Volume 44 Number 4

Selected abstracts from the 24th Biennial WCET® Congress in Glasgow, UK

DOI 10.33235/wcet.44.4.39-47

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Abstract

Delegates at the WCET® Congress, in Glasgow, UK in September, were treated to a very successful scientific programme with diverse, stimulating and high-quality content.

For the benefit of the many members who were unable to attend, here is a sample of what was presented by speakers from around the world.

Managing low anterior resection syndrome

Jennie Burch, RN, BSc, MSc
Head of Gastrointestinal Nurse Education, St Mark’s Hospital, London, UK

Claire Taylor, RGN, PhD
Chief Nursing Officer, Macmillan, UK

Ana Wilson, MD
Consultant Gastroenterologist, St Mark’s Hospital, London, UK

Christine Norton, RGN, PhD
Professor of Nursing, King’s College London, UK

Aims/Objectives The presentation aim is to describe nursing management of boel symptoms occurring after rectal cancer treatment. The objectives are to improve nurses’ knowledge and confidence when caring for this patient group.

Purpose & Background It is known, worldwide each year an estimated million people are diagnosed with rectal cancer (Emmertsen & Laurberg, 2013). Rectal cancer treatment is commonly surgery, chemotherapy and radiotherapy which can potentially result in consequences such as bowel dysfunction, collectively termed low anterior resection syndrome or LARS (Keane et al. 2020). The purpose of this presentation will be to increase knowledge about managing LARS after rectal cancer surgery.

Methods A PhD was undertaken using a multi-phase, mixed-method design to investigate LARS management. A systematic review thematically summarised how rectal cancer treatment consequences affect quality of life. A scoping review charted treatments available to manage LARS. Interviews thematically described what patients need to manage LARS. Focus groups with both patients and clinicians thematically described how this might be achieved.

Results Results reveal quality of life can be negatively affected by LARS, particularly when people could not function in their chosen roles (Burch et al, 2021a). Multiple LARS management options exist but empirical data are limited (Burch et al, 2021b). Patients need knowledgeable clinicians to enquire about and revisit symptoms; providing information on management strategies and signposting to other relevant information (Burch et al, 2023a). Clinicians can help set expectations to enable realistic goal planning (Burch et al, 2023b). Nurse-led supported LARS management can improve bowel symptoms in conjunction with supplementary information.

Conclusion/Outcome In conclusion, a greater knowledge about LARS should increase nurses’ confidence to assist patients with rectal cancer to manage their bowel symptoms after rectal cancer treatment. More research is needed to understand how best to provide nurse-led LARS interventions.

Keywords LARS, low anterior resection syndrome, rectal cancer, nurse, survivorship

References

Burch J., Taylor C., Wilson A., Norton C. (2021a) Symptoms affecting quality of life after sphincter-saving rectal cancer surgery: a systematic review. European Journal of Oncology Nursing, 52.

Burch J., Swatton A., Taylor C., Wilson A., Norton C. (2021b) Managing bowel symptoms after sphincter-saving rectal cancer surgery: a scoping review. Journal of Pain and Symptom Management 62(6), 1295-1307.

Burch J., Wright J., Taylor C., Wilson A., Norton C. (2023a) “He’s a surgeon, like I’m not going to waste his time”: interviews to determine healthcare needs for patients with low anterior resection syndrome (LARS) after rectal cancer surgery. Colorectal Disease 25, 880-887.

Burch J., Taylor C., Wilson A., Norton C. (2023b) “You’re just on your own”: Exploring bowel symptom management needs after rectal cancer surgery through patient and clinician focus groups. European Journal Oncology Nursing. https://doi.org/10.1016/j.ejon.2023.102406.

Emmertsen K.J., Laurberg S. (2013) Impact of bowel dysfunction on quality of life after sphincter-saving resection for rectal cancer. British Journal of Surgery 100(10), 1377-1387.

Keane C., Fearnhead N.S., Bordeianou L.G., Christensen P., Basany E.E., Laurberg S., Mellgren A., Messick C., Orangio G.R., Verjee A., Wing K., Bissett I. (2020) International consensus definition of low anterior resection syndrome. Diseases of the Colon & Rectum 63(3), 274-284.

 

All My Life I have to Adapt With My Stoma: A Phenomenological Study

Ria Andjarwati, MD, ONS, ETN,
Head Nurse, Wound and Stoma Consultant, Oncology Nurse Specialist, National Cancer Center “dharmais” Hospital, Indonesia

Yati Afiyanti, Prof. PhD. MN
Honarary Lecture in Nursing Faculty University of Indonesia, University of Indonesia, Indonesia

Aims/Objectives  The purpose of this study was to describe the experiences of cancer patients who had a stoma in the first year. A qualitative descriptive study was conducted.

Purpose & Background Cancer patients who undergo stoma surgery experience a major life change. Many problems arise both physically, psychologically, sexually and spiritually, especially in the first year. Delayed discharge planning in out-of-hospital settings, often happens to new ostomates, because of poor pre-operative education and information. By exploring patients’ experiences thoughout the difficult time with stoma surgery, health care providers can understand and empower the patients with the right care.

Methods Eleven participants were invited for semi-structured in-depth interviews. Data were analysed using thematic analysis.

Results Two themes were identified: 1) Complaints experienced while undergoing therapy; 2). Adaptation to life after stoma. Ostomates facing a major life changes due to adapting to life with the stoma. Many aspects in ostomates’ live need to be adjusted, Feelings of rejection and denial rise up in approximately the first month after stoma surgery. Adjustment followed by adaptation finally acknowledged by the ostomate entering six month above.

Conclusion/Outcome  This study provides nurses and others with insight in to the experiences of Indonesian ostomates about their adaptation processes physically, psychologically, socially, spiritually and sexually, and their plans for their future lives with stoma. It is very useful for patients with colorectal cancer or other cancers who undergo a life with a stoma attached.

