigated three layers of social information that female D. suzukii may use in oviposition site selection—(1) pre-existing egg density, (2) pre-existing larval occupation, and (3) host marking by adults. We found that the presence of larvae and host marking, but not egg density, influenced oviposition behavior and that the two factors interacted over time. Adult marking appeared to deter oviposition only in the presence of an unmarked substrate. These results are the first behavioral evidence for a host marking pheromone in a species of Drosophila. These findings may also help elucidate D. suzukii infestation and preference patterns within crop fields and natural areas.

Robotic right upper lobectomy: Twelve steps.

Robotic right upper lobectomy: Twelve steps.

Workplace well-being of Advanced Practice Nurses and patient outcomes.

Workplace well-being has been defined as a state of pleasure in doing your own job. Work engagement is an effective indicator to measure workplace well-being. To investigate the level of work engagement among the Advanced Practice Nurses and describe patient outcomes. A survey based on Utrecht Work Engagement Scale-17 (ranging 0-6) was administered to 11 Advanced Practice Nurses; data were collected in August 2021. Different outcomes were detected: incidence of pressure ulcers in COVID 19 patients; postoperative issues; number of cornea donations in eligible patients (from 2017 to 2020); number of preoperative stoma site marking. The results showed a median age of 48 [41-52] years, most of the partecipants were women (63.64%). Advanced Practice Nurses showed high levels of engagement as a whole (5.18 0.30) and on vigor (4.91 0.82), dedication (5.51 0.80) and absorption categories (5.12 0.68). 360 patients with COVID-19 were observed and only 17 of them (4,5%) had Pressure Ulcers (density incidence: 2,72ulcers/1000 patients day). Intervention by case manager completely solved the patient's problem in 10 cases (71.43%) during the postoperative period. A 13% increase in corneal donations was observed in eligible patients from 2017 to 2020. Preoperative stoma site marking was present in 103 (99.3%) of eligible patients. Advanced Practice Nurses present high levels of work engagement. Outcome results are coherent with the literature; a high level of work engagement seems to correlate with better patient outcomes. Postgraduate nursing training improves clinical outcomes for patients and process indicators. Healthcare organizations management should value workplace well-being of their Advanced Practice Nurses.

The Effects of Preoperative Education, Marking and Adequate Positioning of Stoma on Self-Esteem and The Quality of Life of Patients with Intestinal Ostomy and Their Families

Aim. The purpose of this systematic review is to examine all available research studies on quality of life of ostomy patients and their families, which is contingent upon the effects of adequate preoperational education, the best and most acceptable ostomy site marking on the patients’ abdomen, and subsequently, the effect on the ostomy patients’ self-esteem. Methods. A literature search was carried out using scientific electronic databases - Science Direct, PubMed and Medline. Analysed period was from 2010 to 2016 in order to get insight into the most recent findings. Search terms included preoperative education, stoma marking, quality of life, self-esteem, influence on family life. Overview of articles was made in three stages. Results. We found 1440 scientific articles. In the first stage, we eliminated 1271 articles because they were unsuitable. In the second stage, we analysed 34 articles and made a conclusion based on 13 full text available articles. Conclusion. The patient is content while being treated in the hospital; however, only after the patient has been released do the hardships occur, which are often the main cause of discontent, isolation, anxiety, and fear – thus resulting in diminished quality of life. Preoperational education and marking the most acceptable place for ostomy procedure significantly affect the self-esteem and the quality of life of ostomy patients and their families. Ostomy patients need to be followed up, and the home care system, as well as the support systems of public health care for patients with a gastrointestinal ostomy, need to be strengthened.

Investigation of WWII/postwar mass burials in Croatia—The implementation of the Croatian model of searching for the imprisoned and missing persons

The search for victims of World War Two (WWII) and the immediate aftermath period (postwar) in Croatia started together with the search for Homeland War victims in 1991. It continued through years, most often sporadically and in a non-homogenous way. It was just with the adoption of the Law on Research, Arrangement and Maintenance of Military Cemeteries, Cemeteries of Victims of WWII and Postwar Period in 2013 that the search became more structured and gained a formal governmental body responsible for the organization and supervision of the activities related to it. It was then that the well-established model of searching for Homeland War victims, based on many years of field work and research, started to be implemented in the search and analysis of WWII/postwar victims. The model represents a continuously growing and developing project which encompasses a wide variety of steps and procedures, from the investigation of alleged burial locations to the analysis and reburial of recovered mortal remains. From its implementation in 2016, it allowed the successful investigation of 1300 alleged burial locations, 484 field surveys, 42 exhumations and the recovery of remains of more than 1600 individuals. Besides, care for military cemeteries, marking of mass burial sites and arranging of international treaties are conducted in order to guarantee proper handling, relocation and repatriation of all those that perished during WWII and the postwar period.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer.

An Invited Commentary on “Effectiveness and safety of tumor site marking with near-infrared fluorescent clips in colorectal laparoscopic surgery: A case series study”

An Invited Commentary on “Effectiveness and safety of tumor site marking with near-infrared fluorescent clips in colorectal laparoscopic surgery: A case series study”