Keywords cancer patients, experience, ostomate, postoperative, stoma

References

  1. Alenezi A, McGrath I, Kimpton A, Livesay K. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021;30(21-22):3111-3123. doi:10.1111/jocn.15840
  2. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I BF. International Agency for Research on Cancer 2020. Glob Cancer Obs Cancer Today. 2020;419:1-2.
  3. Kugler CM, Breuing J, Rombey T, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy—protocol of a systematic review and meta-analysis. Syst Rev. 2021;10(1):1-8. doi:10.1186/s13643-021-01684-8
  4. Summers MC. The Effect of Ostomate-to-Ostomate Support on Psychosocial Adaptation to Stoma. Dr Nurs Pract Capstone Proj. 2018;28.
  5. Burch J. Post-discharge care for patients following stoma formation: what the nurse needs to know. Nurs Stand. 2017;31(51):41-45. doi:10.7748/ns.2017.e10198
  6. Capilla-Díaz C, Bonill-de las Nieves C, Hernández-Zambrano SM, et al. Living With an Intestinal Stoma: A Qualitative Systematic Review. Qual Health Res. 2019;29(9):1255-1265. doi:10.1177/1049732318820933
  7. Vonk-Klaassen SM, de Vocht HM, den Ouden MEM, Eddes EH, Schuurmans MJ. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res. 2016;25(1):125-133. doi:10.1007/s11136-015-1050-3
  8. Hahne J, Liang T, Khoshnood K, Wang X, Li X. Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients. Patient Educ Couns. 2020;103(2):286-291. doi:10.1016/j.pec.2019.08.022
  9. de Almeida Silva K, Duarte AX, Cruz AR, de Araújo LB, das Graças Pena G. Time after ostomy surgery and type of treatment are associated with quality of life changes in colorectal cancer patients with colostomy. PLoS One. 2020;15(12):1-17. doi:10.1371/JOURNAL.PONE.0239201
  10. Dibley L, Czuber-Dochan W, Wade T, et al. Patient Decision-Making about Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives. Inflamm Bowel Dis. 2018;24(2):235-246. doi:10.1093/ibd/izx043
  11. Cross AJ, Wooldrage K, Robbins EC, et al. Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study. Br J Cancer. 2019;120(2):154-164. doi:10.1038/s41416-018-0335-z
  12. Jin Y, Zhang J, Zheng MC, Bu XQ, Zhang JE. Psychosocial behaviour reactions, psychosocial needs, anxiety and depression among patients with rectal cancer before and after colostomy surgery: A longitudinal study. J Clin Nurs. 2019;28(19-20):3547-3555. doi:10.1111/jocn.14946
  13. Jayarajah U, Samarasekera DN. Psychological adaptation to alteration of body image among stoma patients: A descriptive study. Indian J Psychol Med. 2017;39(1):63-68. doi:10.4103/0253-7176.198944
  14. Tiranda Y, Siripul P, Sangchart B, Septiwi C. Perspectives of adult survivors of colorectal cancer with an ostomy on their needs: Synthesis of qualitative research studies. Cent Eur J Nurs Midwifery. 2019;10(4):1155-1166. doi:10.15452/CEJNM.2019.10.0027
  15. Rafiei H, Hosseinzadeh K, Hoseinabadi-Farahani MJ, et al. The relationship between psychological health and spiritual wellbeing in Iranian stoma patients. Gastrointest Nurs. 2019;17:S18-S22. doi:10.12968/gasn.2019.17.Sup5.S18
  16. Rafiei H, Hoseinabadi-Farahani MJ, Aghaei S, Hosseinzadeh K, Naseh L, Heidari M. The prevalence of psychological problems among ostomy patients: A cross-sectional study from Iran. Gastrointest Nurs. 2017;15(2):39-44. doi:10.12968/gasn.2017.15.2.39
  17. Choudhary M, Kaur H. Experiences of living with intestinal ostomy: A qualitative meta-synthesis. Indian J Palliat Care. 2020;26(4):421-427. doi:10.4103/IJPC.IJPC_21_20
  18. ingan MJ, Kump K. Getting Ready for Ostomy Certification. J Wound, Ostomy Cont Nurs. 2022;49(3):290-293. doi:10.1097/won.0000000000000872
  19. Kirkland-Kyhn H, Martin S, Zaratkiewicz S, Whitmore M, Young HM. Ostomy Care at Home educating family caregivers on stoma management and potencial complications. Am J Nurs. 2018;118(4):63-68. https://nursing.ceconnection.com/ovidfiles/00000446-201804000-00035.pdf;jsessionid=E5B7110C68566021C914937447205896
  20. Marinez AC, Bock D, Carlsson E, et al. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Color Dis. 2021;23(5):1091-1101. doi:10.1111/codi.15494
  21. Bulkley JE, McMullen CK, Grant M, Wendel C, Hornbrook MC, Krouse RS. Ongoing ostomy self-care challenges of long-term rectal cancer survivors. Support Care Cancer. 2018;26(11):3933-3939. doi:10.1007/s00520-018-4268-0
  22. Stelton S. CE: Stoma and Peristomal Skin Care: A Clinical Review. Am J Nurs. 2019;119(6):38-45. doi:10.1097/01.NAJ.0000559781.86311.64
  23. Correa Marinez A, Bock D, Carlsson E, et al. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Color Dis. 2021;23(5):1091-1101. doi:10.1111/codi.15494
  24. Rowe KM, Schiller LR. Ileostomy diarrhea: Pathophysiology and management. Baylor Univ Med Cent Proc. 2020;33(2):218-226. doi:10.1080/08998280.2020.1712926
  25. Alenezi A, McGrath I, Kimpton A, Livesay karen. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021;30(21-22):3111-3123. doi:10.1111/JOCN.15840
  26. Nam KH, Kim HY, Kim JH, Kang KN, Na SY, Han BH. Effects of social support and self-efficacy on the psychosocial adjustment of Korean ostomy patients. Int Wound J. 2019;16(October 2018):13-20. doi:10.1111/iwj.13038
  27. García-Rodríguez MT, Barreiro-Trillo A, Seijo-Bestilleiro R, González-Martin C. Sexual dysfunction in ostomized patients: A systematized review. Healthc. 2021;9(5):1-11. doi:10.3390/healthcare9050520
  28. Zhang Y, Xian H, Yang Y, Zhang X, Wang X. Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: A descriptive, cross-sectional study. J Clin Nurs. 2019;28(15-16):2880-2888. doi:10.1111/jocn.14876
  29. Sarabi N, Navipour H, Mohammadi E. Sexual Performance and Reproductive Health of Patients with an Ostomy: A Qualitative Content Analysis. Sex Disabil. 2017;35(2):171-183. doi:10.1007/S11195-017-9483-Y
  30. Moreira WC, Vera SO da, Sousa GN de, Araújo SNM, Damasceno CKCS, Andrade EMLR. Sexualidade de pacientes com estomias intestinais de eliminação Sexuality of patients with bowel elimination ostomy. Rev Pesqui Cuid é Fundam Online. 2017;9(2):495-502. doi:10.9789/2175-5361.2017.v9i2.495-502
  31. Kandemir D, Oskay Ü. Sexual Problems of Patients with Urostomy: A Qualitative Study. Sex Disabil. 2017;35(3):331-340. doi:10.1007/s11195-017-9494-8
  32. Medina-Rico M, Zárate-Velasco AM, Quiñonez A, López-Ramos H. Sexuality in People With Ostomies: A Literature Review. Sex Disabil. 2019;37(4):571-586. doi:10.1007/s11195-019-09604-4
  33. Habib A, Connor MJ, Boxall NE, Lamb BW, Miah S. Improving quality of life for Muslim patients requiring a stoma: A critical review of theological and psychosocial issues. Surg Pract. 2020;24(1):29-36. doi:10.1111/1744-1633.12409
  34. Bulkley J, McMullen CK, Hornbrook MC, et al. Spiritual well-being in long-term colorectal cancer survivors with ostomies. Psychooncology. 2013;22(11):2513-2521. doi:10.1002/pon.3318

 

Defining the High Output Stoma

Michelle Carr, BNursing, GradCertSTN, MClinNurs(Wound), MNursingSc(NP)
Nurse Practitioner, Wound Management/Stomal Therapy, Sunshine Coast University Hospital, Australia

Paris E. Purnell, RN STN MBA
Senior Manager , Global Clinical Education APAC, Hollister Incorporated, Illinois, US

Aims/Objectives To offer a new definition of the High Output Stoma (HOS) that encompasses all aspects of the phenomenon that is relevant to all health disciplines. To encourage consistency in terminology across all disciplines managing the patient with a HOS. To provide a platform from which further research into HOS can be conducted.

Purpose & Background HOS patients are at risk of developing complications leading to increased morbidity, mortality, reduced quality of life, increased length of hospital stays, and frequent hospital readmissions.1,5,6,7,8, 10. While the literature is paying increasing attention to the management of HOS, there are many elements of this condition that are yet to be researched in depth, for example, the incidence of HOS, health outcomes, financial cost to the health system and social cost to the community. Most interestingly, consensus has yet to be reached on what defines a HOS: the definition varies within and across the disciplines, and the principles underpinning the definitions are not fully described. 1,2,3,4,5

Methods Representing several countries, the authors undertook an extensive literature review, to understand the variety of definitions described, patient characteristics, and the aetiologies that influence the output of a stoma in order to gain a consensus for providing a new definition of a HOS that incorporates parameters such as the volume of output, time frames, anatomical variations, and biochemical markers.

Results The resulting definition will be shared at the Congress with a view to it gaining acceptance as the new standard global definition.

Conclusion/Outcome An accurate and clear definition of HOS should form the cornerstone for further discussion and research into the phenomenon allowing useful conclusions to be drawn that are relevant and consistent for promoting evidence-based practices, that ultimately benefits the patient with HOS.

Keywords high output, stoma, definition, ostomy

References

  1. Goodey & Colman, 2016, ‘Safe management of ileostomates with high-output stomas,’ British Journal of Nursing, 25(17):1–5.
  2. Baker ML, Williams, RN & Nightingale, JM, 2011, ‘Causes and management of a high-output stoma’, Colorectal Diseases, 13(2):191–197.
  3. McDonald A, 2014, ‘Orchestrating the management of patients with high output stomas’, British Journal of Nursing, 23(12):645–649.
  4. ASCN Stoma Care, Clinical Guidelines 2016, pp. 21-25.
  5. Mountford CG, Manas DM, Thompson NP. A practical approach to the management of high-output stoma. Frontline Gastroenterol. 2014 Jul;5(3):203-207. doi: 10.1136/flgastro-2013-100375. Epub 2013 Oct 31. PMID: 28839771; PMCID: PMC5369744.
  6. Lee YJ, Kweon, MR & Park, M. ‘Nutritional management of a patient with a high-output stoma after extensive small bowel resection to treat Crohn’s disease’, Clinical Nutrition Research, 2019. 8(3):247–253.
  7. Nasser, R, Parrish, CR, & Bridges, M. ‘High output ileostomies: The stakes are higher than the output’, 2019. Practical Gastroenterology, XLIII(9): 20-33.
  8. Chen, SY, Stem, M, Cerullo, M, Canner, JK, Gearhart, SL, Safar, B, Fang, SH & Efron, JE. ‘Predicting the risk of readmission from dehydration after ileostomy formation: The DRIP score’, 2018. Diseases of Colon & Rectum, 61(12):1410–1417.

 

War, Weather, Weapons and Wounds: W4

Michele R. Burdette-Taylor, PhD, MSN, RN, CWCN, CFCN, NPD-BC, LTC-R
Associate Professor, Saint Martin University, Washington, US

Aims/Objectives Identify intervention/s of foot and wound care in the 19th that influenced 21st century practices. Isolate the evolution of military combat and wound care according to types of weapons over time and weather-related injuries. Discuss the science “silver linings” of war and combat for development of technology, products, adjunctive/advanced therapies, and devices.

Purpose & Background To share the evidence-based research highlighted with personal and professional experience. As a retired military nurse who focused on wound care during Persian Gulf, Operation Enduring Freedom, Operation Iraqi Freedom and recently Ukraine and Israel Wars, this presentation is provides a unique opportunity to share for the ostomy and wound care colleagues world-wide. As a Nightingale Scholar investigating the military medical system interventions during the Crimean War and as a nurse passionate about the history of health and welfare of soldier. The purpose is to link the history of combat injuries related to weapons, weather-related issues and at-the-moment in time standard wound care management.

Methods Integrative review conducted of the historical, seminal, and current evidence to support how wound care nurses may utilise military interventions to facilitate successful healing in the civilian sector.

Results The extensive review of the literature results focused on the development of products, devices, adjunctive and advanced technologies to improve healing rates, reduce severity of amputations, and wounds. Since the Crimean War many inventions and interventions have evolved have been developed to facilitate healing of soldiers, while reducing morbidity and mortality.

Conclusion/Outcome Understanding the history allows for improvement of care while avoiding same or similar mistakes. Sharing with providers “how we got to where we are today” provides an enlightened ah-ha moment for ostomy and wound care nursing, from a five decade career in military and civilian wound care arenas.

Keywords adjunctive munitions, x-rays, antibiotics, communication

References

Enloe, C. (2019). Wounds: militarized nursing, feminist curiosity, and unending war. International Relations, 33, 393-412.

Gumeniuk, K., Lurin, I.A.,Tsema, I., Malynovska, L., Gorobeiko, M. & Dinets, A. (2023). Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014-2020. BMC Surgery, https://doi.org/10.1186/s12893-023-01919-6

Manring, M., Hawk, A. & Calhoun, J.H. (2009). Treatment of war wounds. Clinical Orthopedic Relations Research, 467, 2168-2191.

Nightingale, F. (1858). Notes on hospitals. John W. Parker and Son, West Strand, UK. - 2 papers read at the National Association for the Promotion of Social Science in Liverpool

Nightingale, F. (1858). Notes on matters on the health, efficiency, and hospital administration of the British Army founded chiefly on the experience of the late war. London; 860 pages, 1000 copies distributed.

Nightingale, F. (1860). Notes on nursing, what it is and what it is not. Pacific Publishing Studio by Madison Park, www.PacPS.com

Protas, M., Schumacher, M. Iwanaga, J., Yilmaz, E., Oskoulan, R.J. & Tubbs, S. (2018). Treatment of gunshot wounds to spine during late 19th century. World European Surgery, 115, 285-287.

 

Life with a long-term stoma across five European countries

Marianne Krogsgaard, PhD, Associate Professor
Clinical Nurse Specialist, Department of Surgery, Center for Surgial Science, Zealand University Hospital, Koege, Denmark; Department of People and Technology, Roskilde University, Denmark

Helle Kristensen, PhD MD
Department of Surgery, Aarhus University Hospital; Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Denmark

Peter Christensen, Professor MD
Department of Surgery, Aarhus University Hospital; Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Denmark

Aims/Objectives To examine the prevalence and impact of stoma-related problems on patients’ everyday life

Purpose & Background Follow-up policies are changing throughout the world in order to personalise follow-up to those patients most in need. Concurrently, a high prevalence of late effects following colorectal cancer surgery has been revealed. For stoma nurses to design future follow-up care for patients with a long-term stoma after rectal cancer, knowledge of the prevalence, type, and impact of stoma-related problems on patients’ everyday lives is needed. Such knowledge is lacking.

Methods We performed a cross-sectional study across five European countries on 2262 long-term survivors using validated patient-reported outcome measures. Stoma problems’ association with restrictions in everyday life was calculated using multivariable regression analysis that adjusted for potential confounding factors.

Results Stoma-related problems were highly prevalent 5.4 (IQR 3.8-7.6) years after stoma surgery; leakage from stoma onto skin (58%), troublesome odour (55%), skin problems (27%), and pain at stoma site (21%). Almost one in five patients (19%) was restricted in everyday life due to the stoma. Experiencing odour and leakage ≥1 per week, skin problems, and change frequency of stoma bag >4 times daily were significantly associated with restrictions.

Conclusion/Outcome A high prevalence of morbidity of colostomies was reported by patients. To potentially help patients restricted in everyday life, easy and swift access to stoma care nurses is warranted. Annual surveys or screening of stoma function and problems could be the first step towards long-term follow-up after stoma formation.

Keywords Rectal cancer, long-term survivor, stoma care, symptoms, daily living

 

When unprepared for the emergence of a parastomal bulge – a qualitative study

Marianne Krogsgaard, PhD, Associate Professor
Clinical Nurse Specialist, Department of Surgery, Center for Surgial Science, Zealand University Hospital, Koege, Denmark; Department of People and Technology, Roskilde University, Denmark

Pia Dreyer, Professor
Clinical Nurse Specialist, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark ; Department of Public Health, Section of Nursing Science, Aarhus University, Denmark

Thordis Thomsen, Professor
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark

Aims/Objectives To investigate patients’ experiences of being prepared for the emergence of a parastomal bulge in relation to a stoma.

Purpose & Background Parastomal bulging has a significant impact on patients’ lives. We have limited information from the patient’s perspective on the information provided on parastomal bulging.

Methods Qualitative interviews with 20 patients participating in five focus groups. Analysis was performed using a three-phased phenomenological-hermeneutic approach inspired by Paul Ricoeur.

Results The unforeseen bulge gave rise to increasing concerns and worry about the cause and consequences of the bulging skin. Patients sought explanations in their own lives. In this way, one’s own behaviour or previous illness such as influenza, coughing, and efforts to rehabilitate after surgery, were suspected to have induced the bulge. Patients were under the impression that healthcare professionals knew about preventive interventions that patients were not informed about. Missing or conflicting information led to counterproductive behaviour and patients unknowingly carried on with hard and strenuous work after stoma surgery, a behaviour they would have refrained from had they known about the bulge. Patients were disappointed with healthcare professionals due to the lack of information. As patients found the bulge hard to live with, they sought the surgeon’s opinion and advice on surgical repair. Some patients were reassured not to undergo surgery and got on with their lives. Others were left with little hope of change.

Conclusion/Outcome Lack of information may lead to mistrust and disappointment with healthcare professionals. Addressing patients’ individual support needs and information needs is important to preserve patient autonomy and well-being. Surgeons and stoma nurses should be aware of the impact of their approach to communicating with patients about parastomal bulging.

Keywords parastomal bulge, hernia, information, preparation, qualitative

References

Krogsgaard M, Dreyer P, Thomsen T. Understanding patients’ perspectives when unprepared for the emergence of a parastomal bulge—a qualitative study. Colorectal Dis. 2023;00:1–8. https://doi.org/10.1111/ codi.16750

 

Effectiveness and Safety of Negative Pressure Wound Therapy on Melanoma-Resected Surgical Wounds

Kyoung Ae NAM
Wound Care Specialist, Yonsei University Severence Hospital, South Korea

Aims/Objectives  Negative pressure wound therapy (NPWT), a wound dressing system that provides sub-atmospheric pressure throughout the wound site, promotes wound healing, and reduces surgical complications. Although it is contraindicated in malignant wounds due to the potential risk of tumorigenesis, the evidence is limited.

Purpose & Background To compare tumor recurrence and wound healing performance, and surgical complications to provide evidence for the use of NPWT on melanoma-resected wounds.

Methods We retrospectively reviewed the medical records of 232 patients who were histopathologically diagnosed with acral lentiginous melanoma without nodal and distant metastasis between Jan 2006–Feb 2020. In all 179 patients received NPWT, and 53 patients received conventional surgical dressing.

Results Fifty one (28.5%) patients in the NPWT group had recurrence, of which 18 (10.1%) were local recurrence, 17 (32.1%) patients who received conventional surgical dressing had recurrence, of which 5 (9.4%) was local recurrence. There were no significant differences in recurrence-free survival between both group (Log rank test, P=0.701). Patients who received NPWT with skin grafting showed significantly faster wound healing compared to those who received conventional surgical dressing alone, and NPWT without skin grafting (P<0.001). Patients who received NPWT had lower surgical site infection rate than conventional surgical dressing (15.1% vs 28.3%, P=0.028).

Conclusion/Outcome NPWT does not significantly increase tumor recurrence in melanoma-resected wounds. Compared to conventional surgical dressing, NPWT offers several advantages in promoting wound healing and reducing surgical site infection.

Keywords negative pressure wound therapy (NPWT), melanoma-resected surgical wounds

References

  1. Venturi ML, Attinger CE, Mesbahi AN, Hess CL , Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. Am J Clin Dermatol 2005;6:185-94.
  2. Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM et al. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg 2021;35:164-70.
  3. Wang YJ, Yao XF, Lin YS, Wang JY , Chang CC. Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta-analysis. Int Wound J 2022;19:573-82.
  4. Hays TR, Singh G, Saragossi J, Park J, Shekar S, Marquez JE et al. Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022;150:655e-70e.
  5. Andrades P, Figueroa M, Sepúlveda S, Benitez S, Erazo C , Danilla S. Tumor Recurrence after Negative Pressure Wound Therapy: An Alert Call. Case Reports in Clinical Medicine 2014;03:350-2.
  6. Cai SS, Gowda AU, Alexander RH, Silverman RP, Goldberg NH , Rasko YM. Use of negative pressure wound therapy on malignant wounds - a case report and review of literature. Int Wound J 2017;14:661-5.
  7. Putri IL, Adzalika LB, Pramanasari R , Wungu CDK. Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials. Int Wound J 2022;19:1578-93.
  8. Pflibsen LR, Lettieri SC, Kruger EA, Rebecca AM , Teven CM. Negative Pressure Wound Therapy in Malignancy: Always an Absolute Contraindication? Plast Reconstr Surg Glob Open 2020;8:e3007.
  9. Oh BH, Lee SH, Nam KA, Lee HB , Chung KY. Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot. Br J Dermatol 2013;168:333-8.
  10. Mendez-Eastman S. Guidelines for Using Negative Pressure Wound Therapy. Advances in Skin & Wound Care 2001;14:314-23.

 

Negative Pressure Wound Therapy for Colorectal Incisions: A Systematic Review and Meta-Analysis of Controlled Trials

Ting-Kuang Wang
Nurse practitioner, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Chien-Hsin Chen M.D.
Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Kee-Hsin Chen
Assistant Professor, Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan

Chiehfeng Chen M.D., Ph. D.
Taipei Medical University, Taipei, Taiwan

Aims/Objectives  Colorectal surgery carries a significantly higher risk of wound infection, showing an eightfold increase in adverse events compared to alternative procedures. Despite the growing popularity of minimally invasive approaches, open surgery remains the standard, particularly in complex conditions. Our study aims to evaluate the efficacy and safety of NPWT for colorectal incisions.

Purpose & Background Negative pressure wound therapy (NPWT) has demonstrated promising results for reducing surgical site infection (SSI) rates after orthopedic, vascular, cardiothoracic, plastic, and abdominal surgery. The literature on NPWT for colorectal incisions is growing, with several randomised controlled trials (RCTs), but findings have been inconsistent.

Methods The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov databases were searched for RCTs and non-randomised controlled trials (non-RCTs) comparing NPWT and standard care.

Results Five RCTs and six non-RCTs were included (n=2,193). NPWT significantly reduced the rate of infection in colorectal incisions (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.41 to 0.78; I2=14%; p<0.0005) and wound complications (OR, 0.33; 95% CI, 0.13 to 0.88; I2=59%; p=0.03). NPWT also shortened the wound healing time by 3 days (mean difference, −2.98; 95% CI, −4.99 to −0.97; I2=0%; p=0.004). Subgroup analysis revealed that NPWT conferred greater benefits on wounds resulting from life-threatening emergency surgery and contaminated or dirty wounds.

Conclusion/Outcome NPWT is an effective intervention for the closure of wounds in patients after colorectal surgery, that significant reduction of SSI, overall wound complications, mean complete wound healing time, and more effectively in emergency, and contaminated to dirty wounds. Treatment options should be considered in terms of cost benefits and adequate patient selection during shared decision-making.

Keywords negative pressure wound therapy, colorectal surgery, systematic review, meta-analysis

References

Murphy P, Lee K, Dubois L, et al. Negative pressure wound therapy for high-risk wounds in lower extremity revascularization: study protocol for a randomized controlled trial. Trials. 2015;16:504.

Gomoll AH, Lin A, Harris MB. Incisional Vacuum-Assisted Closure Therapy. Journal of orthopaedic trauma. 2006;20(10):705-709.

Fowler AL, Barry MK. Closed incision negative pressure therapy: Results of recent trials and recommendations for clinical practice. Surgeon. 2020;18(4):241-250.

O’Leary DP, Peirce C, Anglim B, et al. Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following  Abdominal Operations: A Randomized, Controlled, Open-label Trial: The P.I.C.O. Trial. Annals of surgery. 2017;265(6):1082-1086.

Shen P, Blackham AU, Lewis S, et al. Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies. J Am Coll Surg. 2017;224(4):726-737.

 

Prevalence and risk factors of multidrug-resistant bacteria infection in patients with autoimmune bullous disease

Lei Guo
Nurse-in-charge, Hospital of Skin Diseases, Chinese Academy of Medical Sciences, China

Aims/Objectives Aim to summarise the prevalence and risk factors for multidrug-resistant bacteria (MDROs) infections of patients with autoimmune bullous disease (AIBD). In order to provide basis for the formulation of clinical prevention and nursing programs.

Purpose & Background The occurrence of infection in AIBD has a great negative impact on the treatment and control of the primary disease. Studies generally believed that the drug resistance rate of bacteria has been increasing in recent years, and the emergence of multi-drug resistant bacteria such as MRSA is not conducive to the control of subsequent wound infection. There is a lack of research on the high risk factors of skin infection with multi-drug resistant bacteria in patients with all autoimmune bullous diseases.

Methods A retrospective study was conducted to collect the information of 271 hospitalised patients with AIBD. Univariate and binary logistic regression were used to analyze the independent risk factors of multidrug-resistant bacteria infection in patients.

Results 440 patients with AIBD were treated within 3 years. The bacterial culture rate was 72.7% and the positive rate was 55.7%. 74 patients were infected with multi-drug resistant bacteria. Staphylococcus and Enterobacter were the main bacterial groups with multi-drug resistance, accounting for 75.9% and 13.9% respectively. There were statistically significant differences in the length of hospitalization, severity, self-modification of dosage, external use of antibiotic ointment, use of immunosuppressant, duration of glucocorticoids use, maximum dose of glucocorticoids and albumin value at the first admission between the two groups ( P < 0.05). Regression analysis showed that external use of antibiotic ointment, use of immunosuppressants, maximum dose of glucocorticoids and self-modification were independent risk factors for multidrug-resistant bacterial infection.

Conclusion/Outcome AIBD patients are prone to MDROs infections, with Staphylococcus being the most common multi-drug resistant pathogen.Topical antibiotic ointment, large use of immunosuppressants and glucocorticoids, self-modification of dosage will increase the risk of MDROs infection.

Keywords autoimmune bullous disease, wound Infection, multidrug-resistant

References

  1. Kutlubay Z, Sevim Keçici A, Çelik U et al. A survey of bullous diseases in a Turkish university hospital: clinicoepidemiological characteristics and follow-up. Turkish Journal Of Medical Sciences, 2021,51(1):124-133. DOI:10.3906/sag-2006-231.
  2. Chams-Davatchi C, Valikhani M, Daneshpazhooh M, et al. Pemphigus: analysis of 1209 cases. Int J Dermatol, 2005,44(6):470-476.. DOI:10.1111/j.1365-4632.2004.02501.x.
  3. Forsti A K, Jokelainen J, Timonen M, et al. Increasing incidence of bullous pemphigoid in Northern Finland: a retrospective database study in Oulu University Hospital. Br J Dermatol, 2014,171(5):1223-1226. DOI:10.1111/bjd.13189.
  4. Amber K T, Murrell D F, Schmidt E, et al. Autoimmune Subepidermal Bullous Diseases of the Skin and Mucosae: Clinical Features, Diagnosis, and Management. Clinical Reviews in Allergy & Immunology, 2018,54(1):26-51. DOI:10.1007/s12016-017-8633-4.
  5. Morin C, Fardet L. Systemic glucocorticoid therapy: risk factors for reported adverse events and beliefs about the drug. A cross-sectional online survey of 820 patients. Clinical Rheumatology, 2015,34(12):2119-2126. DOI:10.1007/s10067-015-2953-7.
  6. Ferri M, Ranucci E, Romagnoli P, et al. Antimicrobial resistance: A global emerging threat to public health systems. Crit Rev Food Sci Nutr, 2017,57(13):2857-2876. DOI:10.1080/10408398.2015.1077192.
  7. van Duin D, Paterson D L. Multidrug-Resistant Bacteria in the Community. Infectious Disease Clinics of North America, 2020,34(4):709-722. DOI:10.1016/j.idc.2020.08.002.
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  9. Swanson T, Ousey K, Haesler E, et al. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care, 2022,31(Sup12):S10-S21. DOI: 10.12968/jowc.2022.31.Sup12.S10.
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  13. Rzany B, Partscht K, Jung M, et al. Risk factors for lethal outcome in patients with bullous pemphigoid: low serum albumin level, high dosage of glucocorticosteroids, and old age. Arch Dermatol, 2002,138(7):903-908. DOI:10.1001/archderm.138.7.903.
  14. Lam W Y, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int, 2015,2015:217047. DOI:10.1155/2015/217047.
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  19. Liu Y, Tong Z, Shi J, et al. Drug repurposing for next-generation combination therapies against multidrug-resistant bacteria. Theranostics, 2021,11(10):4910-4928. DOI:10.7150/thno.56205.

Resúmenes seleccionados del 24th Congreso Bienal de WCET® en Glasgow, Reino Unido

DOI: 10.33235/wcet.44.4.39-47

PDF

Los delegados del Congreso WCET®, en Glasgow, Reino Unido, celebrado en septiembre disfrutaron de un programa científico de gran éxito, con contenidos diversos, estimulantes y de gran calidad.

Para los numerosos miembros que no pudieron asistir, he aquí una muestra de lo que presentaron los ponentes de todo el mundo.

Tratamiento del síndrome de resección anterior baja

Jennie Burch, RN, BSc, MSc
Jefa de formación de enfermería gastrointestinal, St Mark's Hospital, Londres, Reino Unido

Claire Taylor, RGN, PhD
Jefa de enfermería, Macmillan, Reino Unido

Ana Wilson, MD
Gastroenteróloga consultora, St Mark's Hospital, Londres, Reino Unido

Christine Norton, RGN, PhD
Profesora de Enfermería, King's College London, Reino Unido

Metas/Objetivos El objetivo de la presentación es describir el manejo por parte de las enfermeras de los síntomas intestinales que aparecen tras el tratamiento del cáncer rectal. Los objetivos son mejorar los conocimientos y la confianza de las enfermeras a la hora de atender a este grupo de pacientes.

Objetivo y Antecedentes Se sabe, en todo el mundo cada año un millón de personas son diagnosticadas con cáncer rectal (Emmertsen & Laurberg, 2013). El tratamiento del cáncer rectal suele consistir en cirugía, quimioterapia y radioterapia, lo que puede tener consecuencias como la disfunción intestinal, denominada colectivamente síndrome de resección anterior baja o LARS (Keane et al. 2020). El propósito de esta presentación será aumentar el conocimiento sobre el manejo del LARS después de la cirugía de cáncer rectal.

Métodos Se realizó un doctorado utilizando un diseño multifase de métodos mixtos para investigar la gestión del LARS. Una revisión sistemática resumió temáticamente cómo afectan a la calidad de vida las consecuencias del tratamiento del cáncer rectal. Una revisión del alcance trazó los tratamientos disponibles para tratar el LARS. Las entrevistas describieron temáticamente lo que necesitan los pacientes para gestionar el LARS. Los grupos de discusión con pacientes y médicos describieron temáticamente cómo conseguirlo.

Resultados Los resultados revelan que la calidad de vida puede verse afectada negativamente por el LARS, en particular cuando las personas no pueden desempeñar las funciones que han elegido (Burch et al, 2021a). Existen múltiples opciones de gestión del LARS, pero los datos empíricos son limitados (Burch et al, 2021b). Los pacientes necesitan médicos bien informados que les pregunten y revisen los síntomas, les informen sobre las estrategias de tratamiento y les remitan a otra información pertinente (Burch et al, 2023a). Los clínicos pueden ayudar a establecer expectativas que permitan planificar objetivos realistas (Burch et al, 2023b). El tratamiento del LARS apoyado por enfermeras puede mejorar los síntomas intestinales junto con información complementaria.

Conclusión/Resultado En conclusión, un mayor conocimiento sobre el LARS debería aumentar la confianza de las enfermeras para ayudar a los pacientes con cáncer rectal a controlar sus síntomas intestinales después del tratamiento del cáncer rectal. Se necesita más investigación para comprender cuál es la mejor manera de proporcionar intervenciones LARS dirigidas por enfermeras.

Palabras clave LARS, síndrome de resección anterior baja, cáncer rectal, enfermera, supervivencia

Referencias

Burch J., Taylor C., Wilson A., Norton C. (2021a) Symptoms affecting quality of life after sphincter-saving rectal cancer surgery: a systematic review. European Journal of Oncology Nursing, 52.

Burch J., Swatton A., Taylor C., Wilson A., Norton C. (2021b) Managing bowel symptoms after sphincter-saving rectal cancer surgery: a scoping review. Journal of Pain and Symptom Management 62(6), 1295-1307.

Burch J., Wright J., Taylor C., Wilson A., Norton C. (2023a) “He’s a surgeon, like I’m not going to waste his time”: interviews to determine healthcare needs for patients with low anterior resection syndrome (LARS) after rectal cancer surgery. Colorectal Disease 25, 880-887.

Burch J., Taylor C., Wilson A., Norton C. (2023b) “You’re just on your own”: Exploring bowel symptom management needs after rectal cancer surgery through patient and clinician focus groups. European Journal Oncology Nursing. https://doi.org/10.1016/j.ejon.2023.102406.

Emmertsen K.J., Laurberg S. (2013) Impact of bowel dysfunction on quality of life after sphincter-saving resection for rectal cancer. British Journal of Surgery 100(10), 1377-1387.

Keane C., Fearnhead N.S., Bordeianou L.G., Christensen P., Basany E.E., Laurberg S., Mellgren A., Messick C., Orangio G.R., Verjee A., Wing K., Bissett I. (2020) International consensus definition of low anterior resection syndrome. Diseases of the Colon & Rectum 63(3), 274-284.

 

Toda mi vida he tenido que adaptarme con mi estoma: Un estudio fenomenológico

Ria Andjarwati, MD, ONS, ETN,
Enfermera Jefe, Consultora de Heridas y Estomas, Enfermera Especialista en Oncología, Hospital del Centro Nacional del Cáncer "dharmais", Indonesia

Yati Afiyanti, Prof. PhD. MN
Conferencia honoraria en la Facultad de Enfermería de la Universidad de Indonesia, Universidad de Indonesia, Indonesia

Metas/Objetivos El objetivo de este estudio era describir las experiencias de los pacientes con cáncer que tuvieron un estoma durante el primer año. Se realizó un estudio cualitativo descriptivo.

Finalidad y Antecedentes Los pacientes con cáncer que se someten a una operación de estoma experimentan un cambio vital importante. Surgen muchos problemas tanto físicos como psicológicos, sexuales y espirituales, sobre todo en el primer año. El retraso en la planificación del alta en entornos extrahospitalarios, ocurre a menudo a los nuevos ostomizados, debido a la escasa educación e información preoperatoria. Explorando las experiencias de los pacientes a lo largo del difícil periodo de la cirugía de estoma, los profesionales sanitarios pueden comprender y capacitar a los pacientes con los cuidados adecuados.

Métodos Se invitó a once participantes a realizar entrevistas en profundidad semiestructuradas. Los datos se analizaron mediante análisis temático.

Resultados Se identificaron dos temas: 1) Quejas experimentadas durante la terapia; 2). Adaptación a la vida después del estoma. Ostomizados que se enfrentan a grandes cambios en su vida debido a la adaptación a la vida con el estoma. Muchos aspectos de la vida de las personas ostomizadas tienen que adaptarse, Los sentimientos de rechazo y negación surgen aproximadamente en el primer mes tras la operación de estoma. El ajuste, seguido de la adaptación y el reconocimiento final del ostomizado conlleva más de seis meses.

Conclusión/Resultado Este estudio proporciona al personal de enfermería y a otras personas una visión de las experiencias de los ostomizados indonesios sobre sus procesos de adaptación física, psicológica, social, espiritual y sexual, y sus planes para su vida futura con estoma. Es muy útil para los pacientes con cáncer colorrectal u otros cánceres que se someten a una vida con un estoma.

Palabras clave pacientes con cáncer, experiencia, ostomizado, postoperatorio, estoma

Referencias

  1. Alenezi A, McGrath I, Kimpton A, Livesay K. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021;30(21-22):3111-3123. doi:10.1111/jocn.15840
  2. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I BF. International Agency for Research on Cancer 2020. Glob Cancer Obs Cancer Today. 2020;419:1-2.
  3. Kugler CM, Breuing J, Rombey T, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy—protocol of a systematic review and meta-analysis. Syst Rev. 2021;10(1):1-8. doi:10.1186/s13643-021-01684-8
  4. Summers MC. The Effect of Ostomate-to-Ostomate Support on Psychosocial Adaptation to Stoma. Dr Nurs Pract Capstone Proj. 2018;28.
  5. Burch J. Post-discharge care for patients following stoma formation: what the nurse needs to know. Nurs Stand. 2017;31(51):41-45. doi:10.7748/ns.2017.e10198
  6. Capilla-Díaz C, Bonill-de las Nieves C, Hernández-Zambrano SM, et al. Living With an Intestinal Stoma: A Qualitative Systematic Review. Qual Health Res. 2019;29(9):1255-1265. doi:10.1177/1049732318820933
  7. Vonk-Klaassen SM, de Vocht HM, den Ouden MEM, Eddes EH, Schuurmans MJ. Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review. Qual Life Res. 2016;25(1):125-133. doi:10.1007/s11136-015-1050-3
  8. Hahne J, Liang T, Khoshnood K, Wang X, Li X. Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients. Patient Educ Couns. 2020;103(2):286-291. doi:10.1016/j.pec.2019.08.022
  9. de Almeida Silva K, Duarte AX, Cruz AR, de Araújo LB, das Graças Pena G. Time after ostomy surgery and type of treatment are associated with quality of life changes in colorectal cancer patients with colostomy. PLoS One. 2020;15(12):1-17. doi:10.1371/JOURNAL.PONE.0239201
  10. Dibley L, Czuber-Dochan W, Wade T, et al. Patient Decision-Making about Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives. Inflamm Bowel Dis. 2018;24(2):235-246. doi:10.1093/ibd/izx043
  11. Cross AJ, Wooldrage K, Robbins EC, et al. Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study. Br J Cancer. 2019;120(2):154-164. doi:10.1038/s41416-018-0335-z
  12. Jin Y, Zhang J, Zheng MC, Bu XQ, Zhang JE. Psychosocial behaviour reactions, psychosocial needs, anxiety and depression among patients with rectal cancer before and after colostomy surgery: A longitudinal study. J Clin Nurs. 2019;28(19-20):3547-3555. doi:10.1111/jocn.14946
  13. Jayarajah U, Samarasekera DN. Psychological adaptation to alteration of body image among stoma patients: A descriptive study. Indian J Psychol Med. 2017;39(1):63-68. doi:10.4103/0253-7176.198944
  14. Tiranda Y, Siripul P, Sangchart B, Septiwi C. Perspectives of adult survivors of colorectal cancer with an ostomy on their needs: Synthesis of qualitative research studies. Cent Eur J Nurs Midwifery. 2019;10(4):1155-1166. doi:10.15452/CEJNM.2019.10.0027
  15. Rafiei H, Hosseinzadeh K, Hoseinabadi-Farahani MJ, et al. The relationship between psychological health and spiritual wellbeing in Iranian stoma patients. Gastrointest Nurs. 2019;17:S18-S22. doi:10.12968/gasn.2019.17.Sup5.S18
  16. Rafiei H, Hoseinabadi-Farahani MJ, Aghaei S, Hosseinzadeh K, Naseh L, Heidari M. The prevalence of psychological problems among ostomy patients: A cross-sectional study from Iran. Gastrointest Nurs. 2017;15(2):39-44. doi:10.12968/gasn.2017.15.2.39
  17. Choudhary M, Kaur H. Experiences of living with intestinal ostomy: A qualitative meta-synthesis. Indian J Palliat Care. 2020;26(4):421-427. doi:10.4103/IJPC.IJPC_21_20
  18. ingan MJ, Kump K. Getting Ready for Ostomy Certification. J Wound, Ostomy Cont Nurs. 2022;49(3):290-293. doi:10.1097/won.0000000000000872
  19. Kirkland-Kyhn H, Martin S, Zaratkiewicz S, Whitmore M, Young HM. Ostomy Care at Home educating family caregivers on stoma management and potencial complications. Am J Nurs. 2018;118(4):63-68. https://nursing.ceconnection.com/ovidfiles/00000446-201804000-00035.pdf;jsessionid=E5B7110C68566021C914937447205896
  20. Marinez AC, Bock D, Carlsson E, et al. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Color Dis. 2021;23(5):1091-1101. doi:10.1111/codi.15494
  21. Bulkley JE, McMullen CK, Grant M, Wendel C, Hornbrook MC, Krouse RS. Ongoing ostomy self-care challenges of long-term rectal cancer survivors. Support Care Cancer. 2018;26(11):3933-3939. doi:10.1007/s00520-018-4268-0
  22. Stelton S. CE: Stoma and Peristomal Skin Care: A Clinical Review. Am J Nurs. 2019;119(6):38-45. doi:10.1097/01.NAJ.0000559781.86311.64
  23. Correa Marinez A, Bock D, Carlsson E, et al. Stoma-related complications: a report from the Stoma-Const randomized controlled trial. Color Dis. 2021;23(5):1091-1101. doi:10.1111/codi.15494
  24. Rowe KM, Schiller LR. Ileostomy diarrhea: Pathophysiology and management. Baylor Univ Med Cent Proc. 2020;33(2):218-226. doi:10.1080/08998280.2020.1712926
  25. Alenezi A, McGrath I, Kimpton A, Livesay karen. Quality of life among ostomy patients: A narrative literature review. J Clin Nurs. 2021;30(21-22):3111-3123. doi:10.1111/JOCN.15840
  26. Nam KH, Kim HY, Kim JH, Kang KN, Na SY, Han BH. Effects of social support and self-efficacy on the psychosocial adjustment of Korean ostomy patients. Int Wound J. 2019;16(October 2018):13-20. doi:10.1111/iwj.13038
  27. García-Rodríguez MT, Barreiro-Trillo A, Seijo-Bestilleiro R, González-Martin C. Sexual dysfunction in ostomized patients: A systematized review. Healthc. 2021;9(5):1-11. doi:10.3390/healthcare9050520
  28. Zhang Y, Xian H, Yang Y, Zhang X, Wang X. Relationship between psychosocial adaptation and health-related quality of life of patients with stoma: A descriptive, cross-sectional study. J Clin Nurs. 2019;28(15-16):2880-2888. doi:10.1111/jocn.14876
  29. Sarabi N, Navipour H, Mohammadi E. Sexual Performance and Reproductive Health of Patients with an Ostomy: A Qualitative Content Analysis. Sex Disabil. 2017;35(2):171-183. doi:10.1007/S11195-017-9483-Y
  30. Moreira WC, Vera SO da, Sousa GN de, Araújo SNM, Damasceno CKCS, Andrade EMLR. Sexualidade de pacientes com estomias intestinais de eliminação Sexuality of patients with bowel elimination ostomy. Rev Pesqui Cuid é Fundam Online. 2017;9(2):495-502. doi:10.9789/2175-5361.2017.v9i2.495-502
  31. Kandemir D, Oskay Ü. Sexual Problems of Patients with Urostomy: A Qualitative Study. Sex Disabil. 2017;35(3):331-340. doi:10.1007/s11195-017-9494-8
  32. Medina-Rico M, Zárate-Velasco AM, Quiñonez A, López-Ramos H. Sexuality in People With Ostomies: A Literature Review. Sex Disabil. 2019;37(4):571-586. doi:10.1007/s11195-019-09604-4
  33. Habib A, Connor MJ, Boxall NE, Lamb BW, Miah S. Improving quality of life for Muslim patients requiring a stoma: A critical review of theological and psychosocial issues. Surg Pract. 2020;24(1):29-36. doi:10.1111/1744-1633.12409
  34. Bulkley J, McMullen CK, Hornbrook MC, et al. Spiritual well-being in long-term colorectal cancer survivors with ostomies. Psychooncology. 2013;22(11):2513-2521. doi:10.1002/pon.3318

 

Definición del estoma de alto débito

Michelle Carr, BNursing, GradCertSTN, MClinNurs(Wound), MNursingSc (NP)
Enfermera Practicante, Tratamiento de Heridas/Terapia Estomal, Hospital Universitario Sunshine Coast, Australia

Paris E. Purnell, RN STN MBA
Director, Educación Clínica Global APAC , Hollister Incorporated, Illinois, EE.UU

Metas/Objetivos Ofrecer una nueva definición del estoma de alto débito (HOS) que abarque todos los aspectos del fenómeno y que sea relevante para todas las disciplinas sanitarias. Fomentar la coherencia terminológica entre todas las disciplinas que tratan al paciente con HOS. Proporcionar una plataforma a partir de la cual se pueda seguir investigando sobre el HOS.

Finalidad y Antecedentes Los pacientes con HOS corren el riesgo de desarrollar complicaciones que conducen a una mayor morbilidad, mortalidad, reducción de la calidad de vida, aumento de la duración de las estancias hospitalarias y frecuentes reingresos hospitalarios.1,5,6,7,8, 10. Aunque en la bibliografía se presta cada vez más atención al tratamiento del HOS, hay muchos elementos de esta enfermedad que aún no se han investigado en profundidad, por ejemplo, la incidencia del HOS, los resultados sanitarios, el coste económico para el sistema sanitario y el coste social para la comunidad. Lo más interesante es que aún no se ha llegado a un consenso sobre lo que define un HOS: la definición varía dentro de las disciplinas y entre ellas, y los principios en los que se basan las definiciones no están descritos en su totalidad. 1,2,3,4,5

Métodos En representación de varios países, los autores llevaron a cabo una extensa revisión bibliográfica para conocer la variedad de definiciones descritas, las características de los pacientes y las etiologías que influyen en la salida de un estoma, con el fin de llegar a un consenso para proporcionar una nueva definición de HOS que incorpore parámetros como el volumen de salida, los plazos, las variaciones anatómicas y los marcadores bioquímicos.

Resultados La definición resultante se compartirá en el Congreso con vistas a que sea aceptada como la nueva definición global estándar.

Conclusión/Resultado Una definición precisa y clara del HOS debería constituir la piedra angular de futuros debates e investigaciones sobre el fenómeno, permitiendo extraer conclusiones útiles que sean relevantes y coherentes para promover prácticas basadas en la evidencia, que en última instancia beneficien al paciente con HOS.

Palabras clave alto débito, estoma, definición, ostomía

Referencias

  1. Goodey & Colman, 2016, ‘Safe management of ileostomates with high-output stomas,’ British Journal of Nursing, 25(17):1–5.
  2. Baker ML, Williams, RN & Nightingale, JM, 2011, ‘Causes and management of a high-output stoma’, Colorectal Diseases, 13(2):191–197.
  3. McDonald A, 2014, ‘Orchestrating the management of patients with high output stomas’, British Journal of Nursing, 23(12):645–649.
  4. ASCN Stoma Care, Clinical Guidelines 2016, pp. 21-25.
  5. Mountford CG, Manas DM, Thompson NP. A practical approach to the management of high-output stoma. Frontline Gastroenterol. 2014 Jul;5(3):203-207. doi: 10.1136/flgastro-2013-100375. Epub 2013 Oct 31. PMID: 28839771; PMCID: PMC5369744.
  6. Lee YJ, Kweon, MR & Park, M. ‘Nutritional management of a patient with a high-output stoma after extensive small bowel resection to treat Crohn’s disease’, Clinical Nutrition Research, 2019. 8(3):247–253.
  7. Nasser, R, Parrish, CR, & Bridges, M. ‘High output ileostomies: The stakes are higher than the output’, 2019. Practical Gastroenterology, XLIII(9): 20-33.
  8. Chen, SY, Stem, M, Cerullo, M, Canner, JK, Gearhart, SL, Safar, B, Fang, SH & Efron, JE. ‘Predicting the risk of readmission from dehydration after ileostomy formation: The DRIP score’, 2018. Diseases of Colon & Rectum, 61(12):1410–1417.

 

Guerra, clima, armas y heridas: W4

Michele R. Burdette-Taylor, PhD, MSN, RN, CWCN, CFCN, NPD-BC, LTC-R
Profesora asociada, Universidad Saint Martin, Washington, EE.UU

Metas/Objetivos Identificar la/s intervención/es del cuidado de los pies y heridas en el siglo XIX que influyeron en las prácticas del siglo XXI. Aislar la evolución del combate militar y la atención a las heridas según los tipos de armas a lo largo del tiempo y las lesiones relacionadas con el tiempo. Discutir los "resquicios de esperanza" científicos de la guerra y el combate para el desarrollo de tecnología, productos, terapias adyuvantes/avanzadas y dispositivos.

Finalidad y Antecedentes Compartir la investigación basada en la evidencia destacada con la experiencia personal y profesional. Como enfermera militar jubilada que se centró en el cuidado de heridas durante las guerras del Golfo Pérsico, la Operación Libertad Duradera, la Operación Libertad Iraquí y recientemente las guerras de Ucrania e Israel, esta presentación es una oportunidad única para compartir con los colegas del cuidado de heridas y ostomías de todo el mundo. Como becaria Nightingale que investiga las intervenciones del sistema médico militar durante la guerra de Crimea y como enfermera apasionada por la historia de la salud y el bienestar del soldado. El objetivo es vincular la historia de las heridas de combate relacionadas con las armas, los problemas relacionados con el tiempo y el tratamiento estándar del cuidado de heridas en el momento.

Métodos Se llevó a cabo una revisión integradora de las pruebas históricas, seminales y actuales que respaldan el modo en que las enfermeras de atención de heridas pueden utilizar las intervenciones militares para facilitar una curación satisfactoria en el sector civil.

Resultados La extensa revisión de los resultados bibliográficos se centró en el desarrollo de productos, dispositivos, tecnologías complementarias y avanzadas para mejorar los índices de curación, reducir la gravedad de las amputaciones y las heridas. Desde la guerra de Crimea se han desarrollado numerosos inventos e intervenciones para facilitar la curación de los soldados y reducir al mismo tiempo la morbilidad y la mortalidad.

Conclusión/Resultado Comprender el historial permite mejorar la atención y evitar errores iguales o similares. El hecho de compartir con los proveedores "cómo hemos llegado hasta donde estamos hoy" supone un momento de iluminación para la enfermería especializada en ostomías y cuidado de heridas, a partir de una carrera de cinco décadas en los ámbitos militar y civil del cuidado de heridas.

Palabras clave municiones adyuvantes, rayos X, antibióticos, comunicación

Referencias

Enloe, C. (2019). Wounds: militarized nursing, feminist curiosity, and unending war. International Relations, 33, 393-412.

Gumeniuk, K., Lurin, I.A.,Tsema, I., Malynovska, L., Gorobeiko, M. & Dinets, A. (2023). Gunshot injury to the colon by expanding bullets in combat patients wounded in hybrid period of the Russian-Ukrainian war during 2014-2020. BMC Surgery, https://doi.org/10.1186/s12893-023-01919-6

Manring, M., Hawk, A. & Calhoun, J.H. (2009). Treatment of war wounds. Clinical Orthopedic Relations Research, 467, 2168-2191.

Nightingale, F. (1858). Notes on hospitals. John W. Parker and Son, West Strand, UK. - 2 papers read at the National Association for the Promotion of Social Science in Liverpool

Nightingale, F. (1858). Notes on matters on the health, efficiency, and hospital administration of the British Army founded chiefly on the experience of the late war. London; 860 pages, 1000 copies distributed.

Nightingale, F. (1860). Notes on nursing, what it is and what it is not. Pacific Publishing Studio by Madison Park, www.PacPS.com

Protas, M., Schumacher, M. Iwanaga, J., Yilmaz, E., Oskoulan, R.J. & Tubbs, S. (2018). Treatment of gunshot wounds to spine during late 19th century. World European Surgery, 115, 285-287.

 

La vida con un estoma de larga duracion en cinco paises Europeos

Marianne Krogsgaard, PhD, Profesora Asociada
Especialista en Enfermería Clínica, Departamento de Cirugía, Centro de Ciencia Quirúrgica, Hospital Universitario de Zelanda, Koege, Dinamarca; Departamento de Personas y Tecnología, Universidad de Roskilde, Dinamarca

Helle Kristensen, PhD MD
Departamento de Cirugía, Hospital Universitario de Aarhus; Sociedad Danesa del Cáncer Centro de Investigación sobre Supervivencia y Efectos Adversos Tardíos tras un Cáncer en los Órganos Pélvicos, Dinamarca

Peter Christensen, Professor MD
Departamento de Cirugía, Hospital Universitario de Aarhus; Sociedad Danesa del Cáncer Centro de Investigación sobre Supervivencia y Efectos Adversos Tardíos tras un Cáncer en los Órganos Pélvicos, Dinamarca

Metas/Objetivos Examinar la prevalencia y el impacto de los problemas relacionados con el estoma en la vida cotidiana de los pacientes

Finalidad y Antecedentes Las políticas de seguimiento están cambiando en todo el mundo para personalizar el seguimiento de los pacientes que más lo necesitan. Al mismo tiempo, se ha revelado una alta prevalencia de efectos tardíos tras la cirugía del cáncer colorrectal. Para que el personal de enfermería especializado en estomas pueda diseñar futuros cuidados de seguimiento para pacientes con un estoma de larga duración tras un cáncer rectal, es necesario conocer la prevalencia, el tipo y el impacto de los problemas relacionados con el estoma en la vida diaria de los pacientes. Faltan esos conocimientos.

Métodos Realizamos un estudio transversal en cinco países europeos sobre 2262 supervivientes a largo plazo utilizando medidas de resultados validadas informadas por los pacientes. La asociación de los problemas de estoma con las restricciones en la vida diaria se calculó mediante un análisis de regresión multivariable que ajustaba los posibles factores de confusión.

Resultados Los problemas relacionados con el estoma fueron altamente prevalentes 5,4 (IQR 3,8-7,6) años después de la cirugía del estoma; fugas del estoma sobre la piel (58%), olor molesto (55%), problemas cutáneos (27%) y dolor en el lugar del estoma (21%). Casi uno de cada cinco pacientes (19%) tenía limitaciones en su vida cotidiana debido al estoma. Experimentar olores y fugas ≥1 vez por semana, los problemas cutáneos y la frecuencia de cambio de la bolsa del estoma >4 veces al día se asociaron significativamente con las restricciones.

Conclusión/Resultado Los pacientes informaron de una elevada prevalencia de morbilidad de las colostomías. Para poder ayudar a los pacientes en su vida cotidiana, es necesario un acceso fácil y rápido al personal de enfermería especializado en estomas. Las encuestas anuales o el cribado de la función y los problemas del estoma podrían ser el primer paso hacia un seguimiento a largo plazo tras la formación del estoma.

Palabras clave Cáncer rectal, superviviente a largo plazo, cuidados del estoma, síntomas, vida diaria

 

Cuando no se está preparado para la aparición de una protuberancia paraestomal - un estudio cualitativo

Marianne Krogsgaard, PhD, Profesora Asociada
Especialista en Enfermería Clínica, Departamento de Cirugía, Centro de Ciencia Quirúrgica, Hospital Universitario de Zelanda, Koege, Dinamarca; Departamento de Personas y Tecnología, Universidad de Roskilde, Dinamarca

Pia Dreyer, Profesora
Enfermera Clínica Especialista, Departamento de Anestesiología y Cuidados Intensivos, Hospital Universitario de Aarhus, Dinamarca ; Departamento de Salud Pública, Sección de Ciencias de Enfermería, Universidad de Aarhus, Dinamarca

Thordis Thomsen, Profesor
Departamento de Anestesiología, Hospital Herlev, Universidad de Copenhague, Dinamarca; Departamento de Medicina Clínica, Facultad de Ciencias de la Salud, Universidad de Copenhague, Dinamarca

Metas/Objetivos Investigar las experiencias de los pacientes cuando se les prepara para la aparición de una protuberancia pareastomal en relación con un estoma.

Finalidad y Antecedentes El abombamiento paraestomal tiene un impacto significativo en la vida de los pacientes. Disponemos de información limitada desde el punto de vista del paciente sobre la información facilitada acerca del abombamiento paraestomal.

Métodos Entrevistas cualitativas con 20 pacientes participantes en cinco grupos focales. El análisis se realizó mediante un enfoque fenomenológico-hermenéutico en tres fases inspirado en Paul Ricoeur.

Resultados El abultamiento imprevisto dio lugar a una creciente inquietud y preocupación por la causa y las consecuencias de la piel abultada. Los pacientes buscaban explicaciones en sus propias vidas. De este modo, se sospechaba que el propio comportamiento o enfermedades previas como la gripe, la tos y los esfuerzos de rehabilitación tras una intervención quirúrgica habían inducido el abultamiento. Los pacientes tenían la impresión de que los profesionales sanitarios conocían intervenciones preventivas de las que los pacientes no estaban informados. La falta de información o la información contradictoria condujeron a un comportamiento contraproducente y, sin saberlo, los pacientes continuaron con un trabajo duro y extenuante después de la cirugía de estoma, un comportamiento del que se habrían abstenido si hubieran sabido lo del abultamiento. Los pacientes se mostraron decepcionados con los profesionales sanitarios por la falta de información. Como a los pacientes les resultaba difícil vivir con la protuberancia, buscaban la opinión y el consejo del cirujano sobre la reparación quirúrgica. A algunos pacientes se les tranquilizó para que no se operaran y siguieran con sus vidas. Otros se quedaron con pocas esperanzas de cambio.

Conclusión/Resultado La falta de información puede generar desconfianza y decepción con los profesionales sanitarios. Atender las necesidades individuales de apoyo e información de los pacientes es importante para preservar su autonomía y bienestar. Los cirujanos y el personal de enfermería especializado en estomas deben ser conscientes de la repercusión de su enfoque a la hora de comunicarse con los pacientes sobre el abombamiento paraestomal.

Palabras clave protuberancia paraestomal, hernia, información, preparación, cualitativa

Referencias

Krogsgaard M, Dreyer P, Thomsen T. Understanding patients’ perspectives when unprepared for the emergence of a parastomal bulge—a qualitative study. Colorectal Dis. 2023;00:1–8. https://doi.org/10.1111/ codi.16750

 

Eficacia y seguridad de la terapia de heridas con presión negativa en heridas quirúrgicas por melanoma

Kyoung Ae NAM
Especialista en cuidado de heridas, Hospital Severence de la Universidad de Yonsei, Corea del Sur

Metas/Objetivos La terapia de heridas con presión negativa (NPWT), un sistema de apósito de heridas que proporciona una presión subatmosférica en toda la zona de la herida, favorece su curación y reduce las complicaciones quirúrgicas. Aunque está contraindicado en heridas malignas debido al riesgo potencial de tumorigénesis, la evidencia es limitada.

Finalidad y Antecedentes Comparar la recurrencia del tumor y el rendimiento de la curación de heridas, así como las complicaciones quirúrgicas para aportar pruebas sobre el uso de NPWT en heridas resecadas por melanoma.

Métodos Se revisaron retrospectivamente las historias clínicas de 232 pacientes diagnosticados histopatológicamente de melanoma lentiginoso acral sin metástasis ganglionares ni a distancia entre enero de 2006 y febrero de 2020. En total, 179 pacientes recibieron NPWT y 53 pacientes recibieron apósito quirúrgico convencional.

Resultados Cincuenta y un (28,5%) pacientes del grupo de NPWT presentaron reaparición, de los cuales 18 (10,1%) fueron reapariciones locales, 17 (32,1%) pacientes que recibieron vendaje quirúrgico convencional presentaron reaparición, de los cuales 5 (9,4%) fueron reapariciones locales. No hubo diferencias significativas en la supervivencia libre de reapariciones entre ambos grupos (Log rank test, P=0,701). Los pacientes que recibieron NPWT con injerto cutáneo mostraron una curación de la herida significativamente más rápida en comparación con los que recibieron vendaje quirúrgico convencional solo y NPWT sin injerto cutáneo (P<0,001). Los pacientes que recibieron NPWT presentaron una tasa de infección del lecho quirúrgico inferior a la del vendaje quirúrgico convencional (15,1% frente a 28,3%, P=0,028).

Conclusión/Resultado La NPWT no aumenta significativamente la recurrencia tumoral en heridas por melanoma. En comparación con el apósito quirúrgico convencional, la NPWT ofrece varias ventajas para favorecer la curación de heridas y reducir la infección del lecho quirúrgico.

Palabras clave terapia de heridas con presión negativa (NPWT), heridas quirúrgicas por melanoma

Referencias

  1. Venturi ML, Attinger CE, Mesbahi AN, Hess CL , Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. Am J Clin Dermatol 2005;6:185-94.
  2. Normandin S, Safran T, Winocour S, Chu CK, Vorstenbosch J, Murphy AM et al. Negative Pressure Wound Therapy: Mechanism of Action and Clinical Applications. Semin Plast Surg 2021;35:164-70.
  3. Wang YJ, Yao XF, Lin YS, Wang JY , Chang CC. Oncologic feasibility for negative pressure wound therapy application in surgical wounds: A meta-analysis. Int Wound J 2022;19:573-82.
  4. Hays TR, Singh G, Saragossi J, Park J, Shekar S, Marquez JE et al. Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2022;150:655e-70e.
  5. Andrades P, Figueroa M, Sepúlveda S, Benitez S, Erazo C , Danilla S. Tumor Recurrence after Negative Pressure Wound Therapy: An Alert Call. Case Reports in Clinical Medicine 2014;03:350-2.
  6. Cai SS, Gowda AU, Alexander RH, Silverman RP, Goldberg NH , Rasko YM. Use of negative pressure wound therapy on malignant wounds - a case report and review of literature. Int Wound J 2017;14:661-5.
  7. Putri IL, Adzalika LB, Pramanasari R , Wungu CDK. Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials. Int Wound J 2022;19:1578-93.
  8. Pflibsen LR, Lettieri SC, Kruger EA, Rebecca AM , Teven CM. Negative Pressure Wound Therapy in Malignancy: Always an Absolute Contraindication? Plast Reconstr Surg Glob Open 2020;8:e3007.
  9. Oh BH, Lee SH, Nam KA, Lee HB , Chung KY. Comparison of negative pressure wound therapy and secondary intention healing after excision of acral lentiginous melanoma on the foot. Br J Dermatol 2013;168:333-8.
  10. Mendez-Eastman S. Guidelines for Using Negative Pressure Wound Therapy. Advances in Skin & Wound Care 2001;14:314-23.

 

Terapia de heridas con presión negativa para incisiones colorrectales: Revisión sistemática y metanálisis de ensayos controlados

Ting-Kuang Wang
Enfermera especializada, Hospital Wan Fang, Universidad Médica de Taipei, Taipei, Taiwán

Chien-Hsin Chen M.D.
Hospital Wan Fang, Universidad Médica de Taipei, Taipei, Taiwán

Kee-Hsin Chen
Profesora adjunta, Programa de posgrado en Enfermería, Facultad de Enfermería, Universidad Médica de Taipei, Taipei, Taiwán

Doctor en Medicina Chiehfeng Chen D.
Universidad Médica de Taipei, Taipei, Taiwán

Metas/Objetivos La cirugía colorrectal conlleva un riesgo significativamente mayor de infección de la herida, multiplicando por ocho los acontecimientos adversos en comparación con otros procedimientos alternativos. Pese a la creciente popularidad de los abordajes mínimamente invasivos, la cirugía abierta sigue siendo la norma, sobre todo en patologías complejas. Nuestro estudio pretende evaluar la eficacia y la seguridad de la NPWT para las incisiones colorrectales.

Finalidad y Antecedentes La terapia de heridas con presión negativa (NPWT) ha demostrado resultados prometedores en la reducción de las tasas de infección del lecho quirúrgico (SSI) tras cirugía ortopédica, vascular, cardiotorácica, plástica y abdominal. La bibliografía sobre la NPWT para incisiones colorrectales está creciendo, con varios ensayos controlados aleatorios (RCT), pero los resultados han sido inconsistentes.

Métodos Se realizaron búsquedas en las bases de datos Registro Cochrane Central de Ensayos Controlados, PubMed, EMBASE, Índice acumulativo de la bibliografía sobre enfermería y profesiones afines y ClinicalTrials.gov en busca de RCT y ensayos controlados no aleatorios (no RCT) que compararan la NPWT y la atención estándar.

Resultados Se incluyeron cinco RCT y seis no RCT (n=2 193). La NPWT redujo significativamente la tasa de infección en las incisiones colorrectales (cociente de probabilidades [OR], 0,57; intervalo de confianza [IC] del 95%, 0,41 a 0,78; I2=14%; p<0,0005) y las complicaciones de la herida (OR, 0,33; IC del 95%, 0,13 a 0,88; I2=59%; p=0,03). La NPWT también acortó el tiempo de curación de heridas en 3 días (diferencia media, -2,98; IC del 95%, -4,99 a -0,97; I2=0%; p=0,004). El análisis de subgrupos reveló que la NPWT confería mayores beneficios en las heridas resultantes de una cirugía de urgencia potencialmente mortal y en las heridas contaminadas o sucias.

Conclusión/Resultado NPWT es una intervención eficaz para el cierre de heridas en pacientes después de la cirugía colorrectal, con una reducción significativa de SSI, de las complicaciones generales de la herida y del tiempo medio de curación completa de heridas, y es más eficaz en caso de emergencia y contaminación de heridas sucias. Las opciones de tratamiento deben considerarse en términos de coste-beneficio y selección adecuada del paciente durante la toma de decisiones compartida.

Palabras clave terapia de heridas con presión negativa, cirugía colorrectal, revisión sistemática, metaanálisis

Referencias

Murphy P, Lee K, Dubois L, et al. Negative pressure wound therapy for high-risk wounds in lower extremity revascularization: study protocol for a randomized controlled trial. Trials. 2015;16:504.

Gomoll AH, Lin A, Harris MB. Incisional Vacuum-Assisted Closure Therapy. Journal of orthopaedic trauma. 2006;20(10):705-709.

Fowler AL, Barry MK. Closed incision negative pressure therapy: Results of recent trials and recommendations for clinical practice. Surgeon. 2020;18(4):241-250.

O’Leary DP, Peirce C, Anglim B, et al. Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following  Abdominal Operations: A Randomized, Controlled, Open-label Trial: The P.I.C.O. Trial. Annals of surgery. 2017;265(6):1082-1086.

Shen P, Blackham AU, Lewis S, et al. Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies. J Am Coll Surg. 2017;224(4):726-737.

 

Prevalencia y factores de riesgo de infección por bacterias multirresistentes en pacientes con enfermedad ampollosa autoinmune

Lei Guo
Enfermera a cargo, Hospital de Enfermedades de la Piel, Academia China de Ciencias Médicas, China

Metas/Objetivos Resumir la prevalencia y los factores de riesgo de las infecciones por bacterias multirresistentes (MDRO) en pacientes con enfermedad ampollosa autoinmune (AIBD). Con el fin de proporcionar bases para la formulación de programas de prevención clínica y de enfermería.

Finalidad y Antecedentes La aparición de infecciones en la AIBD tiene un gran impacto negativo en el tratamiento y control de la enfermedad primaria. En general, los estudios consideran que la tasa de farmacorresistencia de las bacterias ha ido en aumento en los últimos años, y la aparición de bacterias multirresistentes, como el MRSA, no favorece el control de la infección posterior de heridas. Faltan investigaciones sobre los factores de alto riesgo de infección cutánea por bacterias multirresistentes en pacientes con todas las enfermedades ampollosas autoinmunes.

Métodos Se realizó un estudio retrospectivo para recoger la información de 271 pacientes hospitalizados con AIBD. Se utilizó la regresión logística univariante y binaria para analizar los factores de riesgo independientes de infección por bacterias multirresistentes en los pacientes.

Resultados se trató a 440 pacientes con AIBD en un plazo de 3 años. La tasa de cultivos bacterianos fue del 72,7% y la de positivos del 55,7%. 74 pacientes estaban infectados por bacterias multirresistentes. Staphylococcus y Enterobacter fueron los principales grupos bacterianos con multirresistencia, con un 75,9% y un 13,9% respectivamente. Hubo diferencias estadísticamente significativas en la duración de la hospitalización, la gravedad, la automodificación de la dosis, el uso externo de pomada antibiótica, el uso de inmunosupresor, la duración del uso de glucocorticoides, la dosis máxima de glucocorticoides y el valor de albúmina en el primer ingreso entre los dos grupos ( P < 0,05). El análisis de regresión mostró que el uso externo de pomada antibiótica, el uso de inmunosupresores, la dosis máxima de glucocorticoides y la automodificación eran factores de riesgo independientes de infección bacteriana multirresistente.

Conclusión/Resultado Los pacientes con AIBD son propensos a las infecciones por MDRO, siendo el estafilococo el patógeno multirresistente más común. La pomada antibiótica tópica, el gran uso de inmunosupresores y glucocorticoides, la automodificación de la dosis aumentarán el riesgo de infección por MDRO.

Palabras clave enfermedad ampollosa autoinmune, infección de heridas, multirresistente

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